Clinical Connections: February 2023

Clinical Connections – Optum Transition Details + more!

Dear Colleagues,

We’re off to a great start to 2023. Below is the latest news from WHA, including updates on our transition to Optum for behavioral health services (along with their recent research on adolescent mental health), our Medicare ratings (and where your support would be appreciated), and our links to cultural competency training.

Health disparities may be influenced by the cultural match between providers and their patients. Providing your demographic information in the WHA provider directory may help our members make more informed choices about which doctor may be the best fit for their healthcare. Use the email: providerdemographics@westernhealth.com to easily submit your race, ethnicity, and spoken languages for our clinical provider directory. Simply include your name, NPI number (if available), and your race, ethnicity, and language information.

Thanks so much for your attention and consideration. 

Khuram Arif M.D., MBA, CPE
Chief Medical Officer,
Chief Operating Officer,
Western Health Advantage

Provider Referral Guide and Patient Resources from Optum Behavioral Health

WHA seamlessly transitioned our members to Optum Behavioral Health for mental health services last month. Please note these PCP links below: 

• PCP website at providerexpress.com to access behavioral toolkits.
• A Provider Referral Guide to Optum’s behavioral health services to download, use, and share with your patients.
• Optum Behavioral Health: Latest research on adolescent mental health revealed three common points of intersection with opportunities to enhance preventive measures, provide treatment, and improve the mental health and well-being of individuals. Read details in this synopsis on teen/young adult mental health support.
• Optum’s enhanced digital portal and self-care tools are available for patients to screen their symptoms, get triaged to the most suitable care, and search for mental health professionals.
• Access to the provider directory and WHA member resources available at mywha.org/bh.

Medicare Stars

WHA brought on Medicare Advantage members in 2021 and by August 2022 WHA was able to ascertain its baseline measurement HEDIS rates (MY2021). The table below showcases rates for diabetes care, along with the corresponding Medicare Stars ranking. As noted below, WHA did very well for “HbA1c Control (<8.0%)” and “Monitoring Nephropathy.” However, for “Diabetic Retinal Eye Exam” and diabetics who “Received Statin Therapy,” the Star rankings were 2 and 1, respectively. These rates reveal opportunities for improvement especially since our ultimate goal is to achieve 5 Stars for all our Medicare measures.

To improve our rating, we need your help by ensuring your diabetes patients are counseled about the importance of comprehensive diabetes care. We are doing our part by ensuring these measures are included in our value-based P4P program, providing monthly dashboards on gaps in care to each medical group, and offering a disease management program for our Medicare members.

Cultural Competency Training: Why it Matters

According to the U.S Census Bureau, California ranks 2nd in the nation, and Sacramento County ranks 17th amongst all counties, with the highest Diversity Index.  This index measures the probability that two people chosen at random will be from different race and ethnicity groups. While having a diverse population increases the chance of having a concordant patient-physician relationship, it may not be enough to combat health care bias and disparities.  Being respectful and responding to the beliefs, practices, and needs of a diverse population requires thoughtful planning and education.

Western Health Advantage is committed to supporting our networked providers in achieving health equity with the goal of supporting a diverse, equitable, and inclusive culture. We encourage you to take advantage of these resources available: 

• The Office of Minority Health, Think Cultural Health Resources 
• Think Cultural Health, A Physician’s Practical Guide to Culturally Competent Care (9 CME available)
• Western Health Advantage’s Language Assistance Program Guide
• The Office of Minority Health Resource Center

CALL TO ACTION:

WHA Made it Easy - Share Your Demographics Today!

Our provider relations team developed a new way to easily submit your demographic information so we can include it in our Provider Directory. Please click on this email link of providerdemographics@westernhealth.com and let us know how you would like to identified by: Race, Ethnicity, and Language. Please include your name, NPI number (if available), and your race, ethnicity, and language information.

Nutritional Counseling Available for Weight Management

WHA is pleased to be one of the first health plans to dramatically expand coverage for nutrition and dietary counseling for weight management issues — whether dealing with obesity, eating disorders, or a needed weight gain. This benefit is available to many WHA members (WHA plans vary, so members need to check if their plan includes this program). The benefit provides access to a nutritionist for several sessions, depending on the medical condition. Feel free to print/share this flyer with WHA patients.

Pharmacy Reminder

As you may know, the Inflation Reduction Act (IRA) includes enhanced pharmacy benefits for our Medicare members. Please remind your WHA MyCare Medicare Advantage patients of these two major changes:

• $0 copays for adult vaccines that are approved by the Advisory Committee on Immunization Practices (ACIP) recommendation list
• $35 copay/month limits for Part D insulin products

WHA patients can review the 2023 MyCare Formulary where insulin products are covered and review with your patients any outstanding vaccines for which they may be eligible.