Clinical Connections News for Summer
Dear Colleagues,
I am pleased to announce new leaders at Western Health Advantage as we continue to sharpen the focus on quality health care. I will assume duties as President of Western Health Advantage (WHA) this July. Dr. Tasnim Khan steps up from the Medical Director role as our new Chief Medical Officer. Simultaneously, our current Pharmacy Director Dr. Kiran Biring steps up to a new Chief Pharmacy Officer position at WHA.
As you know, Western Health Advantage was founded by two health systems; Dignity Health in the Sacramento area and NorthBay Health in Solano County. Our WHA Board includes leaders from Dignity Health, NorthBay Health, and Hill Physicians. With three clinical leaders now on the Western Health senior leadership team, we continue to be a ‘different’ health plan. One that understands the joys and challenges of medical practice and the value our clinical providers bring to members in their health care journey.
We look forward to our continued collaboration with you as we build innovative care programs to enhance the health care experience of our members. Thank you for your continued support and for the dedicated care that you provide to our members.
Khuram Arif M.D., MBA, CPE
Chief Medical Officer,
Chief Operating Officer,
Western Health Advantage
NEWS TO USE!
Subscribe Today!
Don’t miss WHA’s latest news, updates, and programs available to your WHA patients! Please share with your newest providers and staff and encourage them to subscribe to our quarterly Clinical Connections. It’s our way to keep you current with WHA news. You can easily subscribe on the Provider Communications webpage. Visit: WHA’s Provider Communications webpage, look to the right for the form to enter information to subscribe.
Clinical Provider Handbook 2024 is here!
Please download and share with your staff WHA’s latest 2024 Clinical Provider Handbook. If you need additional hard copies, email WHA Provider Relations at providerrelations@westernhealth.com.
Closing Care Gaps Leads to Member Reward
WHA continues to partner with Icario to offer its Healthy Rewards program to encourage and reward CalPERS and Covered California members for taking advantage of preventive care (and closing those all-important care gaps). Eligible members can receive a $20 gift card for completing preventive care activities including breast and colon cancer screenings, A1c test, diabetic retinal eye exam, blood pressure readings, prenatal and postpartum visits, combo 10 immunizations (for ages 0 - 24 months), adolescent immunizations (ages 11 - 13), and annual wellness visits, including those to discuss nutrition, physical activity and healthy weight (BMI). We wanted our clinical providers to know about the program should your patients ask you about this program or for information required to complete the form. Email a.adams@westernhealth.com with any questions.
Behavioral Health HEDIS Measures
Being proactive is an important part of improving patient outcomes and overall performance. HEDIS scores are shared annually and show prior year performance. However, since many of the HEDIS measures rely on claims data, it can be challenging to always be proactive. Some of the measures require follow-up as early as seven days after discharge. Others rely on finding the code for screenings in the medical record for those already performed such as for depression, ADHD, and SBIRT for substance abuse. A good way to be successful is to know what is expected within each measure. Keep this Tip Sheet on hand that Optum BH created as a helpful tool: Behavioral Health HEDIS Measure Summary for Primary Care.
Provider Satisfaction Survey
We wanted to report that for 2023, the response rate to our Provider Satisfaction Survey increased from 10.0 % to 11.2%, which comprised 70.1% of PCPs and 31.8% of specialists responding. Overall, Western Health Advantage performed higher than the 2022 PG Book of Business for all measures. We encourage your ongoing participation by responding to this annual survey as it helps us identify improvement opportunities. One way you can help increase the number of responses is to ensure that we have your email address on file so that you can complete the survey at your convenience. Please do so by emailing providerrelations@westernhealth.com.
PHARMACY UPDATES
Tipping the Scales – Smart Strategy around Weight Loss
GLP-1 and weight loss medications – patients want them, and understanding appropriate access is a challenge. When GLP-1 came out in 2005, they treated type 2 diabetic patients but, with weight loss noted as a side effect, it has evolved into the obesity treatment market. These drugs have been shown to create weight loss by almost 20%, comparable to what can be achieved through bariatric surgery. Even the most effective weight loss drugs require obesity management which should also include appropriate lifestyle, diet changes, and exercise. Patients on these drugs don’t stay on them long-term, and as such may see the weight come back, as there are FDA safety concerns and warnings around safety and clinical concerns.
Under the WHA benefit, anti-obesity medications are a benefit exclusion, unless medically necessary. While we are seeing increased demand, many are not meeting our criteria for medical necessity. Please visit our website to learn more about our criteria. As the clinical evidence continues to unfold, WHA remains committed to ensuring a smart strategy around weight loss by ensuring safe, effective, and appropriate options for our members.
Vaccine Access
Over the past year, WHA has been working with our medical groups to understand access to vaccines for our members. Our HEDIS scores in preventive vaccines continue to be an area of opportunity with nominal increases in vaccine completion. Feedback often received by the plan is that WHA does not allow pharmacies to administer vaccines.
However, during the COVID-19 pandemic, WHA expanded access to flu and COVID-19 vaccinations and noted increased adherence and compliance. To the end, WHA is expanding access to all Health Care Reform Vaccines at point-of-sale pharmacies for WHA members over age nine. Flu and COVID-19 vaccines will continue to be covered for members (ages 3 years and above). Dengue vaccine will only be available through appropriate prior authorization to ensure use for HCR indications. WHA members will not have a cost share applied. For a full list of vaccines please visit Pharmacy Information.
ARTICLE TO READ
Prior Authorization (PA) Denials – Tips to Manage with Confidence
Last issue, we provide links and information on Prior Authorizations and this issue, we’ve provided additional information to your staff, please read here. In addition, WHA’s Provider Portal is an excellent resource for you/staff.
Reminder: Submit Race, Ethnicity, and Language Information
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. Thank you!