Fall 2014
Provider Vitals!
Free Over-theCounter Medications
FHN patients must choose a health plan
FHN enrollees can now receive non-prescription medications
for free with a script from their doctor. FHN will cover the cost
of these medications for our Enrollee. The list of medications
that are covered can be found on our website at
http://www.fhnchicago.com/FHN%20OTC.pdf.
The Medicaid Reform law requires that 100% of
people in the Chicago metro area under Medicaid be enrolled in a care coordination program
by Jan. 1, 2015. That is why the Illinois Dept. of
Healthcare and Family Services (HFS) recently
mailed Medicaid recipients a letter that says
they must choose a managed care health plan.
It is very important that Family Health Network
(FHN) members do so. Otherwise they risk losing you as their doctor, and they will not be eligible to receive all of the extra benefits and
healthy rewards that FHN offers.
The list can help you select the medications that are right for
your patients. Some medications may still be covered that are
not listed. enrollees must have a valid prescription from their
physician in order to receive any over-the-counter medications.
Family Health Network has gone social!
What should I tell my FHN patients?
You can find us on Facebook, Twitter, YouTube and LinkedIn
Come join the conversation and let’s stay connected!
Tell your FHN patients that they must choose
a health plan and enroll in it. If they don’t
they will be auto-assigned to a different
health plan and may not be able to see you
for their health care services (if you are not
in-network with the new health plan that
they are given.)
‘Follow’ us on Twitter for up-to-the-tweet news: www.twitter.com/fhnchicago
‘Like’ us on Facebook to get updates in your Facebook feed: www.facebook.com/fhnchicago
‘Follow’ us on LinkedIn for the latest company news: www.linkedin.com/company/family-health-network
‘Subscribe’ to our YouTube channels for all our latest videos: www.youtube.com/fhnchicago
There are several ways your patients can
choose a health plan. They can:
What happens if my patient doesn’t choose a
health plan?
1. Mail the form back to HFS. Remember, if
your patients want to stay with FHN they
must choose FHN as their health plan.
If your patient does not choose a health plan
they will be auto-assigned to a different
health plan and possibly a new doctor. They
can switch back to FHN and back to you as
their medical provider, but they may have to
see another doctor and will go without FHN’s
extra benefits and healthy rewards for a
period of time.
2. Call the Illinois Client Enrollment Services to
enroll with any health plan. The phone
number to call is 1-877-912-8880. If your
patients want to stay with FHN they must
say so when they call.
3. Visit the Client Enrollment Services website
at http://enrollhfs.illinois.gov/enroll. If your
patient wants to stay with FHN they must
select FHN as their health plan.
4. Call FHN Member Services to enroll with
FHN. The phone number to call is
1-888-346-4968.
What if my patient didn’t get a letter from
HFS?
If one of your patients did not get a letter
from HFS they should contact the Illinois
Client Enrollment Services. The phone number to call is 1-877-912-8880.
Care Coordination Responsibilities in New
Contract Environment
FHN received its new contract from HFS
effective July 1, 2014 which will expand the
number of enrollees and their covered services. Covered services are divided into two
major areas called Service Packages.
Service Package I has the familiar covered
services. All FHN enrollees are eligible to receive these services. The new covered services
under Service Package I include:
• Vision (children and adults)
• Dental (children and adults)
• Effective 10/1/2014, podiatric services for
all enrollees age 21 and over
• Nursing Facility services 91 + days included
in Service Package II
• Mental Health Services under the Medicaid
Clinic Option, Medicaid Rehab Option, and
Targeted Case Management Option
The New covered services are in Service Package
II. Home and Community Based Services (HCBS)
waiver program provide support with functional
needs. Examples of functional needs are Activities of Daily Living (ADL) and Instrumental ADL
like managing money, routine health and special
health needs. The goals of providing these
waivers are to either transition to or keep an enrollee in their home or community.
FHN is responsible for managing five HCBS
waivers:
•
•
•
•
•
Physical Disability
Traumatic Brain Injury
HIV/AIDS
Aging/Elderly (> 60 years old)
Supportive living Facility
Enrollees must meet separate eligibility criteria
as per the Department of Aging (DOA) and
the Department of Human Services/Division
of Rehabilitation (DHS/DRS). FHN has an
agreement with its subsidiary, Community
Care Alliance of Illinois (CCAI) to provide care
coordination services for the HCBS waiver
program. CCAI care coordinators will take the
lead on FHN’s enrollees who have HCBS
waivers. The enrollees remain FHN members.
Another change takes FHN to a higher level in
care coordination with the formal introduction of Interdisciplinary Care Teams (ICT).
The core members of these teams will be
the enrollee, the PCP and the RN care coordinator. This allows for the three core members and others involved in the enrollees
care to meet, and develop, and implement
To learn more about your Health Plan choices please contact Illinois Client Enrollment Services
at 1-877-912-8880 or visit www.EnrollHFS.Illinois.gov.
Family Health Network Provider News
(cont. next page)
F1279 – 10/14
Member Services 1-888-346-4968
Provider Vitals is published bi-monthly to share information
with providers as part of Family Health Network
© 2014. All rights reserved. Printed in the U.S.A.
Sarah Mahisekar, Editor
(312) 880-1660
Lourdes Reyes, RN, Vice President of Medical
Management
(312) 880-1617
Susan Oyetunde, MD, Medical Director
(312) 880-1675
Family Health Network
322 South Green St., Ste. 400
Chicago, IL 60607
SYCAMORE, IL
PERMIT NO. 42
PAID
NONPROFIT ORG.
U.S. POSTAGE
Care Coordination Responsibilities in New Contract Environment (cont. from cover)
the Individualized Care Plan or the Waiver
Service Plan. FHN’s care coordinators are
the lead on the ICT and are responsible to
ensure the care plan is communicated to the
ICT and its services are implemented. FHN’s
care coordinators will invite PCPs to review
the individualized care plan, which can be
coordinated over the telephone, in the clinic
or other appropriate settings.
There are many more details and if you need
any further information or wish to discuss
one of your FHN enrollees, please call Gloria
Hopkinson MHA, RN, Director, Care Coordination, in the FHN Medical Management department at 312-605-9867 or by email at
[email protected]
NEW!! 2014 HEDIS Incentive Add-On Bonus**
to Boost Provider Payouts:
In Quarter 3, 2014 FHN implemented a significant new HEDIS bonus initiative that rewards
providers with a separate $75.00 payment for
every care gap closed after July 1, 2014 in
eligible members for the eight HFS Pay-forPerformance measures:
• Asthma - Use of Appropriate Medications
(Long Acting Therapy) in People with Asthma
• Diabetes - Comprehensive Diabetes Care:
HbA1c Screening
• Cervical Cancer - Cervical Cancer Screening
• Initial Prenatal Visit - Within First Trimester
or 42 Days of Enrollment
• Post-Partum - Visit Within 21-56 days
Following Delivery
• Childhood Immunizations - Complete before
2nd Birthday (Combo-3 per FHN Guidelines)
• Well-Child Preventive Visits - 6+ Visits Prior
to 15 Months of Life
• Well-Child Preventive Visits - 1 Visit
Annually in Children 3-6 Years of Age
To take advantage of this incentive FHN
providers are encouraged to:
• Review monthly HEDIS Care Gap Reports
for your eligible members.
• Outreach, schedule and conduct preventive
care visits, perform essential care and
screenings.
• Submit accurate claim and encounter
data documenting care delivery via your
claims management process with FHN.
Payments on eligible incentives begin in
November, 2014 and continue monthly.
**Program is in addition to FHN Pay-forPerformance Incentive Sets #1 (HFS 1%
Withhold), #2, (Supplemental Encounter
Payments), and #3 (Care Collaboration
Incentive).
During the initial contact with a FHN OB
nurse care coordinator, all pregnant women
receive education about the FHN Brighter Beginnings enrollee incentive program. This
program allows the pregnant enrollee to earn
cash value rewards for each prenatal visit
they attend, as well as for completing her
post-partum visit within 21-56 days following
delivery. Additionally, the program provides
all eligible participants who complete the
minimum required visit schedule (based on
enrollment date and gestation), with a Graco
Pack & Play® crib, a safe sleep survival kit,
and other essential baby care items. Preliminary data from SFY 2014 show that enrollees
in the Brighter Beginnings program had a
lower incidence of very low birth weight babies (1.60%) than those who were not enrolled in the program (2.11%).
FHN has shared a successful working relationship with several key community partners, including Human Resources
Development Institute, Inc (HRDI) since November 2012. HRDI offers a voluntary program to provide social/supportive services to
FHN pregnant Enrollee and children up to age
one including services such as:
• Prenatal and post-partum depression
screening and referral
• Education on planning future pregnancies
• WIC food services
• Bus cards for doctor’s visits
• Breast-feeding education
• Information about jobs
• Emergency diapers
• Day care referrals
The number of diabetic enrollees within the
FHN network increases proportionally as
membership grows, exceeding 800 in recent
months. A high priority has been outreach to
all diabetic members with a focus on education and support for completing essential
care and screenings for 2014.
This year FHN Quality and Peer Review Committees distributed a simplified and standardized clinical practice guideline which
summarizes the annual screening and monitoring requirements for diabetic patients
(shown below). Along with this guideline, performance reports detailing missing services for
all diabetic enrollees were shared with FHN
providers in September, asking that providers
facilitate scheduling these important preventive visits before year end.
Of note, there are FIVE possible FHN incentive
bonus payments available for providers who
ensure that guideline-based diabetes care is
completed on FHN members annually. These
include:
1 VARIABLE $$ (can exceed $200.00/eligible
patient): HEDIS incentive payment from
State of Illinois HFS for compliant enrollees
in HEDIS HbA1c sample, when your percent
compliant meets goal (paid annually;
amount based on HEDIS outcomes).
2 VARIABLE $$ (can be up to $50.00/eligible
encounter): FHN Encounter Supplemental
Payment for providers who deliver and
code preventive care visits (paid monthly;
amount is equivalent to your Medicare
parity payment from FHN).
3 $50.00 Diabetes Incentive for Providers
(per eligible patient): FHN pays quarterly
to providers for completing the composite
diabetes measure (all 5 required screenings
in diabetic members each calendar year:
HbA1c, LDL, Nephropathy, Eye Exam,
Blood Pressure in Control).
4 $50.00 Diabetes Control Incentive for
Providers (per eligible patient): FHN pays
annually to providers for every diabetic
patient whose HbA1c screening result is
≤7.0 mg/dl.
5 $75.00 (per eligible patient) NEW 2014
HEDIS BONUS PAYMENT: FHN pays
monthly (beginning October 2014) for
completing outstanding HbA1c screenings
between July 1, 2014 and before end of
calendar 2014.
As you can see, FHN providers can earn more
than $400.00 per eligible diabetic Enrollee
above your fee for service reimbursement for
delivering guideline-based diabetes care and
improving member health outcomes.
Guidelines for Monitoring Type I and Type II
DIABETES MELLITUS
Perinatal Program Expansion
FHN’s Perinatal Program is targeted specifically to caring for pregnant women during
the entire perinatal period. As enrollees are
identified, an OB nurse care coordinator initiates outreach to ensure that they are assessed for potential health risks. Enrollees are
encouraged to have prenatal and post-partum visits as per ACOG standards, and to
complete an evidence-based perinatal depression screening.
Diabetes Care Guidelines
FHN works with Catholic Charities of the
Archdiocese of Chicago to provide pregnancy/maternity services free of charge including:
• 24 hour hotline
• Confidential counseling
• Assistance with arranging medical care
and community resources
• Adoption planning
• Information and referral and parenting
support education as needed, with limited
baby care items when available
• Community outreach
Providers are eligible to receive a $25.00 incentive for each initial pregnancy notification
they submit to FHN. As well, all claims/encounters for maternity visits are eligible for
FHN preventive care supplemental encounter
payments. Please direct questions regarding
the FHN Perinatal Program and incentives to
Donna Stanislawski, MS, APN, RNC-MNN,
Manager, Perinatal Care Program at
[email protected].
Screening / Monitor
Controlled HbA1c
HbA1c ≤ 8mg / dl
Meeting individual goals
HbA1c
Semi-Anually
Quarterly
LDL-C
Annually
Annually
Fasting Blood Sugar
Semi-Annually
Quarterly
Nephropathy Studies
Annually
Annually
Retinal eye examination
(dilated or digital)
At Diagnosis
Annually if positive
Bi-annually if negative
Annually if positive
Biannually if negative
Blood pressure
Semi-Annually and at Every Visit
Quarterly and at Every Visit
Foot Examination
Annually
Quarterly
At Diagnosis
As Needed
Annually
Quarterly
Annually
Annually
Uncontrolled HbA1c > 8mg/dl
Deviating from individual goals
After change in therapy
Minimum Frequency
Urine Micro / Macroalbumin
BUN / Creatinine
GFR
Neruopathy Screenings
Assessment of Self-Care
Effective Self-care management
Quality of Life
Psychosocial and Emotional Well-Being
Interdisciplinary Referrals
Self Care / Safety
It’s Flu Season
Medication Monitoring
Healthy Lifestyle
Smoking cessation
As you know, the flu season is here and it is
important to educate all your patients on
how they can prevent the spread of the flu.
Especially amongst children, senior citizens
and those with an underlying health condition
because they are easily at risk of contracting
the flu.
FHN recently began their annual flu campaign, which will run through May 2015. Patient education materials including postcards
reminding members to get the flu shot and
flyers about preventing the spread of the flu
are being shared with enrollees. If you would
like FHN Flu Prevention material, Please con-
Family Health Network Provider News
tact Elaine McLaughlin, RN, at (312) 6059808.
The importance of getting a flu shot also is
being mentioned in member newsletters and on
social media. Please encourage your patients to
get the flu shot and give everyone who is eligible to receive a shot the option.
Member Services 1-888-346-4968
Nutritionist / Dietician
Medical nutrition therapy
Physical Activity
Obesity management
Immunization Update
Family Health Network Provider News
Member Services 1-888-346-4968