WHA

Clinical Connections Fall 2024

Clinical Connections News for Fall

Dear Colleagues,

As Chief Medical Officer of Western Health Advantage, I want to personally request your participation in our Provider Experience Survey. Your feedback is critical in helping us understand what we’re doing well and where we can improve to better support you in delivering exceptional care to your patients (our members).  

We understand that your time is valuable, but the few minutes you spend on this survey will have a direct impact on how we serve you and your practice. For example, past survey feedback has led us to simplify prior authorization processes, reduce administrative burden for your work, and improve the responsiveness of our provider support team. 


Tasnim Khan, MD, MHCM
Chief Medical Officer
Western Health Advantage

Your input has also guided improvements in claims processing, advised us on what additional services your patients could benefit from, and helped us develop better training and educational resources tailored to your needs. 

This year, we want to hear from you on several important topics, such as:

  • ease of communication with our health plan team 
  • experience with claims submission and resolution 
  • support and resources we provide for patient care
  • opportunities for improving clinical workflows 

Your insights help us identify pain points and shape initiatives that foster a stronger partnership with you. Whether it’s reducing administrative hurdles or enhancing patient care coordination, your feedback directly influences the strategies we implement to make your experience with Western Health Advantage as seamless as possible. 

Please take a few minutes to complete the survey and let us know how we can better support you. Your voice matters, and together we can enhance the healthcare experience for you and the patients we both serve.

WHA NEWS

Be on the Lookout: Provider Surveys

Please help us by responding to these surveys, as they are vital to continuous improvement:

  • Provider Satisfaction Survey is currently underway – and seeing low response rates, so we urge your participation in this important review. This is just a reminder that SPH Analytics has started conducting telephone interviews through 9/27/2024 with providers who did not respond to the original initiation of the survey. Results are reported to WHA’s Quality Improvement Committee (QIC) and impact WHA’s NCQA scores and accreditation status directly. When WHA is audited by DMHC they refer to this survey results as a source. If the response rate does not meet the threshold, the survey will be completely invalidated.
  • Provider Appointment Availability Survey (PAAS) measures patient access to routine appointments, urgent appointments not requiring prior authorization, and urgent appointments requiring prior authorization. The DMHC requires plans to ensure that health care services are provided to patients promptly and following the standards under 28 CCR § 1300.67.2.2(c)(5). For PCPs, please also participate in the Advanced Access (AA) survey. This survey, if found compliant will allow you to be counted as compliant with PAAS standards for three years. These surveys begin fielding in August-September each year.
  • HICE After Hours Access Survey is a statewide collaborative project, fielding a telephonic survey of medical groups/IPAs, for primary care physician (PCP) offices to determine compliance with the DMHC Timely Access Regulations regarding after-hours provider access for screening/triage. The survey runs from October 2024 and ends in December 2024.

PHARMACY UPDATES

Class 1 Drug Recall Notice

We’re committed to ensuring our members and providers have access to FDA-issued Class 1 drug recall and withdrawal information. On 6/25/2024, Glenmark announced a consumer-level recall of 114 lots of potassium chloride extended-release capsules because they may not dissolve correctly which may lead to hyperkalemia. On 08/09/2024, WHA was notified by Optum Rx that the recall classification type had been updated to Class 1. A drug recall notification was mailed to 19 potentially affected WHA members and their providers on 07/10/2024.

Routine Vaccines through our Pharmacies 

In June, we shared that your WHA patients are now able to obtain routine vaccines at no cost through their nearby network pharmacy and reminded them of the importance of staying current with their vaccine schedules for themselves and their families. Your patient simply needs to show their WHA I.D card at the pharmacy counter. 

WHA REMINDERS

Wellness Refresher – Help Your Patients Get the Best out of a WHA Plan!

Most WHA plans feature a wealth of wellness programs for fitness, in support of chronic conditions or simply, to maintain good health. You can help your patients get the most out of their WHA plan through these programs/services*:

  • Diabetes reversal: Virta Health reverses diabetes through this innovative, telehealth program that helps you lower your A1c, reduce or eliminate diabetes medications, and lose weight.
  • Digital PT: for anyone suffering from acute or chronic pain, whether a stiff neck, shoulders, knee, or back issues. Download this app from Kaia for support via a mobile phone. 
  • Nutritional Counseling: for those struggling with weight-related illness whether obesity, eating disorder, or weight loss, WHA has coverage for visits for lifestyle, nutrition, and dietary support through a dietician or nutritionist; your referral and authorization are required.
  • Pregnancy and Postpartum: Supporting care during parenthood, WHA offers 24/7 virtual coaching and education appointments with Maven’s specialists: prenatal nutritionists, lactation consultants, career coaches (and more), through three months postpartum.
  • Smoking Cessation: Quit for Life® is designed to give confidence and support through a personalized Quit Plan, classes, and personal coaches via phone, chat, or text.
  • Weight Loss: Losing weight can be vital for overall health. Real Appeal® is a 52-week personalized, weight management program, with personalized coaching, digital tools and resources, virtual group sessions, and more to help members reach your wellness goals.
  • Wellness and fitness discounts: Take part in CommunityFIT classes, get recipe ideas from our MyWHA Wellness videos, and access health and wellness tips. Also, don’t forget: Active&Fit and Choose Healthy give discounts for gym memberships, health equipment, athletic apparel, healthy home meal delivery, and other services, like therapeutic massage.  

Please share this WHA Benefits Highlight Handout with your WHA Patients. Note: WHA members must check their specific plan details to see if they have these programs available and if they are eligible.  

Your Role in the Mental Health of Patients 

Primary Care Providers play a very important role in their patients’ behavioral health journey. Implementing referrals and providing timely follow-up for patients who have been discharged from the emergency department (or higher levels of care) will improve clinical outcomes and coordination of care. Optum Health Education offers a 3-part video series that shares strategies for bridging the practice gap and developing skills to implement effective treatment plans. This learning opportunity can improve health care quality as measured by HEDIS for anti-depression and anti-psychotic medication management, and follow-up for discharges related to mental illness and substance use disorders. 

Visit www.optumhealtheducation.com/primary-care-behavioral-health to learn more and earn free CME/CNEs.  

HEDIS UPDATES 

Please note the following updated HEDIS articles:

Medication Management for People with Asthma  

Asthma is one of the most prevalent chronic diseases, becoming increasingly more commonplace over the past 20 years. In the United States, approximately 26 million people have asthma…(Read more)   

Childhood and Adolescent Immunization Status  

The National Committee for Quality Assurance (NCQA) developed childhood immunization measures as part of the Healthcare Effectiveness Data and Information Set (HEDIS) measures, widely used to assess the reliability of pediatric immunization delivery. (Read more)

CATCH UP WITH WHA 

Don’t miss WHA’s latest news, updates, and programs available to your WHA patients! If you know of staff/doctors who don’t yet get Clinical Connections in their inbox, visit WHA’s Provider Communications webpage to subscribe. 

You can always catch up on all that WHA has to offer in our Advantage Magazine – Summer issue online now!