PCC Plan

MassHealth’s Primary Care Clinician (PCC) Plan Newsletter • www.mass.gov/dma/MassHealth • www.masspartnership.com
PCC Plan
Easy Access to Care Benefits Patients
with Chronic Conditions
Winter 2005
Quarterly
Important Numbers
A North Andover PCC has found that
patients, especially those with chronic
conditions, are more likely to receive
regular, preventive care when they can
access walk-in appointments or can
schedule same-day appointments.
PCC Plan Hotline
For three years, Community Medical
Professionals (CMP) has flexed its
appointment scheduling, making
walk-in and same-day appointments
available from 9:00 a.m. to 4:00 p.m. daily.
The practice believes that this has allowed
staff to provide care earlier in the disease
cycle. “Now, patients don’t wait and let
health problems get out of control. We tell
them, ‘Rather than going to the emergency
room, you should just come in—we know
your history, your pharmacy, your side
Doreen McDonald, CMP practice manager
effects,’” says Doreen McDonald, CMP
and Alberto Sobrado, MD, director.
practice manager. She explains, patients
are now developing ongoing relationships
Clinicians initially feared being swamped
with practice staff and are more likely to
by walk-ins. Staff also needed assurances
seek primary care first rather than
that open-door scheduling would be limited
seeking care in the emergency room.
to existing patients. Both concerns have
now disappeared: on Mondays and
How to manage walk-ins
To manage the scheduling shift, McDonald Fridays, there are an average of 15 to 20
walk-ins; on Tuesday through Thursday,
analyzed daily patient traffic flow. She
tracked no-shows and open appointments about 10 to 15. CMP still schedules all
specialty visits, such as eye appointments
by time of day and developed a schedule
for diabetic patients.
that doesn’t overload treaters or bump
scheduled appointments. While no-shows
Despite the availability of same-day and
have not been reduced, walk-ins fill gaps
in the schedule caused by no-shows. “This walk-in appointments, sometimes
generates a full schedule for the practice,” patients revert to old habits and go to
says McDonald. “Even with plenty of out- the emergency room for treatment of
illnesses. A CMP nurse calls immediately
reach, we couldn't stop the no-shows, but
Continued on page 2
we were able to compensate for it.”
1-617-790-5633
The PCC Plan Quarterly, Winter 2005
1-800-495-0086, ext. 3
For PCC and office staff information
and assistance, Plan information,
Member outreach assistance, and
health education materials
PCC Plan Community
Service Provider Program
For assistance with engaging
Members in their treatment plans
Provider Services Dept.
1-800-325-5231
For questions about billing
and claims payment
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Enrollment and Credentialing
1-800-322-2909
For questions about PCC Plan
provider application and
enrollment issues
Behavioral Health
1-800-495-0086, ext. 3
For behavioral health (mental health
and substance abuse treatment
services) for PCC Plan Members
Member Services
1-800-841-2900
For Members to call about PCC Plan
enrollment, Member services,
and transportation.
MassHealth REVS
1-800-554-0042
Automated voice response to verify
a Member’s MassHealth eligibility
and managed care enrollment
Request for assistance with
MassHealth billing issues
may be faxed to 703-917-4949.
MassHealth will reply within
five business days.
1
Continued from page 1
to follow up after emergency room
visits. “We ask them to come in
and bring their meds with them.
We discuss how they ended up in
the emergency room. Then we reeducate them to come to us first,”
says McDonald.
Patients are now developing
ongoing relationships with
practice staff and are more
likely to seek primary care
first rather than seeking care
in the emergency room.
An incredible access rate
“Because of their open door
policy, CMP has an incredible
access rate,” says Gerry Reed,
MBHP regional network manager,
who notes that 87 percent of the
PCC Plan Members in the practice
were seen by a CMP clinician in
2003. CMP’s semiannual HbA1C
diabetes screening rate has
reached as high as 86 percent.
“Now, patients don’t
wait and let health
problems get out of control.”
–Doreen McDonald,
CMP practice manager
The practice, directed by Alberto
Sobrado, MD, employs another
physician, two nurse practitioners,
an RN, and an LPN. To expand
walk-in and same-day appointment hours, the practice is now
interviewing for an additional
full-time physician who would
also handle hospital rounds for
the practice. CMP intends to
expand open-door hours to
7 p.m. on weekdays and add
Saturday hours. ■
The PCC Plan Quarterly, Winter 2005
Letter from the Director
The PCC Plan staff is continually
working to enhance the Plan’s
ability to support providers in
delivering care to Members and
to ease administrative burdens for
enrolled PCCs. The following are a
few examples of activities designed
to support these PCC Plan goals.
So that the provider doesn’t receive
duplicative requests for information, the PCC Plan and the
MassHealth-contracted MCOs have
developed and implemented a
joint effort to survey providers on
how long Members wait for
appointments for certain services.
The MCO and the PCC contracts
each contain standards for access
to certain kinds of services, and
there is a large amount of overlap
in the provider networks for each
of the health plans. Now each
provider is surveyed only once
about wait time, and the data is
shared among the health plans.
To increase coordination between
medical and behavioral health care
services for PCC Plan Members, the
PCC Plan will gather information
from both medical and behavioral
health care providers in the coming
year to identify barriers to effective
communication among providers.
This data will be the basis for new
initiatives to improve coordination
of care for Members.
To support more PCCs in delivering
care in accordance with accepted
clinical guidelines, the Plan now
makes PCC Profile Reports and
related site visits available to
selected PCCs with fewer than 200
Plan Members enrolled, and the
PCC Plan Health Education and
Support Materials catalog is now
available to all PCCs, regardless
of PCC panel size.
If at any time you have questions
about the PCC Plan or wish to
provide feedback to the Plan,
please feel free to contact the
PCC Plan Hotline at 800-495-0086.
Thank you for your participation
in the PCC Plan.
Louise Bannister, Director
PCC Plan
Notwithstanding any of the information appearing in this PCC Quarterly
Newsletter, the rules governing the state’s PCC Plan, behavioral health, and
pharmacy programs are governed by state and federal law and regulation,
and by the state’s PCC, behavioral health, and pharmacy contracts. In the
event of any conflict between any provision set forth in this PCC Quarterly
Newsletter and any other provision of law, regulation, or contract, the legal
and/or contractual provision shall take precedence over the provision in this
PCC Quarterly Newsletter.
2
How Are We Doing?
The PCC Plan
Wants to Know.
The PCC Plan wants to know how
well we are doing in managing the
Plan. Please let us know your feedback on issues ranging from referring
Members to specialists to the PCC
Profile Report by completing the
Primary Care Clinician (PCC)
Satisfaction Survey. Your responses
are very important to the PCC Plan
and will help improve Plan services.
Check your mailbox for the survey
and mail it back to the Plan in the
postage paid return envelope supplied.
If you have questions about the survey,
please contact the PCC Plan Hotline
at 1-800-495-0086. Thanks! ■
Pharmacy Corner
Tips for Reducing Pharmacy Costs
Prescribers are increasingly feeling
the pressure to provide medications
to their patients, in part, the result
of direct-to-consumer advertising.
Many patients now expect to walk
away from every doctor’s visit with
a new prescription in hand, often
one they’ve seen advertised. As a
result, MassHealth would like to
recommend several practices
designed to both safeguard patient
health and reduce unnecessary
pharmacy costs.
Reviewing the Medication Profile
About two-thirds of doctor visits
now result in the provider writing
a prescription. At each visit,
prescribers should reinforce the
Member’s understanding of which
medications to continue using and
which to stop, particularly when
a new medication is prescribed.
Dose Consolidation
Dose consolidation is an important
tool for reducing prescription medication costs. Many medications
can be prescribed as a once-a-day
dose, rather than a lesser strength
dose taken two or three times
a day. For example, the cost of a
prescription for Norvasc 5mg.
tablet taken twice a day is $86.25
per month, compared with $60.12
per month for a prescription for
Norvasc 10 mg. taken once per day.
The PCC Plan Quarterly, Winter 2005
Before recommending dose consolidation, a prescriber should consider
both medication effectiveness and
cost-savings.
Here are some other examples of
drugs that can be taken once a day
and comparative monthly costs:
Twice-A-Day
Actos 15 mg BID
Aricept 5mg BID
Lisinopril 10 mg BID
Toprol XL 50mg BID
Zoloft 50mg. BID
Zyprexa 5mg BID
$192.88
$264.38
$10.89
$46.02
$147.82
$364.55
Once-A-Day
Actos 30 mg. QD
Aricept 10 mg QD
Lisinopril 20 mg QD
Toprol XL 100mg. QD
Zoloft 100mg QD
Zyprexa 10mg QD
$154.98
$133.71
$8.25
$35.31
$75.41
$275.16
“Pill Splitting”
Some medications are “flat-priced,”
which means that a drug will have
the same approximate costs for all
available strengths of that drug.
Zoloft, for example, costs about the
same per tablet price no matter the
strength. This explains the large
price differential between Zoloft
prescribed at 50mg. and Zoloft
at 100mg. (see graphic). Other
examples of drugs that are
flat-priced are Accupril, Aricept,
Celexa, Crestor, Lipitor, Terazocon,
Viagra, and Zocor.
Prescribers can educate Members
to split pills to reduce pharmacy
costs of flat-priced drugs. Drugs
such as Celexa
and Zoloft are
scored, which
makes it easy for
the patient to cut
the tablets in half.
For example, a
monthly prescription for 30 tablets
of Zoloft at
50mg. taken
once
daily
would
cost
$75.38.
If the
prescriber writes the prescription
for 15 tablets of Zoloft at 100mg.,
which the Member splits in half,
the cost is $39.20.
A prescriber should be able to
answer any questions regarding the
appropriateness of pill splitting for
a particular medication. ■
3
150 Federal Street
3rd Floor
Boston, MA 02110
In This Issue of
PCC Plan Quarterly
Easy Access to Care Benefits
1
Letter from the Director
2
How Are We Doing?
3
Pharmacy Corner: Pharmacy Costs
3
New Tool to Access Patient
Prescription Information
In an effort to improve safety and quality of care, emergency room (ER) physicians in a few Massachusetts
hospitals have begun to use a new patient safety tool to
access prescription information before treating patients.
The Massachusetts Health Data
Consortium (MHDC) has
launched a new electronic tool
called MedsInfo-ED (Prescription
History in the Emergency
Department) that uses secure
Internet technology to deliver
real-time patient medication history
to ER physicians. MedsInfo-ED
allows ER doctors to electronically
access prescription claims
information from multiple data
sources. While patients can
continue to verbally provide prescription information
to physicians, this tool aims to improve patient safety by
limiting situations that may lead to errors in diagnosis
and treatment.
caregivers who are all prescribing different medications.
For the first time, ER doctors can see all this information
on one screen.” Three Massachusetts hospitals—Emerson
Hospital, Boston Medical Center, and Beth Israel Deaconess
Medical Center—are piloting the program. The three hospitals
are representative of medical teaching and communitybased facilities. These types of facilities have a combined
volume of approximately 14,000 emergency patients
monthly. Emerson Hospital was the first hospital to
launch MedsInfo-ED in the emergency department.
In the past, ER doctors had to track separate sources of
information, including the family, pharmacies, transfer
lists from other providers and facilities, emergency medical
technician notes, and pill bottles to access prescription
information. Now, doctors will be able to more efficiently
achieve the same goal by contacting one source. This
translates into better care for the patient and long-term
savings for both the health care system and the consumers
that use it.
MedsInfo-ED will not provide patient prescription information that violates state patient-privacy regulations or
policies developed by the patient’s health plan.
MHDC launched MedsInfo-ED at the request of the
Alliance for Health Care Improvement, a collaboration
The initial sources for prescription history data include: of medical directors in six health plans in Massachusetts,
Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim to address the type of errors described in a recent study
by the Institute of Medicine. According to the study,
Health Care, MassHealth (Medicaid), Neighborhood
To Err is Human, as many as 98,000 patients die each
Health Plan and Tufts Health Plan.
year as a result of medical errors that could have been
prevented. Many result when doctors do not have
“It’s about communication,” says Elliot Stone, CEO,
complete information for a patient. ■
MHDC. “We found that many patients have multiple
The PCC Plan Quarterly newsletter is published for PCCs, behavioral health, and substance abuse providers as a forum for sharing information.