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2nd Quarter 2022

The CAHPS survey is currently being fielded to Medicare, Commercial and Marketplace members. Medicare members have until 6/6/2022 to complete their survey (the deadlines for Marketplace and Commercial are 4/30/2022 and 5/10/2022, respectively). As always, your passionate care and dedicated service to our members is invaluable. Read more about the specific CAHPS questions and SummaCare’s ratings here.

During measurement year 2022, members’ blood pressure control will be weighted 3x for health plans’ 2024 Medicare Star ratings. SummaCare’s Condition Management and Health Coaching programs can assist members with education, care coordination, nutritional counseling, and lifestyle behavior changes. How can you help? Use CPT II codes (in addition to Category I codes) to allow for more accurate risk stratification and enrollment into our programs, as well as reducing requests for medical record review.  

Appropriate E/M code;
and
ICD code for high blood pressure (I10-I16);
and
CPT Category II code: 
3074F (Systolic < 130 mm HG) or
3075F (Systolic 130-139 mm HG) or
3077F (Systolic >/= to 140 mm HG) or
and
3078F (Diastolic < 80 mm HG) or
3079F (Diastolic 80-89 mm HG) or
3080F (Diastolic >/= to 90 mm HG)

Formerly a stand-alone measure, Medication Reconciliation has been incorporated into the Transitions of Care (TRC) measure applicable to Star Ratings. This measure seeks to ensure that providers are administering comprehensive care to members following their hospitalization and discharge from an inpatient facility. The Med Rec sub-measure requires providers to document the reconciliation of member medications within 30 days after discharge.

Medication Reconciliation can occur during a virtual visit of any kind or an in-person visit. More details on codes and additional TRC components are available here.

As SummaCare works to continually improve our authorization requirements, we’ve recently made the decision to remove the prior authorization requirement for the current SummaCare Back Program. As a result, members no longer require prior authorization for a member referral to undergo a consultation with a spine surgeon, including orthopedic spine surgeons as well as neurosurgeons for the evaluation and treatment of low back pain. Click here to read the full memo.

SummaCare reminds and encourages members to get their preventive screenings by mailing annual preventive health letters, including education specific to certain chronic conditions. Below is a calendar of campaigns and topics that go out to our members:

January—Preventative Health and AWV/PCP Incentive
March—Diabetes Health; Quarterly Condition Management Education
May—Colorectal Cancer Screening; Diabetic Retinal Eye
June—Colorectal Fit Kits; Women’s Health Breast/Cervical Screenings; Quarterly Condition Management Education
September—Flu Vaccine; Quarterly Condition Management Education
October—Child Vaccines; Adolescent AWV/VAC
December—Quarterly Condition Management Education

Provider satisfaction is essential for achieving shared success and SummaCare is committed to focusing upon areas that are of the upmost importance to you. A recent area of focus within our online provider tool, Plan Central, has been claim denials and improving the ease of submitting a claim dispute. Plan Central is easy to use, intuitive and accessible whenever one needs to file a dispute. If you don’t yet have access, please visit summacare.com/plancentral today to begin the user registration process.

As a provider, it is important for you and your patients’ to know their Member Rights and Responsibilities. We encourage you and your SummaCare patients to read the Member Rights and Responsibilities here.

The case of Mr. Green, a recent enrollee of SummaCare’s Enhanced Support Program, is an excellent example of how this program can aid its members and their family member caregivers. Mr. Green is a 102-year-old male living in his own home. His nephew, Steve, stays to provide care for his uncle every night and Steve’s wife, Michelle, stays during the day. Together they are providing around-the-clock care. Mr. Green has no children, is wheelchair bound, sleeps in a hospital bed and is dependent for his activities of daily living (ADLs). He presents with dementia, hearing loss and has urinary incontinence with decreased output over the past few months. Steve and Michelle communicated to the program’s nurse that they were struggling with their role as Mr. Green’s caregivers. The nurse provided supportive listening and allowed Steve and Michelle to share and express their feelings related to their caregiving responsibilities. The nurse also provided resources including information on the Papa Pals program, HOMELINK and the OTC benefit. She will follow this family to continue regular assessments of Mr. Green and to provide support and navigation assistance for the family care unit. The nurse also confirmed Mr. Green’s upcoming appointment with the Center for Senior Health and spent time reviewing important questions the family may wish to discuss at the upcoming appointment.

Enrollees like Mr. Green and so many others are the primary focus of the SummaCare Enhanced Support Program. But taking that support one step further to ensure caregivers like Steve and Michelle also have the tools and education they need, results in better quality outcomes for the SummaCare members and their loved ones.

Direct referrals can be made by emailing referral information to referrals@turn-keyhealth.com

Refer Your Patients to Health Coaching

Many chronic conditions require sustained lifestyle changes in order to reduce or eliminate a patient’s health risks. Healthier choices such as smoking cessation, diet modification, increased physical activity and more all become easier for a patient with additional support. SummaCare is proud to offer free health coaching. Read more about this service here.

Looking for provider policies, resources, news and education?  Check out our Provider page on our SummaCare website!

summacare.com/providers