WHA

Clinical Connections: June 2023

Clinical Connections News + WHA Family and Diversity Benefit

Dear Colleagues,

We are pleased to announce a new Family and Diversity Support Benefit demonstrating our commitment to supporting diverse families in our community.

It enriches pregnancy support with:

  • Up to 3 cycles of artificial insemination for members without a diagnosis of medical infertility
  • Up to 3 cycles of sperm collection for members without a diagnosis of medical infertility
  • Covers medications for ovarian stimulation 
  • Covers basic laboratory tests and basic imaging studies related to a fertility workup
  • Pre-implantation genetic testing for members with a history of life-threatening genetic illness
  • Download/Print: Family and Diversity Benefit Flyer and Copayment Summary

Western Health is confident this new benefit will be especially helpful to single women and men, same-sex couples, and members of traditional relationships who need added support to achieve a healthy pregnancy. We are grateful to our medical providers who helped us design this new ground-breaking benefit, which will initially be available through our large employer group plans.

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

**New 2023 Clinical Provider Handbook

  • Print/Share WHA’s New: 2023 Clinical Provider Handbook. This comprehensive resource is for clinical providers and their staff to access policies, procedures, and standards in patient (WHA member) care, as well as important contacts, tools, and processes for communications with WHA, and the ongoing delivery of health care services to our members. Request additional copies by contacting WHA’s Provider Relations: call 844.870.2178 or email providerrelations@westernhealth.com.

WHA’s Nonpharmacological Pain Management Options

In 2023, California’s Patient’s Bill of Rights encourages the use of evidence-based nonpharmacological therapies for pain management. Here are WHA’s treatment options for our members:

  • Kaia Health’s Virtual Physical Therapy addresses acute or chronic pain – from neck and back issues to hip, wrist, or knees – from personalized PT in a program + app that is accessible anytime or anywhere. A smartphone or tablet is all a member needs to get started.
  • Acupuncture and Chiropractic services through our partner (Landmark Healthplan of CA), treat acute neuromusculoskeletal conditions: chiropractic care for low back pain, sprains and strains, headaches, neck pain, and muscle spasms; acupuncture for dysfunction of the neck, back, or joints, headaches, carpal tunnel, arthritis, allergies, and asthma.

Pharmacy Updates

Prior Authorization. There are a small number of drugs, regardless of tier level that require Prior Authorization to ensure appropriate use based on criteria set by the WHA Pharmacy and Therapeutics (P&T) Committee. Drugs are evaluated regularly, to determine the additions to and possible deletions from the PDL, and to ensure rational and cost-effective use of pharmaceutical agents, through the P&T Committee, which meets every quarter. Providers may request that the P&T Committee consider adding specific Medications to the PDL. The Committee reviews all medications for the efficacy, quality, safety, similar alternatives, and cost of the drug in determining the inclusion in the PDL. 

  • ACTION NEEDED: If your member requires a drug that has a PA request, please complete the prior authorization form 61-211 and fax it over to: 916.568.5280 or Access the Online Form here: WHA Prior Authorization Form.

Recall Note: Camber Pharmaceuticals announced a consumer-level Class I recall of one lot of Atovaquone oral suspension due to potential Bacillus cereus contamination in the product. Impacted members have been notified but, wanted to make sure that providers were aware.

Coordination of Care between PCP and Mental Health Provider is Vital

Coordinating care with your patient’s behavioral health practitioner is key to whole-person care. In facilitating referrals, circumventing potential adverse medication reactions, and simply ensuring timely follow-up, you improve your patient’s overall quality of care. Please use this resource guide from Optum and for more on age-based behavioral health clinical guidelines, coordination of care, and more, visit Optum’s Provider Express portal, then select the Clinical Resources” tab, “Behavioral Health Toolkit for Medical Providers” and/or “Coordination of Care”.

Diabetes Patients Reminder of Retinal Exam

Please ensure your diabetic patients have received their annual dilated retinal eye exams. If they have completed the exam, ask your patients to have the results sent to you for your records. Also, let them know WHA offers an incentive of a $25 gift card for completing this exam. Details about the incentive program and the form to complete can be found on WHA’s diabetes wellness webpage. Taking these steps will not only improve your patient’s health but will help to improve HEDIS rates.

Wellness Programs Brochure

WHA Plans have wellness benefits built-in!  In support of our members’ optimal health, share our new brochure with your WHA patients to take advantage of the many benefits WHA offers, including hypertension management, nutritional counseling, diabetes reversal, and digital physical therapy, to name just a few. 

 

Last review date: June 15, 2023