Dear Clinical Providers and Colleagues,
As of January 2023, the Department of Managed Healthcare (DMHC), which regulates all CA health plans, will require all primary care physicians to have ‘urgent’ appointments available within 48 hours; and within 96 hours for certain specialties (Gastroenterology, Cardiology, Endocrinology). Unfortunately, WHA currently measures at 52% availability for ‘urgent’ appointments across PCPs and the above Specialists. Our market competitors do much better than WHA, with Sutter Health Plan at 70%; and Kaiser at 76%.
For your practices to grow and pull market share from the competition, we need your help. This information is available to health insurance brokers who decide to offer WHA to an employer already with Kaiser or Sutter. Yet, some brokers will not consider WHA plans with access lagging behind similarly priced competitors. WHA has been meeting with medical group leaders to ask for at least 1-2 ‘urgent’ appointments be made available for all primary care physicians as well as GI, Cardio and Endo specialists. These appointments should ideally only unfreeze for booking 48 hours in advance for PCPs and 96 hours in advance for GI, Cardio, and Endo. A virtual appointment will meet the DMHC requirement however, PA/NP appointments, and urgent care walk-in clinic options, are not acceptable alternatives. WHA loses a sizeable number of members annually a year and lack of access is noted as a common concern. Adding ‘urgent’ appointments may prevent losing existing patients and threatening the health of your practice. If we can show brokers robust improvement in WHA’s urgent access to PCPs and specialists, it will be a huge y help for WHA and your primary care/specialty practices grow significantly. Please help us keep WHA and your practice strong with robust member retention and vital new membership growth. We hope you’ll be open to meeting this WHA ask and request.
As always, we welcome your feedback on what you want to hear from WHA. Please read our latest issue below with important links to provider forms and useful information. Feel free to pass this on to your staff and colleagues, and if this was forwarded to you, take a minute to subscribe to Clinical Connections here.
Respectfully, Khuram
Email me at k.arif@westernhealth.com.
WHAT'S NEW FROM WHA
Out-of-area Care Options for Summertime Travel
In an emergency, WHA members should go to the nearest hospital ER. However, please remind your WHA patients how to access care, if they get sick or injured while away from home. Encourage WHA patients to download these apps before they leave, so they have access to care in their pocket:
- Virtual urgent care is available through Teladoc. Download the app from this link, for after-hours or when they can’t get to an urgent care center. And, for those WHA patients that are out in the woods camping, care is just a phone call away.
- When traveling 100+ miles away from home WHA has Assist America services for medical consultation, referrals, prescription assistance and non-medical service such as COVID-19 testing, or even help with lost luggage. Encourage them to download the Assist America mobile app here before they leave.
- Got a WHA student/dependent member going away to college? Remind them that WHA has options for care while at school, including your PCP’s and specialist’s telehealth care options, but also for virtual urgent care, (so download the Teladoc app). Once a member’s urgent care needs have been taken care of, they need to contact their PCP to coordinate follow up care. If WHA members have questions or want more information, they can get details from this out-of-area student care flyer.
Mom’s Meals Delivers for WHA MyCare Medicare Advantage Members
Your WHA MyCare patients struggling with a chronic health condition may need extra care following a hospital (or skilled nursing facility) stay. You want them to eat meals packed with vitamins, minerals and fiber, and it may be hard to cook healthy following a hospital stay. WHA MyCare members can get up to 56 meals – that’s two meals a day for four weeks – from Mom’s Meals, delivering nutritious meals right to their door. Check out their newest spring meal options here. But they need a referral from their doctor, so simply complete this referral form and fax to WHA at 916.568.0278.
NEW Innovative Physical Therapy App for WHA Patients
Kaia provides virtual physical therapy for acute and chronic musculoskeletal (MSK) pain. With Kaia, you receive physical therapy through your mobile phone or tablet with artificial intelligence/AI-driven PT instruction and monitoring. Those with pain in their neck, shoulders, back, hips, wrists and knees can benefit from timely physical therapy, when access to in-person therapy session or traveling to appointments can get in the way of getting care. This innovative new technology is designed by orthopedists and physical therapists and available at no cost in WHA’s employer group plans. Your WHA patients can enroll and download the app here.
Depression and Suicide Among Healthcare Workers
According to the American Foundation for Suicide Prevention, physicians have higher rates of burnout, depressive symptoms, and suicide risk than the general population. Read more for insight in this article from our mental health partner, Magellan Healthcare.
Pharmacy Update
With a return to some normalcy, we’ve noticed a pharmacy uptick and specifically, access to prior authorizations. Because PA plays an important role, here are direct links to access our pharmacy tools and real-time formulary data. As always, please feel free to reach out to the pharmacy team with any questions pharmacy@westernhealth.com.
Our formulary is updated monthly and real-time benefit check via our online website is linked below. Members and providers are able to use our portal to look up drugs, UM requirements and drug costs at the WHA Pharmacy Webpage.
For a link to useful resources such as clinical publications and updates on the various changes happening in the pharmaceutical space, access: Healthcare Professional's Portal.
WHA Quality Measures
WHA is working closely with our medical groups to bring attention to a very important topic: Required appointment time standards. Health plans and their contracted providers are required to provide appointments to enrollees within certain timelines for both urgent and non-urgent/routine care. These standards can be viewed at westernhealth.com. Compliance with these standards is measured annually in the Provider Appointment Availability Survey (PAAS), conducted by health plans across the state. Beginning in 2023, health plans will be required to show that at least 70% of their network can offer appointments within the standard times. Be on the lookout for communications from your medical group and WHA with further information and guidance. Your participation in this survey is vital to WHA’s success!
NEW MATERIALS TO PRINT
Please review or print the following new materials from WHA:
- WHA’s Newest 2022 Clinical Provider Handbook is available here. It is your single source for our clinical providers on vital required communications of WHA policies and procedures. Please download/share with your staff.
- WHA Benefit Highlights is available here for you to share with WHA patients as an “at-a-glance” resource of key plan benefits they can take advantage of to help maintain and improve health.
- Group Wellness Brochure provides overview of all our WHA employer group plan member resource to help stay fit, keep healthy, learn how to manage a condition, and access our newest wellness programs. Download the brochure here.