Help your Patients Get Ready for Flu Season
Flu season is here which makes it the perfect time to remind your patients about the importance of getting a flu shot. One way to encourage flu shots is to offer the vaccination at each visit for patients who have not yet received one. Remind your SCFHP patients that flu shots are covered by SCFHP. Members will not be charged for the shot as long as they present their SCFHP member ID card and are currently eligible for coverage.
We encourage members to get their shots from their assigned Primary Care Physician (PCP). Other providers can administer the flu shot as long as it is properly documented in the member’s medical record.
For additional immunization resources, please visit:
https://www.cdc.gov/flu/professionals/index.htm
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Influenza.aspx
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HEDIS 2019 Results
SCFHP would like to thank our providers for participating in a successful Healthcare Effectiveness Data and Information Set (HEDIS) season. 2019 HEDIS results showed continued improvements from previous years, and we could not have done it without the quality care you provide.
We are able to report improved clinical health outcomes demonstrated by rate increases in seven Medi-Cal measures!
| National Committee for Quality Assurance (NCQA) Health Care Effectiveness Data and Information Set |
2019 Rate for Medi-Cal |
2019 NCQA Percentile |
| Cervical Cancer Screening |
| CCS |
61.07% |
50th |
| Controlling High Blood Pressure |
| CBP |
56.93% |
25th |
| Comprehensive Diabetes Care |
| HbA1c Testing |
89.78% |
50th |
| HbA1c Poor Control (>9.0%)* |
43.31% |
25th |
| HbA1c Control (<8.0%) |
46.23% |
25th |
| Eye Exam (retinal) |
64.72% |
75th |
| Medical Attention for Nephropathy |
90.27% |
25th |
| Blood Pressure Control (<140/90 mm Hg) |
62.29% |
25th |
| Childhood Immunization Status |
| CIS-3 |
73.72% |
75th |
| Prenatal & Postpartum Care |
| Timeliness of Prenatal Care |
86.86% |
50th |
| Postpartum Care |
71.78% |
75th |
| Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life |
| W34 |
76.16% |
50th |
*Lower is better
More information is available on SCFHP’s Quality Improvement Program site.
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New 2020 DHCS HEDIS Measure: Child Developmental Screening
Under regulation from the Department of Health Care Services (DHCS), SCFHP monitors rates of childhood developmental screening administered by our Primary Care Providers (PCP). The childhood development screening measure reports the percentage of children screened for risk of developmental, behavioral, and social delays within a child’s first three years. Screening must include scoring and documentation using a standardized screening tool that meets criteria set forth by the American Academy of Pediatrics (AAP) and the Centers for Medicare and Medicaid Services (CMS).
PCPs should use CPT code 96110 for developmental screening with interpretation and report on claims for this service. Claims where modifiers are added to indicate standardized screening for a specific domain, such as social emotional screening via the autism screening (ASQ-SE), will not qualify for this measure. This measure requires tools focused on global developmental screening and identifying risk for developmental, behavioral, and social delays.
Below is a list of AAP recommended tools that meet the requirements for developmental screening:
- Ages and Stages Questionnaire (ASQ) - 2 months to age 5
- Ages and Stages Questionnaire - 3rd Edition (ASQ-3)
- Battelle Developmental Inventory Screening Tool (BDI-ST) - Birth to 95 months
- Bayley Infant Neuro-developmental Screen (BINS) - 3 months to age 2
- Brigance Screens-II - Birth to 90 months
- Child Development Inventory (CDI) - 18 months to age 6
- Infant Development Inventory - Birth to 18 months
- Parents’ Evaluation of Developmental Status (PEDS) - Birth to age 8
- Parent’s Evaluation of Developmental Status - Developmental Milestones (PEDS-DM)
Please contact the QI Department if you have any questions at quality@scfhp.com.
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Community-Based Adult Services: Support for Patients & Caregivers
Community-Based Adult Services (CBAS) can help when your patient is at risk of being admitted to a nursing facility or their caregiver needs a respite option. CBAS, also known as Adult Day Health Care, is a licensed medical program that helps adults with physical or mental impairments continue living in their homes and avoid inappropriate institutionalization. CBAS centers are open 5 days a week and offer personalized care in a supportive, safe, and professionally-staffed setting.
Benefits of participating in CBAS may include:
• Improved disease management, behavior, and sleep
• Enrichment of the recipient’s life
• Reduced social isolation
• Lower levels of caregiving-related stress
• Better psychological well-being of caregivers
For additional details click here.
To make a referral for CBAS, contact the Santa Clara Family Health Plan CBAS Care Coordinator at 1-408-874-1819.
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Safety Reminder: Risks with Sudden Discontinuation of Opioids
On April 9, 2019, the U.S. Food and Drug Administration (FDA) released a safety announcement about the serious harm that may result from suddenly discontinuing opioids or rapidly decreasing the dose in patients who are physically dependent on opioids, including codeine, fentanyl, hydrocodone, hydromophone, morphine, oxycodone, and oxymorphone. The potential consequences include serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.
For patients who are physically dependent on opioids and require a dose decrease or discontinuation of their opioid medications, health care professionals should consider taking a multimodal approach to pain management, including mental health support if needed. Frequent follow-up appointments should be scheduled to ensure that pain and withdrawal symptoms are being adequately managed.
When opioids are discontinued due to a suspected substance use disorder, evaluate and treat the patient or refer the patient for an evaluation and treatment of substance use disorder. Treatment for these patients should include evidence-based approaches, such as medication-assisted treatment. Complex patients with comorbid pain and substance use disorders may benefit from referral to a specialist.
Resources Available:
DHCS DUR Article
FDA Safety Announcement
CDC Pocket Guide on Tapering Opioids for Chronic Pain
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Cal MediConnect Vaccination Billing
The table below should be used to differentiate in-office billing for vaccinations covered by Medicare Part B vs. Part D for Santa Clara Family Health Plan Cal MediConnect members.
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*Vaccine requires a prior authorization to determine proper payment under Medicare Part B or Medicare Part D.
Here are a few other reminders regarding Cal MediConnect vaccination billing:
- Cal MediConnect members may be referred to all major chain pharmacies for vaccinations.
- Medicare Part B does not cover administration of Part D vaccines.
- Part B: Electronic billing is required with the appropriate HCPCS/CPT code.
- Part D: You may bill in-office administered Part D vaccines online using TransactRx. More information is available on the website or by calling 1-866-522-3386.
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Safety Update: Sleep Behavior Risks with Select Sleep Aids
On April 30, 2019, the U.S. Food and Drug Administration (FDA) announced that they are requiring Boxed Warnings be added to the prescribing information and patient Medication Guides for eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist) regarding the risk of complex sleep behaviors, including sleepwalking, sleep driving, and engaging in other activities while not fully awake. These sleep behaviors have resulted in serious injuries and death.
Health care professionals should avoid prescribing eszopiclone, zaleplon, or zolpidem to any patient with a history of a complex sleep behavior after the use of these medications. For more information regarding the Boxed Warning or for further prescribing recommendations, please visit:
DHCS DUR Article
FDA Safety Announcement
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New Resources for Providers: Decoding Billing
SCFHP would like to introduce Decoding Billing, a new resource that will be available for our providers regarding coding best practices. Each installment of Decoding Billing will cover a different performance measure, any new coding requirements, and/or the importance of coding for performance.
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Provider Training Opportunity: SCFHP HEDIS Training
You and your staff are invited to participate in a FREE in-person HEDIS training hosted by SCFHP.
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WHEN
Friday, October 18, 2019
9:00 a.m. -11 a.m.
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WHERE
Santa Clara Family Health Plan
6201 San Ignacio Ave
San Jose, CA 95119
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Learn more about:
- HEDIS and the 19 measures that will need to reach at least a 50% Minimum Performance Level (MPL)
- What it means for you and your office staff
- Best practices for medical coding to improve HEDIS scores and close gaps in care
Who should attend?
Providers, Office Managers, Coders, and Medical Billers
If you are interested in attending, please register as space is limited. If you have questions regarding the training event or HEDIS contact quality@scfhp.com.
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Memo Round Up
Santa Clara Family Health Plan (SCFHP) is dedicated to keeping our providers informed about operational or regulatory changes. Below are important memos that were sent recently:
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SCFHP by the Numbers
Santa Clara Family Health Plan Members (As of September 2019)
| Medi-Cal |
234,478 |
| Cal MediConnect |
8,194 |
| Healthy Kids HMO |
3,512 |
| Total |
246,184 |
Santa Clara Family Health Plan Providers (Unique providers as of September 2019)
| Primary Care Providers |
Medi-Cal |
Healthy Kids HMO |
Cal MediConnect |
| Total |
741 |
725 |
514 |
| Specialists |
Medi-Cal |
Healthy Kids HMO |
Cal MediConnect |
| Total |
3,468 |
3,481 |
2,535 |
| Ancillary Providers |
Medi-Cal |
Healthy Kids HMO |
Cal MediConnect |
| Total |
542 |
552 |
159 |
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