Welcome to Summit Health
Welcome to the April issue of the Summit Health Newsletter. As a valued Summit Health partner, we appreciate your commitment to providing the highest quality care to our members.
Below is a preview of the articles you will find in this month's issue:
Visit archived newsletters here.
To ensure we are providing the information you need to deliver better care to your patients, we would love to hear from you. Please let us know if you have any questions, concerns or recommendations on topics that we can include in future issues.
Thank you,
Your Summit Health Team
At Summit Health, we offer providers to opt-in to the Medicare Advantage Primary Care Incentive Program (MAPCIP). Providers are eligible to earn a per member per month (PMPM) Care Gap Incentive Payment (CGIP) to reward performance meeting set thresholds for quality measure gap closures and an additional PMPM Access to Care Incentive Payment (ACIP) for certain annual physical or wellness visit thresholds. New in 2022, Summit will also include Patient Centered Primary Care Home (PCPCH) capitation payments to support clinic efforts in achieving the incentive program targets.
Your office should have received the 2022 MAPCIP contract by now. Please complete and return to contractrenewal@modahealth.com by April 15th to confirm participation.
For any questions, please email contractrenewal@modahealth.com.
We are committed to working with you to bring better health and overall wellness to your patients by conducting outreaches throughout the year to your patients and your clinic. These programs aim to encourage your patients to close recommended preventive services, follow-up with those who recently discharged from inpatient stays, and provide support for high-risk patients.
To keep you informed of the member- and provider- outreach programs that Summit Health conducts, access our updated 2022 Summit Health Provider Quality Initiatives Calendar.
On Jan. 1, 2021, Summit Health implemented step therapy requirements for Medicare outpatient (Part B) medications. Step therapy is required for certain medications, but only if the following are met for the requested drug:
Outlined below are the changes to the preferred products starting July 1, 2022.
|
Preferred Medication(s) [HCPCS] |
Non-preferred Medication(s) [HCPCS] |
|
Benlysta [J0490] |
Saphnelo [J3590] |
|
Repatha [J9999] OR Praluent [J9999] |
Leqvio [J3490] |
|
Avastin - Ophthalmic |
Vabysmo [J3590], Susvimo [J3590] |
|
Vyvgart [J3590] |
Soliris [J1300] |
To see the full list of Medicare Part B Step Therapy medications, please visit our step therapy requirements and referral and prior authorization guidelines web pages.
Pfizer announced it expects a supply disruption for its short-acting erythropoiesis-stimulating agent (ESA), Retacrit (epoetin alfa-ebpx). The forecasted disruption is expected to start May 2022 and last through Q4 2022. In anticipation of the market shortage, Summit Health will temporarily modify our process to minimize the disruption to your patients and practice.
For patients currently receiving Retacrit, you can seamlessly switch to another epoetin alfa agent (Epogen/Procrit), and Summit will cover the drug at the same level as Retacrit.
For patients initiating treatment with an ESA during the shortage, the requirement to use Retacrit before Epogen/Procrit will be waived. Access to Epogen/Procrit will be approved when prior authorization criteria are met during the active shortage period.
Once supply returns, Summit will go back to our pre-shortage policy and process. Providers currently prescribing ESAs will be receiving more information in the mail.
You can monitor FDA drug shortages at the FDA website.
To better meet the needs of older adults and people with disabilities, we’re here to improve timely access to care from qualified providers who work together to provide coordinated, quality and culturally responsive behavioral health and wellness solutions.
The Behavioral Health Initiative for Older Adult and Physical Disabilities, funded by the Oregon Health Authority, offers resources for both providers and patients. The website includes training modules for providers, a listing of upcoming events, and other resources to help you support your patients.
Please reference their Expanding Behavioral Health Services through Medicare Factsheet to see how behavioral health services can be delivered under Medicare, including billing codes for Health and Behavioral Assessment and Intervention (HBAI) and Behavioral Health Integration (BHI).
Our EOCCO and Summit Health Quality Improvement (QI) team will be conducting clinic trainings on the 2022 VBC and quality measures. These will be held in-person or virtual, depending on your clinic’s preference.
Please contact EOCCOmetrics@modahealth.com to schedule, if interested.
Questions related to EOCCO & Summit Health Quality Measures?
Please email EOCCOmetrics@modahealth.com
Questions for Provider Relations?
Please email Noah Pietz at ProviderRelations@yoursummithealth.com
Questions related to Risk Adjustment?
Please email risk@yoursummithealth.com
Questions related to HEDIS Chart Collection?
Please email HEDIS@modahealth.com
If you would like to be added or removed from this email list, please let us know at ProviderInquiry@yoursummithealth.com
Last updated Oct. 1, 2023
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