Welcome to Summit Health
Welcome to the November 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
Summit Health Medicare Advantage plan will no longer require a referral to see a specialist starting January 1, 2023. 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.
Summit Health has been advocating for our members to engage in primary care and complete their preventive visits this year in hopes of improving and maintaining the overall health of our members.
As we near the end of the year, we hope that you will encourage your patients to complete their Medicare Annual Wellness Visits (AWV) and/or Annual Physical Exams. Closing these care gaps can lead to better health outcomes for your patients and impact your financial incentives in our Medicare Advantage Primary Care Incentive Program (MAPCIP) for 2022.
Your Summit Health patients have a covered AWV (once every calendar year) and an Annual Physical Exam (once every calendar year) at no cost. An AWV and the Annual Physical Exam can be completed at the same visit and can also be combined with a problem visit, but a cost-share would apply if combined with a problem visit. Please be sure to code services accurately, for both your own reimbursement and quality measure reporting. Refer to our Summit Health guide to Preventive Visits to review details about coding, talking points for scheduling, and other helpful tips.
Statin medications are a highly utilized and effective therapy for the prevention of atherosclerotic cardiovascular disease that are associated with a risk of muscle pain or weakness and rhabdomyolysis. Although myopathy associated with substantial muscle damage is rare (approximately 1 case per 10,000 person years), myalgias and arthralgias are frequently reported as side effects of statins. Patients commonly discontinue statins due to perceived statin intolerance, with myalgias and arthralgias cited as the cause of this intolerance.
New evidence has emerged supporting the belief of healthcare professionals that statins may not be the cause of the majority of myalgias reported by patients. A meta-analysis reviewed 23 double-blind trials (19 statin vs. placebo trials and four higher-intensity vs. lower-intensity statin trials) and found that there is a 7% increased risk for muscle symptoms with statin use vs. placebo in this first year of use, with decline of risk during subsequent years of use. Additionally, the risk of muscle symptoms increases slightly with higher intensity statins but is no higher than 10%. While this analysis does indicate low rates of statin induced myopathy, it should be noted that creatine kinase concentration was available in few patients who reported muscle pain or weakness (6.2%), so rates of statin associated muscle damage cannot be accurately estimated.1
Although further scientific evaluation is needed to understand the differences in incidence of statin induced myalgias reported in real world evidence compared to double-blind trials, the cardiovascular benefit of statins remains well understood. In cases where patients complain of myalgia after starting statin therapy, additional testing may be appropriate to rule out other causes of muscle pain or weakness while continuing statin therapy. In all cases, healthcare providers should continue to evaluate risk vs. benefit based on patient specific characteristics before discontinuing stain therapy.
Questions?
We’re here to help. Please call our Summit Health Pharmacy Customer Service team at 541-663-2721.
As always, we appreciate your support in helping our members to better health and wellness.
References
1. Cholesterol Treatment Trialists' Collaboration. Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials. Lancet. 2022 Sep 10;400(10355):832-845. doi: 10.1016/S0140-6736(22)01545-8. Epub 2022 Aug 29. Erratum in: Lancet. 2022 Oct 8;400(10359):1194. PMID: 36049498; PMCID: PMC7613583.
The Centers for Disease Control and Prevention (CDC) reports that more than 133 million Americans live with diabetes. Health care providers play a crucial role in prevention or delay of type 2 diabetes and management of all types of diabetes.
Promote overall health management for your patients with diabetes by:
For more resources on diabetes management:
We invite you to attend the upcoming introductory webinar with the Novillus and Summit Health teams to learn more about the CGMA.
Register for the CGMA Introductory Training.
We look forward to seeing you on November 14th!
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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