Fall - Family Health Network

Provider Newsletter
Inside
Fall 2015
Message from the president........ 2
ANNOUNCEMENT: Over
prescription of Opioids................ 2
ICD-10 is coming.......................... 2
New Medical Director.................. 3
Medicaid’s 50th anniversary........ 3
New website................................ 3
Have you submitted your
satisfaction survey?..................... 4
P4Q incentive program................ 4
Medicaid open enrollment
is here!......................................... 4
322 S. Green Street, Suite 400
Chicago, IL 60607
ANNOUNCEMENT:
Over prescription
of Opioids
The City of Chicago has taken action.
Last year they filled a lawsuit against
five pharmaceutical companies
believed to be falsely marketing
opioids to physicians and patients.
The lawsuit was an attempt to reduce
the influx of over prescribing opioids.
Good news! We were recently notified that the Illinois Department of
Insurance (DOI) approved the HMO Certificate of Authority for Family
Health Network (FHN). This is a big step for our company!
As a provider-sponsored health plan with more than 225,000 members
under our care, we are now positioned even stronger. This new
classification also allows FHN to offer autonomous products like FHN|SILVER
on the Health Insurance Marketplace. This means that not only will FHN
continue to grow, but will have the opportunity to aggressively expand.
If you have experience with companies
marketing opioids to you, the City of
Chicago’s attorneys are interested in
speaking with you. Specifically, they
want to know what you have seen or
heard. This is not a commitment to
testify or serve as an expert witness.
FHN is redefining managed care for people on Medicaid, especially high-risk
members. As you may know, we are the largest managed care plan in the
region under the Medicaid Family Health Plan (FHP) and the Affordable Care
Act (ACA). We have experienced unprecedented growth and that can bring
some challenges. While we have worked diligently to expand operational
capacity in our call center, claims processing and other key areas, we
recognize we have to do better.
To discuss your experience with
opioids being marketed to you,
contact Fiona Burke at Fiona.Burke@
cityofchicago.org or 312-744-6929.
I want to apologize if we didn’t meet your service expectations during
our rapid growth. We now have strategic resources in place to effectively
manage our growth, and are focusing completely on our return to service
and quality—key hallmarks for our continued success. In addition, we have
hired an outside consulting firm to conduct a comprehensive operational
review of our organization, which will include collecting extensive input
from the providers we serve.
ICD-10 is coming
The CMS-mandated deadline for the
ICD-10 conversion is October 1, 2015.
FHN is working on our ICD-10 projects
to ensure that our systems, processes,
policies, and business partners are
ready. As of October 1, 2015 date of
service, standard transactions must
be submitted with ICD-10 codes;
otherwise, the claim will be denied.
(Exception: Claims for emergency
department and observation that
span October 1, 2015 should not be
split per HFS. The appropriate ICD-9CMS diagnosis code should be used
based on the service from date)
If you have any questions, please
utilize the CMS ICD-10 resource
website, www.cms.gov/ICD10, Family
Health Network’s ICD-10 Readiness
webpage, www.fhnchicago.com/
providers/icd-10-readiness, or contact
Eric Allen, FHN/CCAI Project Manager,
at [email protected].
2
Message from the president
Since the expansion of managed care in Illinois, FHN has proven that
patient care coordination has been a critical component to better
outcomes, helping more members make good health care choices. Our
efforts have ultimately improved the health of our members and also
saved significant dollars to the health care system—money that has
been reinvested into our network of hospitals and providers to enhance
critical services.
For 20 years, FHN has provided quality care for people who need it the
most—Medicaid recipients, seniors, people with disabilities, as well as
children and adults with special needs. We want to thank you for your
continued support, particularly during challenging financial times. We
couldn’t offer the quality care to our members without your expertise.
Thanks for being part of our network. We are proud of everything that
we have accomplished together. We value your feedback and look
forward to many more years of collaboration.
Sincerely,
Keith Kudla, president and CEO
Family Health Network
Family Health Network Provider Newsletter Fall 2015
Introducing our Medical Director,
Dr. Susan Oyetunde
Dr. Susan Oyetunde has been appointed Family Health Network’s (FHN)
Medical Director in a full-time capacity. For the past four years, Dr. Oyetunde
has served as FHN’s Medical Director on a part-time basis. During this
time, she has made significant contributions to the organization, including
providing thought leadership, clinical expertise and member advocacy.
In her expanded role, Dr. Oyetunde will oversee medical aspects of FHN’s
clinical and quality assurance programs, particularly the asthma, prenatal,
diabetes and high blood pressure care management initiatives, as well as
supporting the care coordination efforts and utilization management that
are provided to more than 200,000 members every day under the FHN
plan. Her leadership will also be critical in fostering close collaboration
among key providers within FHN to achieve successful outcomes.
A board-certified physician with 40 years of experience as an inner-city
practitioner, Dr. Oyetunde received her medical degree from the University
of Navarra in Pamplona, Spain.
Medicaid’s 50th
anniversary
July 30th marked the 50th anniversary
of the federal enactment of the
Medicaid and Medicare programs.
Prior to Medicaid, more than half
of all seniors were uninsured and
thousands of low-income working
Americans couldn’t afford the medical
care they needed to stay healthy.
Since the signing of the amendment
to the Security Act, millions of lives
have been saved and forever changed
the delivery of health care in the
United States. Now having access to
quality and affordable health care has
allowed people to live longer.
Dr. Oyetunde completed her internship in internal medicine and residence
in pediatrics at Cook County Hospital in Chicago. She then completed
a fellowship in pediatrics ambulatory medicine at the same institution.
She holds a master’s degree in business administration from Benedictine
University in Lisle, Ill.
Dr. Oyetunde exhibits an ongoing commitment to empowering the diverse
communities FHN serves. We are excited about her new full-time leadership
role with the company and believe her expertise will further position FHN as
the leading health plan in the marketplace.
Did you know: 1 out of every
3 Americans have Medicaid
or Medicare
New website
Did you know: More than 70 million
children, pregnant women, lowincome adults and people living with
disabilities have received Medicaid
coverage since 1965
Family Health Network is pleased to announce
the launch of its refreshed website
www.fhnchicago.com. You will be happy to
know that the updated site features a new
For Providers section to make caring for and
assisting FHN members easier than ever. Our
goal is to help you easily access information
online so you can save time and focus on your
patient’s well-being. Here, you will find
•S
earchable online provider directory to help you quickly locate in-network
providers for referrals
• Information on becoming a BEP-certified business in the state of Illinois
• ICD-10 readiness updates to prepare you for the upcoming conversion
deadline of October 1, 2015
• LTSS Waiver forms that explain more about LTSS care coordination and
resources for providing care to qualifying members
Did you know: Today, 55 million
Americans depend on Medicare
For the past 20 years, FHN has filled
an important void in providing care
for those who are most vulnerable
and at need. We are proud to
be redefining managed care for
people on Medicaid. Since the
creation of Medicaid, 50 years ago,
so many Americans have seen an
improvement in their quality of life.
Because of this, we are proud to be a
Medicaid health plan and acknowledge
all the work that has been done by
Medicaid programs to improve health
care for so many in the U.S.
3
Have you submitted
your satisfaction
survey?
We are pleased to announce that the
2015 Physician Satisfaction Survey
is now available online at www.
cvent.com/d/frq904.The survey is
user-friendly and will only take a few
minutes of your time to complete.
The link to the survey was also
emailed to group administrators
in September. They were asked to
forward the link you.
If you would like a paper copy of the
survey please contact Melissa Dunne
at [email protected]. She will get
a copy in the mail to you right away.
We hope that you take a few minutes
to complete the survey and return it
back to us.
By completing this brief survey, you
can have a direct impact on improving
the healthcare delivery process. The
results will help us identify specific
areas for improvement and make
positive changes, enabling us to serve
you better and more efficiently.
The deadline to submit the survey
is October 2, 2015.
Provider Pay-for-Quality (P4Q)
incentive program
We are pleased to announce important changes to the 2015 provider
Pay-for-Quality (P4Q) Incentive program which replaces the 2014 P4Q.
The 2015 program is effective with July 1, 2015 dates of service, and is
now comprised of three incentive sets.
Consistent with prior years, FHN’s 2015 incentives are designed to promote
collaborative, quality-centered partnerships with our providers and medical
groups. The program allows us to reward providers for delivering the
highest quality care to FHN members in high-risk groups. We hope that you
will find the significant earning potential behind FHN’s 2015 P4Q program a
source of support for your practice now and into the future.
Incentive Set #1: HFS Capitation Withhold Program
Funded by the HFS Capitation Withhold program, 100% of funds earned
by FHN are returned to our providers. It is paid based on the number of
compliant members in selected HEDIS measures annually. HFS changed
the target measures in the program in 2015 and increased the payment
thresholds to the 75th percentile NCQA benchmark for Medicaid plans.
Incentive Set #2: Collaborative Care Program
Provides per-patient payment for notifying FHN of newly pregnant
members, and for approving the initial FHN care plan in newly pregnant
or chronically ill members. New in this program in 2015 are incentives for
achieving controlled outcomes in patients with diabetes and hypertension.
Incentive Set #3: HEDIS Close the Gap Program
Provides payment for every eligible member in targeted HEDIS populations.
The new tiered payment structure provides higher rewards for groups and
providers who reach the 50th and 75th percentile in multiple measures.
As in prior years, incentive sets #2 and #3 are fully funded by the FHN
administrative budget. We are very pleased to offer these rewards totaling
over $4 million in earning potential in 2015 to our network of providers in
recognition of outstanding care and service you provide to FHN members.
Your network management specialist or quality improvement manager
can provide details specific to your earning potential and answer any
questions in regard to this year’s P4Q program.
Family Health Network (FHN) was
founded in 1995 with an important
objective – bringing quality health
insurance to those who need it the
most. FHN is a not-for-profit provider
sponsored HMO that serves nearly
230,000 members in Chicago, Cook
County and Northern Illinois.
Family Health Network
322 S. Green Street, Suite 400
Chicago, IL 60607
1-888-FHN-4YOU (346-4968)
www.fhnchicago.com
join the conversation…
Medicaid open enrollment is here!
Starting last month in Rockford, and this month in Chicago, individuals
and families who qualify can enroll in FHN’s Medicaid health plan. They
will receive basic benefits and extra benefits such as:
•Transportation arranged by FHN
for all your covered services
•FREE Weight Watchers
Membership
•No co-payments
•NurseNow 24 - hour help hotline
•Free adult dental services
•Rewards for staying healthy
•Adult vision rebates
•And much, much more!
•Book clubs for ages 3-16
F1620-07/15