CCS Newsletter: In this Issue - Community Care of the Sandhills

Our vision to improve the overall health and quality of life of those we serve.
FEBRURARY 2015
IN THIS ISSUE 

Value and Patient Care ........................ 1

PMH Webinar Series............................ 2

Medicaid Personal Care Services.......... 2

SBIRT Webinar Series ........................... 3

Patient Success Story............................ 4

NC Medicaid PDL Updates .................... 5

Prior Authorization Requests ............... 6

New Hires ............................................. 7

NC HIE Updates ................................... 8

Office Locations .................................... 9
INFORMATION PROVIDED BY:
COMMUNITY CARE OF THE SANDHILLS
30 Parker Lane | PO Box 5389 | Pinehurst, NC 28374
O: 910.246.9806 | F: 910.295.7251
www.communitycare-sandhills.org
FEBRURARY 2015
A Message from our Medical Director
Dear Colleagues,
Welcome to the fourth issue of the CCS newsletter.
With 2015 well underway, I want to present a challenge for us all. Some might consider it a silly exercise or even a waste of time, but I would
contend that it may hold part of the solution to the dilemma we face in North Carolina, and even in the United States, related to the delivery of
healthcare. We are incredibly lucky in North Carolina to have already in place an effective infrastructure for delivering healthcare to our most
vulnerable citizens who make up our Medicaid population. It is comprised of a network of primary care providers (pediatricians, internists,
family physicians, obstetricians, nurse practitioners, and physician assistants) who daily are willing to deliver care to our most disadvantaged
patients. These dedicated medical providers are supported by local networks of nurse care managers and social workers, who working with
our local partners, are assisting their patients in implementing their care plans. These are care managers armed with an information system
and a robust set of data generated by sophisticated analytics of CCNC that allow them to target our precious healthcare resources where they
are likely to do the most good.
So what is the challenge?
The challenge for each of us, medical providers
and care managers, is to start thinking on a daily
basis about VALUE. We have to begin asking
questions like: “did the office visit that I just had
with my patient bring value to that patient, to
the payer that I will bill for the service, or to the
community to which we all belong?” As a care
manager, “are my contacts with my patients
bringing value to my patients, their medical
providers, and the entities that pay for the
services?”
As a practicing pediatrician, I have to admit that
most days my focus is to just make it through
the day. My goal is to see all the patients on my
schedule, make a correct diagnosis, and
formulate a good plan of care. I constantly think
about the quality of care that I provide, but not
so much about value. Thinking about value
should move us beyond quality, not replace it.
In a simplistic way, value is quality with
attention to cost. Cost could be measured in
dollars spent or saved, time wasted or saved, or
even in subjective concepts like well-being or
quality of life.
When the policy makers talk about moving away
from the fee-for-service model of care to one
based on managing the health of a defined
population thinking about value becomes
critically important. When a medical
provider is assuming risk for the care of a
population, thinking about value takes on
new meaning. Am I filling my schedule with
the right patients? Am I managing my
patients with the most current evidencebased treatment plans or like I was trained
over 30 years ago? Have I structured my
office flow to maximize my time and
available staff resources? Am I
documenting the care that I provide in a
way that others could use the information
in a timely and effective way? Am I coding
the work that I do to receive the correct
reimbursement? Do I know how much the
medications, tests and therapies I order
cost my patient and their payers? These
are just a few examples of some questions
that could begin to shift our thinking
toward providing high value healthcare.
The fact that healthcare is changing is not in
dispute. I believe the medical providers
who are successful in bringing the concept
of VALUE into their thinking and planning
will lead the way and have the best chance
for continued success.
At Community Care of the Sandhills
we are ready to support this effort.
Our care managers are available to
assist you with caring for the
Medicaid patients assigned to your
practices. Our Practice Support
Teams are ready to help you and
your practices explore ways to
improve and bring value to you and
the care you are providing your
patients.
Dr. Stewart
Page 2
Pregnancy Medical Home
WEBINAR SERIES
CCS Contact:
Donna Deese, RN BSN
Health Department Liaison
(910) 246-9806
[email protected]
PMH Care Pathway on
Perinatal Tobacco
Use, released January
2015, available at:
https://www.communitycarenc.org/population-management/pregnancy-home/pmh-pathways/pmhcare-pathways-perinatal-tobacco-use/
NC TRACKS ISSUE UPDATE:
Providers who obtained a
from MedSolutions from January 16 – 18, 2015, and have received a radiology claim denial
(including ultrasound claims) from NCTracks for no prior approval on those dates can resubmit their claims beginning Monday, February
16, 2015. Any questions related to radiology prior approval, please call MedSolutions client services at 800-575-4517, Option 3.
MEDICAID PERSONAL CARE
SERVICES (PCS)
Providing
home-based
decision support to
primary care providers
CCS Contact:
Brenda Sedberry, RN CCM
What is PCS?
PCS is a Medicaid benefit that provides help in the beneficiary’s residence with
Activities of Daily Living (ADLs) – Bathing, Dressing, Mobility, Toileting and Eating.
(910) 246-9806
[email protected]
Page 3
Page 4
CELEBRATING PATIENT SUCCESS

Age: 56
Diagnosis: CHF, COPD, HTN

Community Care of the Sandhills celebrates strides our patients make at all levels of recovery. It is especially rewarding to be
part of such an important role in helping each patient reach their fullest recovery potential. Our patient success stories are
examples of the recoveries underway in our Network across seven counties.
Candis has truly
made a difference
in his quality of life!
Key components of Transitional Care Management
interventions are our Care Manager’s face-to-face
visits and ongoing follow-up contacts with recently
discharged patients with the objectives to:

Facilitate the patient’s identification of
personal short- and long-term goals through
development of a collaborative patientcentered care plan that meets his/her
preferences and motivation level;

Evaluate the patient’s education around the
recognition of “red flag conditions” to watch
out for and to report quickly to his/her Primary
Care Physician;

Perform medication reconciliation and
teaching to promote adherence; and,

Identify and assist the patient with procuring
necessary bio psychosocial resources within
the community that support self-management
and address barriers.
Describe the problem
being addressed and
why it’s important.
Candis Adcock, RN PCM (above) has been working with a 56-yearold patient who has a longstanding substance use/abuse history
resulting in severe cardiac damage, CHF, chronic pain attributed
to PVD, and co-morbidities of COPD, DM Type II, and HTN. The
patient came to CCS’ care management because of his high
inpatient utilization, often greater than once monthly, with CHF
exacerbations.
Describe the activities
and action steps
taken.
During hospital admissions, it was felt that his admissions could be
attributed to noncompliance with his medication regimen, since
he consistently advised that he had run out of his “fluid pill.”
Routinely at discharge, he was sent home with prescriptions for
Lasix.
Candis noted that he had a prescription for Spironolactone ½
tablet daily. Through conversation with the patient, he stated the
pill was small, hard and he was unable to cut the tablet in half;
thus, he was simply taking the whole pill daily, resulting in using
his prescription up too early every month. This simple
medication issue was a major factor in his chronic CHF
readmissions! Candis contacted his pharmacist and from that
point forward, the pharmacy provides his Spironolactone pre-cut
in half for him. He has had only one hospitalization since July
2014!
Page 5
North Carolina
Medicaid Preferred
Drug List
UPDATES
PDL CHANGES
The NC Medicaid Outpatient Pharmacy Program has implemented changes to the Preferred Drug List (PDL) as of January 1, 2015.
PREFERRED BRAND MEDICATIONS
If a brand name drug is preferred when its equivalent generic is non-preferred, prior authorization is not needed. Likewise,
“brand medically necessary” is NOT needed on the face of the prescription. If you are used to prescribing these medications using
the generic medication name, you may continue to do so – pharmacies can substitute the preferred brand at the time of
dispensing.
Accolate
DermaSmoothe FS
Exelon
**Niaspan ER
Adderall XR
Scalp and Body Oil
Exforge
Opana ER
**Aldara
**Desoxyn
**Focalin
**Prandin
Alphagan P
**Dexadrine Spansules
**Focalin XR
Prevpac
Astelin
Diastat kit
Gabitril
**Provigil
Astepro
Diastat Accudial
Gris-Peg
Pulmicort
**Bactroban cream
Differin gel/cream
Hepsera
**Ritalin LA
BenzaClin
Diovan
Kadian
**Symbyax
Cardizem LA
Diovan HCT
Lovenox
Tobradex
Catapres-TTS
Duetact
**Metadate CD
Toprol XL
Cedax capsule and
Epivir HBV
**Methylin solution
Travatan
suspension
**Entocort EC
Metrogel vaginal
Verelan PM
**Cymbalta
**Epipen
**Natroba
Zovirax ointment
* Bolded brand name medications are newly designated as preferred over their generic equivalent as of
January 1, 2015.
Page 6
PRIOR AUTHORIZATION REQUSTS
HIGHLIGHTS OF
PREFERRED DRUG LIST CHANGES
 Behavioral Health medications including antidepressants, antipsychotics and ADHD
medications will have non-preferred agents listed on the PDL for the first time
o Both Intuniv and its generic guanfacine ER, will become non-preferred
(guanfacine IR, clonidine IR, and clonidine ER (Kapvay) will remain preferred)
o Concerta will become non-preferred (all generic methylphenidate ER products
will remain preferred)
Requests may be submitted via
fax, phone or through the
NCTracks Web Portal using your
NCID and password.
www.nctracks.nc.gov/ncmmisPortal/login
Requests may be submitted via
fax, phone or through the
NCTracks Web Portal using your
NCID and password.
o Both Pristiq and its generic, desvenlafaxine ER, will become non-preferred
o Note: Implementation of oral antipsychotics PDL changes are delayed
 Most triglyceride lowering agents will become non-preferred (gemfibrozil will be the only preferred product)
 Several low use, generic cardiology medications will become non-preferred
 Lansoprazole products will become non-preferred (several omeprazole and pantoprazole products remain preferred)
 Leukotriene modifiers no longer require prior authorization (just have preferred and non-preferred drugs)
 Low sedating antihistamine and decongestant combinations will require prior authorization
 Self-injected epinephrine agents and glucocorticoids will appear on the PDL for the first time
 Premarin vaginal, Estring and Vagifem will remain preferred (all other vaginal estrogen products will become non-preferred)
 Metformin ER (generic Fortamet) will become non-preferred (metformin ER, generic for Glucophage ER, will remain preferred, but
pharmacies may need a new prescription if previous one was written for Fortamet)
NCTRACKS PHARMACY CALL CENTER
Phone: 1-866-246-8505|Fax: 1-855-710-1969
HOURS OF OPERATION:
Monday – Friday, 7:00 AM to 11:00 PM
PDL PATHWAY TO
Saturday and Sunday, 7:00 AM to 6:00 PM
NCTRACKS PHARMACY
SERVICES PAGE, AVAILABLE
AT: https://nctracks.nc.gov/content/public/providers/pharmacy.html
To quickly search through the electronic PDL for a medication or medication class, press
“Ctrl” and “F” simultaneously. A search box will appear on your window.
Page 7
WELCOME NEW CCS TEAM MEMBERS!
MELISSA BELL
CSC
Scotland
REBECCA CURRIE, RN
Care Manager
Richmond
PAULA DARDEN, RN
Care Manager
Harnett
SUSAN GOODFELLOW
Data Coordinator
Pinehurst
KILEY HUNT, RN
Care Manager
Hoke
JACIE LEWIS, RN
QI Program Manager
Pinehurst
HILARY LOCKLEAR, RN
Care Manager
Hoke
NYDIA MANCINI, PHARMD
Network Pharmacist
Pinehurst
MOLLY PARKER, RN
Care Manager
Moore
ALICIA RILEY, BSW
SW Care Manager
Richmond/Scotland
AIMEE SEALS
ED Navigator
Richmond
TASHA SMITH, BSW
SW Care Manager
Hoke/Montgomery/Moor
e
STEVE TAYLOR, RN
Care Manager
Richmond/Scotland
Page 8
Issue #19
January 16, 2015
What’s New at
NC HIE?
The Participant list on the
NC HIE website is now
sortable by facility,
location, provider type
and Community Care
Network (if applicable) by
using the filters at the top
of the spreadsheet. You
can view and download
the list of NC HIE
participants here.
Upcoming and Prerecorded Events:


Upcoming webinars for
“NC HIE Overview and
Current Initiatives” and
Training for Clinical
Portal, Opt Out, and
Site Administrator
hosted by NC HIE can
be found here.
Pre-recorded “Meeting
Meaningful Use with
NC HIE” and Training
for Clinical Portal, Opt
Out, and Site
Administrator hosted
by NC HIE can be found
here.
When connected with NC
HIE, Providers are
connected.
The CCNC NC HIE’s #1 goal is to help all
networks achieve 100% participation
with NC HIE by July 2015.
The NC HIE has reached 40% of its
goal as of January 16, 2015.
Looking back over the last year, the
most successful strategies to engage
and recruit practices has been:
Participation Update
Over 1,000 sites have signed up to
participate with NC HIE, including 35
hospitals. These connections will
cover more than 1,000,000 unique
patients and more than 3,000
providers.
Practices signed up to NC HIE by CCS:
1. Speaking about NC HIE at
scheduled Practice Manager and
Medical Management meetings.
# of Independent Practices signed up
2. Being present and speaking at
network staff meetings.
# of Independent practices needing to
sign up
3. In person practice visits with
network staff. This has been the
most effective method.
65
If your practice is interested in a
practice visit from NC HIE, please
contact your QI Practice Support at
Community Care of the Sandhills:
28
% of Independent practices signed up
30.11%
DMA State Subsidy to Connect to
NC HIE
The DMA State subsidy funding is both
time limited and awarded on a
first-come, first-serve basis.
(910) 246-9806
Practices are eligible for the subsidy if
they are a Carolina Access II practice
or participating in the Medicaid
Meaningful Use Incentive program.
NC Health Information Exchange | 2300 Rexwoods Drive, Suite 390 | Raleigh, NC | 27607
Phone: 919-926-1042 | Website: www.nchie.org
Page 9
www.communitycare-sandhills.org
Our vision is to improve the overall health and quality of life of those we serve.
OFFICE LOCATIONS:
Main Office
COMMUNITY CARE OF THE SANDHILLS
30 Parker Lane
P.O. Box 5389
Pinehurst, NC 28374
Office: (910) 246-9806
Fax: (910) 295-7251
Satellite Office Locations
DUNN
305-D Tilghman Drive
Dunn, NC 28334
Office: (910) 292-2456
Fax: (910) 292-2643
LAURINGBURG
507 Lauchwood Drive
Laurinburg, NC 28352
Office: (910) 506-4936
Fax: (910) 506-4842
ROCKINGHAM
928 S. Long Drive
Rockingham, NC 28379
Office: (910) 817-9590
Fax: (919) 817-9548
SANFORD
1684 S. Horner Boulevard
Sanford, NC 27330
Office: (919) 775-1959
Fax: (919) 775-4590
Harnett, Hoke, Lee, Montgomery, Moore, Richmond, Scotland