Provider Advisory Group Meeting November 18, 2016

Noon – 2 p.m. Agenda

Meeting Location (Host)

4665 Business Center Drive, Fairfield, CA 94534 Video conferencing available in Santa Rosa, Redding, and Eureka office locations

1. Standing Agenda Items

1.1. Welcome and Introductions – Chairperson Bill Byrnes, Clinic Manager, Community Medical Centers

1.2. Review of Minutes

1.3. Review of Agenda

2. Presentation

2.1. Diabetes: Healthy Eating Lifestyle – Debra McAllister, RN & Melissa Rosel, RN

3. Old Business

3.1. None

4. New Business 4.1. PHC Update – Liz Gibboney, CEO

4.2. Claims Department Presentation – Rebecca Mannella, Claims Resolution Manager

4.3. Provider Relations Report – Stephanie Phipps, Lead Senior PR Representative

Upcoming New Trainings and Handouts

4.4. PR Education Team - Staff

4.5. Community Events, Health Fairs and Trainings -- All Attendees

PARTNERSHIP HEALTHPLAN OF CALIFORNIA

MEETING MINUTES

Committee: Provider Advisory Group (PAG)

Date/Time: July 15, 2016 12:30 p.m. – 1:30p.m.

Guests Present: Allyson Carraway, Neville Wall, Jéan Howell, MD, Carmen Guillermo, Sarah Trace, Deb Davis, Sheila Allen, Tatyana Flek. Theresa Boswell, Cheyanne Vongphakdy, Monica Tejada, Lilliana Muratalla, Andrea Trujillo, P.Cathleen Jacques, Terri Snyder Root, Seraph Trice, Krystie San Fillippo, Bambi Eagle

PHC Staff Present: Mark Netherda, MD, Rebecca Mannella, Ledra Guillory, Nick Barajas, Tondenisha Coleman, Maria Cabrera, Lynne DiModica, Carol Parker

AGENDA ITEM

DISCUSSION/CONCLUSIONS

RECOMMENDATIONS / ACTION

DATE RESOLVED

1. Standing Agenda Items 1.1. Welcome and Introductions 1.2. Approval of Minutes 1.3. Review of Agenda

1. None.

1.1. Meeting called to order by Chairperson Allyson Carraway. 1.2. Minutes from 7/15/2015 reviewed. 1.3. Agenda was reviewed.

1. Presented as information only

9/16/2016

2. Presentations

2. Neville Wall, Manager of Provider Partnerships for Beacon Health Strategies, gave a presentation to the group on Mental Health Services for PHC Members.

Medi-Cal behavioral health care is divided across the Medi-Cal Managed Care Plan, services provided by the County, and County-funded Substance Use Disorder Services. Medi-Cal Managed Care

Ways to refer to Beacon include: member self-referral, family member referral, referral by the PCP and referral by behavior health providers.

Forms for PCP referral, level of care transition, and a screening form to determine level of impairment are all available on the Beacon website at http://www.beaconhealthstrategies.com

Beacon is actively recruiting providers to increase member access to mental health services.

2. Presented as information only

9/16/2016

3. Old Business 3.1. None. 3. Presented as information only.

9/16/2016

4. New Business 4.1.1. PHC Updates

4.2. Report from Claims

4.3. Report from Member Services

4.4. Report from Provider Relations

4.1.1. Mark Netherda, MD, Regional Medical Director at Partnership HealthPlan of California reported on recent activities at PHC.

The Healthy Kids program is being phased out. Beginning in June, Medi-Cal will cover all children under 19 years of age, regardless of immigration status, who are eligible for Medi-Cal.

The results of the latest DHCS Audit revealed that PHC did very well. The Quality Improvement Program schedule is being updated. PHC has also

added a new QIP program for Long Term Care facilities in our network. Dr. Netherda introduced the new Yolo County Provider Representative, Nick

Barajas. The California Health Care Foundation's Opioid Safety Coalition Northern

California Fall Convening takes place September 22 in Oakland. PHC will host with live video at all four PHC Regional offices. http://www.chcf.org/events/2016/events-opioid-safety-coalitions-fall-convenings

The next Regional Medical Directors Meeting takes place on Friday, October 14

4.2. Rebecca Mannella, Claims Resolution Manager, spoke to the group regarding Claims issues. Well documented medical records support communication and aid in

coordination of care as well as claim reimbursement. Allergies, chronic health conditions, current medications and specialty referrals should all be listed.

Other documentation should include past medical history including any major illnesses or surgeries, Immunizations, test results and diagnoses. Any consent forms, advanced health directives, etc. should also be part of the medical record.

Past visits, follow-up calls or emails should be documented, and any missed appointments and outreach should be noted.

4.3. Maria Cabrera gave the update from a recent meeting of the PHC Consumer Advisory Committee The recent Consumer Advisory Committee reviewed the materials in the New

Member Packets. Updated materials include a Durable Medical Equipment Fact Sheet, and a Quick Reference Guide.

4.4. Lynne DiModica, Provider Education Specialist, shared information about Phase II of the Online Services Redesign.

The Dashboard has been updated to reflect the newly added modules.

New modules include Advice Nurse Reports, ER Notification, eClaims, eCIF and ReCIF, as well as Code Look-up.

Functions related to authorizations will be part of a future upgrade; they may continue to be accessed through the original Online Services portal.

PHC has upcoming webinars and trainings scheduled for the Phase II changes.

4. Presented as information only.

9/16/2016

5. Provider Questions, Topics of Interest, Announcements, and Upcoming Events

5. Upcoming Events: In addition to the upcoming Online Services Redesign trainings, the Yolo County Healthy Aging Alliance Collaboration Committee Annual Cross Training will take place on Monday, September 26th at the Woodland Community and Senior Center.

5. Presented as information only.

9/16/2016

Meeting Adjourned Next Scheduled meeting: November 18 in Solano County. 11/18/2016

PHC – Provider Advisory Group – September 16, 2016 in Yolo County Minutes prepared and submitted by: Carol Parker 9/16/2015

Chairperson Allyson Carraway Date

DiabetesDebra McAllister, RN, BSN, Health Services Utilization Management Director

Melissa Rosel, MSN, FNP, Health Services Utilization Management Team Manager

November 18, 2016

Topics

Diabetes Facts

What is Diabetes

Signs and Symptoms of Diabetes

Diabetes Prevention

Partnership Healthplan of California Member benefits

Diabetes Facts

25 million people in the United States are Diabetic

The Diabetes Association estimates that in 2015, the cost of care related to Diabetes jumped to $245 billion

Currently the leading cause of new cases of blindness, kidney failure and amputation of the feet and legs

Life threatening complications such as cardiovascular disease, nerve damage and possibly Alzheimer’s disease have been associated with Diabetes

What is Diabetes?

Metabolic disease in which the body has an inability to produce any or enough insulin which in turn causes an elevated levels of glucose in the blood.

Types of diabetes Type 1 – previously known as juvenile Diabetes

Body identifies the cells that make insulin as a foreign invader and destroys them

Insulin dependent

Type 2 – most common form of Diabetes Preventable with proper diet and exercise

Treated with oral medications and if necessary, the addition of insulin

Gestational High blood glucose (sugar) levels during pregnancy

Usually around the 24th week

Symptoms of Diabetes

Urinating often Feeling very thirsty Feeling very hungry even if you are eating Extreme fatigue Blurry vision Slow healing wounds Weight loss even if you are eating more (type 1) Tingling, pain, or numbness in the hands/feet (type 2) Gestational diabetes – often there are no symptomsDiabetes Symptoms. (2015, June 1). Retrieved November 16, 2016, from http://www.diabetes.org/diabetes-basics/symptoms/

Prevention

Eat Right Balance carbs, fruits and vegetables

Eat foods that are baked, broiled, steamed or grilled

Monitor weight

Be Active Moderate physical activity at least 30 minutes a day, 5 days a week

If you are on pills to control your blood sugar, Take them! Taking oral medications as ordered to avoid the need for insulin injections

The Healthy PlateThink of your plate as different sections. One half is for

vegetables, and the other half is for proteins and carbohydrates (carbs).

Questions/Comments?

References

Diabetes Symptoms. (2015, June 1). Retrieved November 16, 2016, from http://www.diabetes.org/diabetes-basics/symptoms/

We are pleased to announce the launch of Phase II of our Provider Online Services

redesign. Use the the information that follows to register for a training webinar on the

eClaims and eCIF Modules.

The audience for this webinar is billers, revenue cycle and other financial services teams.

Eureka | Fairfield | Redding | Santa Rosa (707) 863-4100 | www.partnershiphp.org

PHC Online Services Redesign Phase II eClaims and eCIF Modules

Webinar Topics Enable access to the new modules

Navigate the Claims Module

Explore New Features

Easier navigation from one module to another

View check status

Select frequently requested CIF actions in drop-down menus

Retract CIFs submitted in error

View PHC correspondence associated with claims

Use the link below to select and register for an upcoming training webinar. Select a session from one of the times listed.

The content is repeated in each session.

To register, click the link or copy and paste it into your browser address bar.

https://attendee.gotowebinar.com/rt/1504759004609181697 After registering, participants will receive a confirmation email with

instructions on how to join the webinar.

Questions Email PHC Provider Relations Education Unit at: eSystemsSupport@Partnershiphp.org

Thursday, December 1, 2016 2:00 – 3:00 p.m.

Wednesday, December 7, 2016 11:00 am – Noon

Thursday, December 15, 2016 3:00 – 4:00 p.m.

Wednesday, December 28, 2016 10:00 – 11:00 a.m.

Eureka | Fairfield | Redding | Santa Rosa

(707) 863-4100 | www.partnershiphp.org

DID YOU KNOW?

Providers can receive funds from the State to incorporate Electronic Health Records

(EHR) into the practice!

The Department of Healthcare Services (DHCS) wants to encourage providers to participate in the

Medi-Cal EHR Program.

Professionals can receive $21,250 for adopting, implementing or upgrading a certified EHR, and

$8,500 yearly for meaningful use for up to 5 years.

DHCS has funded 4 organizations around the state to help professionals determine if they are

eligible for the program and to achieve meaningful use of EHRs.

There are “free” certified EHRs that qualify.

WHO QUALIFIES?

• Physicians, nurse practitioners, optometrists, dentists, certified nurse midwifes, physician

assistants (who work in PA-led FQHC or RHC).

• At least 30% of encounters or 30% of panel patients are attributable to Medi-Cal patients,

either individually or as a group during any 90-day period in the previous calendar year.

WHEN?

The program started in 2011. Professionals must start the program in 2016 in order to participate

in the future. The program ends in 2021.

Sign contract with a certified EHR by 12/31/2016.

Submit application to DHCS “State Level Registry” by 3/17/2017.

NEED MORE INFORMATION?

Visit the State’s EHR site for more information: http://medi-cal.ehr.ca.gov/

Provider Bulletin Electronic Health Record Incentive for Providers

Volume 16-11 August 2016

Provider Bulletin Smoking Cessation

Eureka | Fairfield | Redding | Santa Rosa (707) 863-4100 | www.partnershiphp.org

What’s New Medi-Cal added a new benefit and PHC is encouraging the use of this program. Tobacco use is the leading preventable cause of death in the United States and Medi-Cal members have a higher prevalence of tobacco use than the general California population. Tobacco cessation services have been demonstrated to be both clinically and cost effective.

PHC Benefit Criteria Smoking and tobacco cessation counseling is a Medi-Cal and PHC benefit for children and adults. FDA-approved cessation medications are covered.

When Retroactively to dates of service on or after November 1, 2014.

Impact on Claims

• Providers can bill CPT-4 code 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or 99407 (Intensive, greater than 10 minutes).

• Cessation counseling is limited to eight sessions per year.

• Members are not required to participate in counseling or classes in order to receive medication.

• Modifier 25 (Significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service) is allowed.

• If you received a denied claim for CPT codes 99406 & 99407, your claim(s) will be reprocessed. You will not need to submit eCIFs or resubmit claims for previous denials.

Documentation

• Face-to-face counseling for smoking and tobacco cessation must be provided by a physician or other qualified health professional.

• Documentation must be maintained in the patient record that includes total time spent and what was discussed, including cessation techniques, resources and follow-up for each visit.

• Refer members to CA Smokers’ Helpline 1-800-662-8887 (1-800-NO-BUTTS).

Volume 16-13 – November 2016

SAVE THE DATE

Social Determinants of Health Conference

Friday, December 16, 2016

8:30 a.m. to 4:30 p.m.

at

Partnership HealthPlan of California

4665 Business Center Drive

Fairfield, CA 94534

*Video conference available in:

Redding: Partnership HealthPlan Regional Office

(3688 Avetech Parkway, Redding)

Eureka: Partnership HealthPlan Regional Office;

Sequoia Conference Center (901 Myrtle Ave, Eureka)

Santa Rosa: Partnership HealthPlan Regional Office

(495 Tesconi Circle, Santa Rosa)

For More Information and To Register:

https://www.eventbrite.com/e/improving-the-health-of-the-homeless-through-innovation-collaboration-tickets-

28615492709

Improving the Health of Homeless Populations

Through Innovation and Collaboration

Anticipated Outcomes:

Address why homelessness is important to healthcare

Provide insights in building cross-sector partnerships and

leveraging funding

Highlight best practices: quality healthcare for the

homeless

Education Innovation

Economic

Stability

Mental Health

and Trauma

Informed care

Neighborhood

and Built

Environment

Cross-Sector

Collaboration

Social and

Community

Context

Mobile

Outreach

Health and Health

Care

Engaging the

Patient

NOTE

Emergency and acute services, such as hospital care, crisis response, and rehabilitation programs continue to be provided by the county mental health plan.

MENTAL HEALTH SERVICES FOR PARTNERSHIP HEALTHPLAN MEMBERS

Access our online PCP toolkit at: www.beaconhealthoptions.com | ph: 1 .855.465.9703

Beacon Health Options is the behavioral health

partner of Partnership HealthPlan. Use this information

to access mental health services for Partnership

HealthPlan’s Medi-Cal members.

Beacon covers individual and group therapy, psychiatric consultation and psychological testing for

Partnership HealthPlan members with mild to moderate

impairments. Members do not need a PCP referral to

access mental health services, but must undergo a brief

telephonic screening to ensure their condition is mild to

moderate. If the member’s condition is severe, Beacon

will assist in transitioning the member to the county

Mental Health Plan for care.

CALL BEACON AT 855.465.9703 TO:

• Get information on available mental health services

• Locate mental health providers

• Get help making a routine or urgent appointment

• Check a member‘s benefits and eligibility

• Get decision support related to prescribing psychiatric medications from a Beacon psychiatric advisor

• Request support coordinating a member’s care

• Learn about mental health care treatment services offered by the County Mental Health plan

CONTACT

When you call Beacon, let us know that you are a PCP

or that you’re calling on behalf of a PCP. Our staff will

help you immediately or connect you with a clinician, if

necessary. If you call outside of business hours, you will

be automatically transferred to our clinical service team

for urgent concerns.

MENTAL HEALTH CARE

Mental health benefits are available to people with Medi-Cal. You can get services through your Medi-Cal managed care plan or your county mental health plan.

Partnership HealthPlan works with a company called Beacon Health Options to help you connect with mental health services you need.

WHAT SERVICES ARE AVAILABLE?

• Therapy — individual or group• Psychiatric consultation• Psychologiccal testing

WHO CAN ACCESS SERVICES?

The mental health services listed above are a covered benefit to Partnership HealthPlan members through Beacon Health Options.

HOW CAN I GET SERVICES?

Call Beacon at 855.765.9703 and a mental health expert will ask you a few questions. Then the expert will help you find a provider nearby. You may also get help connecting with your county-operated mental health plan if you need more intensive mental health services.

WHAT DOES BEACON DO?

Beacon has a network of doctors and therapists who provide mental health services. We will help you connect to care. Our professional staff will ask you a few questions and then give you a referral to an in-network provider or connect you to your local county mental health plan.

CAN COMMUNITY PROVIDERS MAKE REFERRALS TO BEACON?

Yes. Beacon accepts referrals from our health plan partners, community behavioral health providers, primary care providers and facilities. Use the contact information below to reach us.

Providers can download a referral form online at: www.beaconhealthoptions.com

DOES BEACON OFFER ANY SUBSTANCE USE SERVICES?

No. Medi-Cal substance use services are not available through Beacon. These services are managed by your county’s behavioral health department.

HOW CAN I REACH YOU?

You or a family member can call Beacon Health Options and talk to a mental health professional. Your doctor, nurse or social worker can call us too.

1 .855.765.9703 | www.beaconhealthoptions.com

MENTAL HEALTH CARE SERVICES