Summit Provider Newsletter - May 2022

Welcome to the May 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:

• Healthy Aging Resource for Your Patients
• Medicare Part B Step Therapy Updates
• May is National Osteoporosis Awareness and Prevention Month

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

Healthy Aging Resource for Your Patients

Summit Health understands that one of the best ways to improve overall health and stay healthy is to be proactive and connected with a primary care provider (PCP). We will be sending a healthy aging resource to your patients this month to help your patients assess their health, encourage preventive visits, and remind them about the many ways they have access to care, such as their telehealth benefit and nurse advice line.

Your Summit Health patients have a covered Medicare Annual Wellness Visit (once every calendar year) and an Annual Physical Exam (once every calendar year) at no cost. While these visits are not Medicare Star Measures, they are important opportunities to impact many quality measures and improve better health outcomes for your patients.

The Annual Wellness Visit and the Annual Physical Exam can be completed at the same encounter and can also be combined with a problem visit. Note that a cost-share would apply if combined with a problem visit. Please be sure to explain any additional services that may be done during a visit so that your patients understand their expected out-of-pocket costs.

Medicare Part B Step Therapy Updates

As a reminder, 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:

• Meets the definition of a Medicare Part B medication
• New for the patient, as defined by no use in the last 365 days
• Proposed use of the requested and alternative drug has been determined to be a medically accepted indication under Medicare rules
• Dose, frequency and duration of use may not exceed the safety and efficacy data supporting the medically accepted indication

Outlined below are the changes to the preferred products starting July 1, 2022.

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.

May is National Osteoporosis Awareness and Prevention Month

The Bone Health and Osteoporosis Foundation (BHOF) reports that osteoporosis is responsible for an estimated two million broken bones per year. Yet nearly 80 percent of older Americans who suffer bone breaks are not tested or treated for osteoporosis.

If your patient is at risk for osteoporosis, we encourage you to complete a bone mineral density (BMD) test. Additionally, female patients over the age of 67 should receive a BMD test within 6 months of a fracture to evaluate risk of osteoporosis or prescribed a drug to treat osteoporosis.

Our Summit Health members have no cost-sharing when seeing in-network providers for bone mass measurement (once every 24 months for those at risk or more frequently if medically necessary). Learn more about bone mass measurement coverage and related codes at the Medicare Learning Network

Access more resources and information on clinical osteoporosis care at BHOF’s professional program, BoneSource®.

Upcoming Events & Training

Summit Health Spring Clinic Trainings

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?

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