Summit Provider Newsletter - January 2023

Preparing for 2023 with VBC Updates and Changes

Welcome to the January 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:

• 2023 Summit Value-Based Contract
• Year-End Reporting for 2022 Clinical Quality Measures
• Removal of Referral Requirements in 2023
• Updated COVID-19 Online Resources and Vaccine Schedule

Visit archived newsletters here.

Your voice matters

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

2023 Summit Value-Based Contract

Our Summit Health value-based contract, also known as the Medicare Advantage Primary Care Incentive Program (MAPCIP) rewards performance in meeting set thresholds for both quality measure gap closures and certain wellness visits.

Providers can earn:

• Care Gap Incentive Payment (CGIP): Per member per month (PMPM) payment based on annual performance on quality measures, patient experience of care measures and/or utilization measures
• Access to Care Incentive Payment (ACIP): PMPM payment based on members having completed an annual physical and/or annual wellness visit
• Patient Centered Primary Care Home (PCPCH) Capitation: Risk stratified PMPM payment

For 2023, Summit Health will not require signatures on the updated MAPCIP amendment. Providers will be assumed as participating in our MAPCIP by meeting all three of the following requirements:

1. Be certified by the Oregon Health Authority as a PCPCH Tier 1-5
2. Perform one of the three require data submission activities including connection with Summit Health Provider Data Exchange (PDE), connection with Arcadia Analytics, or utilization of Care Gap Management Application (CGMA) by Novillus
3. Have a Medicare Advantage contract through Summit Health that is active and in good standing at the time incentives are disbursed in June 2024

For questions related to provider contracting and the 2023 Summit Health MAPCIP, please contact providerrelations@yoursummithealth.com. For questions related to data sharing options, please contact ValueBasedDataSharing@modahealth.com.

Year-End Reporting for 2022 Clinical Quality Measures

Summit Health is allowing clinics, who participated in the 2022 Medicare Advantage Primary Care Incentive Program (MAPCIP), to submit a summary report of measure results instead of patient-level data for three of the quality measures:

• Controlling High Blood Pressure (CBP)
• Comprehensive Diabetes Care – HbA1c (CDC-HbA1c Poor Control)
• Colorectal Cancer Screening (COL)

Either Summit Health-specific or all-payer data is acceptable. The data must be submitted via an Excel template, similar to reports for EOCCO CQMs. Specific instructions are included in the template, and you must attest that the data is accurate. Please reach out to summarydata@modahealth.com with any questions. Clinical quality measure performance summary reports must be submitted to providerreports@modahealth.com by March 17th, 2023 to be eligible for the 2022 Performance Based Incentive Payment.

Removing of Referral Requirements in 2023

On January 1, 2023, Summit Health Medicare Advantage plan no longer requires a referral to see a specialist. This means, Primary Care Providers (PCPs) do not need to submit a referral to Summit Health prior to your patients seeing a Specialist.

Summit Health patient claims will no longer deny or pay at the out-of-network rate due to not having a referral on file, and patients can see any in-network provider without a referral on file at the in-network benefit. Please note, some Specialists prefer that a PCP refer patients to them, so you may still need to submit a referral to the Specialist – but Summit Health plan will no longer require one in 2023.

Updated COVID-19 Online Resources and Vaccine Schedule

Our provider community requested a centralized resource for the latest COVID-19 updates to better serve your patients, and we’re excited to share the newly updated COVID-19 webpage.

Here, you will find:

• A downloadable COVID-19 vaccine schedule that details the primary series for each FDA-approved vaccine and the boosters by age group
• Fact sheets on the COVID-19 vaccines
• County-specific COVID-19 information

Upcoming Events & Training

Novillus Care Gap Management Application (CGMA) Information Session & Demonstration 

We invite you to attend the upcoming introductory webinar with the Novillus and Summit Health teams to learn more about the CGMA.

• When: Thursday, February 23rd from 12 to 1 pm PT
• Where: This event will be held virtually. Participants must register via the link below in order to receive the event invitation.

• What: This webinar will cover:
  • How clinics can view and close care gaps related to Medicare Stars measures
  • Explain how the platform can help clinics manage their patient roster and reassign members to another PCP
  • Show examples of real time performance towards Summit incentive program
  • And more!

Questions?

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

If you would like to be added or removed from this email list, please let us know at ProviderInquiry@yoursummithealth.com