Welcome to Summit Health
Welcome to the February 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:
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
Beginning in February and ending in May, Summit Health will retrieve medical records for the Healthcare Effectiveness Data and Information Set (HEDIS) Measurement Year (MY) 2021 Project.
During this time, our partners, KDJ Consultants and Cotiviti, will be reaching out to providers to collect charts for review. This process can be completed by remote access into electronic medical records (EMRs), on-site, or faxing, or mailing of records.
To minimize COVID-19 exposure during the pandemic and reduce your administrative burden, we encourage remote access. To establish remote access, please email HEDIS@modahealth.com. We appreciate your assistance in helping us to fulfill these annual CMS and NCQA requirements.
Summit Health is sending our first-quarter care guide later in February to educate and help your patients schedule their recommended preventive services. We ask that you work with your patients on their open gaps in care and complete those that are appropriate for their overall health management.
These guides are personalized for your patients based on their medical and pharmacy claims information. They will remind your patients about services for which they may be due, including Annual Wellness Visits, cancer screenings, routine diabetes care, and more.
Many of these are directly tied to Star Measures, and others have an indirect opportunity to impact quality measures. Closing these care gaps can lead to better health outcomes. Please be sure to code services accurately, for both your own reimbursement and quality measure reporting. Learn more about Medicare Preventive Services at the Medicare Learning Network.
Please join us in encouraging your patients to complete their Annual Wellness Visits (AWV). Summit Health Customer Service team will be placing welcome calls to our new Summit Health membership to educate and assist members to get their annual checkup. AWVs are fully covered and come at no cost to your patients. In the coming months, your office can expect to receive calls from Summit Health Customer Service team and your patients to schedule AWVs.
While an AWV is not a Medicare Star Measure, it is an opportunity to impact many quality measures and improve better health outcomes for your patients. A key aspect of these visits is the Health Risk Assessment, which is required by Medicare in every AWV. During an AWV, you can assess your patient’s physical health status, psychosocial and behavioral risks, cognitive and functional status, biometric health indicators, and establishing risk factors and personalized plan for preventive care. This enables you and your patients to stay current on preventive screenings and vaccines, effectively manage chronic conditions, and be proactive in addressing any care gaps.
It is important to code the wellness visit accurately, for both your own reimbursement and quality measure reporting. Learn more about how to code an AWV at the Medicare Wellness Visit website.
Focusing on your patients’ heart health has never been more important. Heart disease is the leading cause of death in the United States. It also increases the risk for severe illness from COVID-19 and their risk for heart disease, stroke, and other comorbidities.
We encourage you to use the outreach rosters on the Summit Health provider progress reports to identify your patients with high blood pressure or use an alternative patient registry to proactively manage your patient population with heart disease.
Our Summit members have no cost-sharing when seeing in-network providers for blood tests for detection of cardiovascular disease (once every 5 years) and also one visit per year with their PCP to help lower their risk for cardiovascular disease. During this visit, you may discuss aspirin use (if appropriate), check blood pressure, and offer nutritional and lifestyle recommendations.
Controlling Blood Pressure is a Medicare Star Measure defined as the percent of members who had a diagnosis of hypertension and whose blood pressure is adequately controlled (<140/90). Ensure patients with an elevated blood pressure have scheduled follow-up visits and develop a personal care plan to work towards controlled blood pressure through lifestyle changes and medication adherence, if appropriate.
Access more resources and information for health care professionals related to American Heart month at the Centers for Disease Control and Prevention (CDC).
Our EOCCO and Summit Health Quality Improvement (QI) team provides concierge support through dedicated QI staff, clinic trainings, and regular scheduled meetings to support your quality work.
Please contact EOCCOmetrics@modahealth.com to schedule an introductory meeting, 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
Last updated Oct. 1, 2023
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Our customer service team is available from 7 a.m.– 8 p.m. (Pacific Time), seven days a week October 1 – March 31 (closed on Thanksgiving and Christmas), and weekdays April 1 – September 30. Your call will be handled by our automated phone systems outside business hour.