Quality resources for providers

The Quality Rating System (QRS) is a quality reporting program that compares the performance of Qualified Health Plans (QHP) offered on Exchanges and accounts for both the quality of provided healthcare services and the health plan administration. CMS calculates ratings on a 1-to-5 scale (5 is the highest) each year for eligible QHPs in all Exchanges.

The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). The Star Ratings system helps Medicare consumers compare the quality of Medicare health and drug plans being offered so they are empowered to make the best health care decisions for them. An important component of this effort is to provide Medicare consumers and their caregivers with meaningful information about quality alongside information about benefits and costs to assist them in being informed and active health care consumers.

The Centers for Medicare & Medicaid Services (CMS) developed the Medicaid and Children’s Health Insurance Program (CHIP) Scorecard to improve transparency and accountability about the administration and outcomes of these programs. States and CMS can use the Medicaid and CHIP (MAC) Scorecard to drive improvements in areas such as state and federal alignment, beneficiary health outcomes, and program administration. 

NCQA’s Health Plan Ratings include commercial, Medicare and Medicaid health plans. The overall rating is the weighted average of a plan’s HEDIS® and CAHPS® measure ratings, plus bonus points for plans with a current Accreditation status.

Quitting tobacco can be challenging, given nicotine's highly addictive nature. Supporting our members in this effort can lead to significant health improvements and prevent future health conditions. The following resources can assist you in helping members quit tobacco and maintain a tobacco-free lifestyle:

• Massachusetts Tobacco Cessation & Prevention Program (MTCP)
• New Hampshire Tobacco Prevention & Cessation Program (TPCP)
• Smokefree.gov
• Massachusetts QuitWorks Program (1-800-QUIT-NOW)
• American Cancer Society Quit For Life (1-866-QUIT-4-LIFE)
• National Cancer Institute live chat (1-877-44U-QUIT)

For questions about quitting tobacco or inquiries about prescription drug coverage for tobacco cessation, please contact Member Service.

Ramadan, a time of fasting for Muslims worldwide, will take place from Feb. 28 to March 29 this year. While fasting is typically exempt for individuals with health issues, many Muslims with chronic illnesses still choose to fast, including those with diabetes. Providers should therefore educate their patients about managing the risks fasting poses to people with diabetes, including hypo- and hyperglycemia, ketoacidosis and dehydration. Below are some tips to help you have these conversations with your patients.

About Ramadan

• Observers abstain from food, drink, and oral medications from dawn till dusk.
• Two large meals are prepared to be eaten outside of those hours: suhoor, a pre-dawn meal, and iftar, a meal at sunset.
• The elderly, children, pregnant and breastfeeding women and those with chronic conditions are typically exempt from the fasting requirements, but this will vary based on the individuals own personal and religious preferences.

Tips for providers

• Perform pre-Ramadan medical assessments of any patients you expect will fast 1-2 months before Ramadan. This will help both you and your patients decide if fasting is safe for them.
• Support your patients’ decisions and be understanding of whether patients choose to fast.
• Coach your patients on how to fast as safely as possible, including how to identify and manage complications, like hypo- and hyperglycemia, as well as whether experiencing these complications should make them reconsider their commitment to fasting this year.
• Review and adjust your patients’ medications to minimize blood sugar fluctuations.
• Work with patients to develop a Ramadan-friendly nutrition plan for balanced blood sugar.

More resources

• Clinical best practices: Recommendations for management of diabetes during Ramadan (BMJ)
• Patient education: Ramadan and Diabetes

The CDC recommends the HPV vaccine for boys and girls ages 9-12. The vaccine is crucial in preventing cancers, such as cervical, throat and anal. We want to partner with you to address these myths with evidence-based information and help your patients and our members make informed decisions.

Please feel free to display this information in your offices to ensure patients and their families have the facts they need.

Minority Health Month is a crucial time to raise awareness about health disparities affecting minority communities and recognize challenges they face in healthcare. It’s also a reminder to take action toward improving health equity and strive to bridge the gaps. We share your support of initiatives that promote the health and well-being of minorities.

By taking proactive steps and following key recommendations, we can work together to improve health outcomes for minority populations and build healthier, more equitable communities:

• Education and awareness: Stay up to date on health challenges minority communities face, such as disparities in care, higher disease rates and cultural influences on health.
• Preventive care: Continue to encourage regular check-ups and screenings for conditions like diabetes, hypertension and cancer.
• Healthcare access: Support efforts to expand healthcare services in minority communities.
• Cultural competency: Take advantage of cultural competency training WellSense offers. Training helps you understand patients’ cultural beliefs and any barriers to care these beliefs may cause.
• Community engagement: Get involved in local health events, workshops and fairs to provide resources and support for minority communities.

Improving health equity requires an ongoing commitment beyond Minority Health Month. Let’s continue working together to support better health for all.

Nicotine is highly addictive. In fact, it’s comparable to drugs like cocaine and heroin. That’s what makes quitting so challenging. Nicotine exposure during youth is especially harmful to brain development and can prime the adolescent brain for addiction to other drugs.

Quitting tobacco starts to improve a person’s health almost immediately. That’s why we encourage you to have your patients who are WellSense members take advantage of the counseling services available to them at no additional cost through QuitNow. Members just need to call toll free at (800) QUITNOW (800-784-8669). If they have questions about quitting tobacco or inquiries about prescription drug coverage for tobacco cessation, they can contact WellSense Member Service at 855-833-8128.

Resources to assist you in helping your patients quit tobacco and maintain a tobacco-free lifestyle:

• Massachusetts Tobacco Cessation & Prevention Program
• New Hampshire Tobacco Prevention & Cessation Program
• Smokefree.gov
• Become a Smokefree Teen
• E-cigarettes and Youth: What Parents Need to Know

As a trusted provider partner, we know educating your patients on risks associated with hypertension and ways to keep their blood pressure under control Is something you do every day. You cover the basics.

• Identifying and addressing barriers preventing the patient from filling their prescriptions
• Ensuring your staff repeats blood pressure  checks if the initial reading is abnormally high or low
• Retaking the measurement if blood pressure is greater than 140/90 after allowing the patient time to rest

When noting blood pressure readings in a patient’s chart, please remind your staff of the following:

• When documenting a patient-reported blood pressure, include the exact reading and date in the patient’s chart.
• Record a blood pressure CPT II code in addition to the ICD-10 code for hypertension (see chart below).
  
  

  Hypertension	ICD-10: I10
  Systolic less than 130	CPT-II: 3074F
  Systolic between 130-139	CPT-II: 3075F
  Systolic greater than/equal to 140	CPT-II: 3077F
  Diastolic less than 80	CPT-II: 3078F
  Diastolic 80-89	CPT-II: 3079F
  Diastolic greater than/equal to 90	CPT-II: 3080F
  Remote blood pressure monitoring codes	CPT: 93784, 93788, 93790, 99091
  Outpatient codes	CPT: 99201-99205, 99211-99215, 99241-99245, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99429, 99455, 99456, 99483, 99341-99345
  Telephone visits	98966-98968, 99441-99443

   

As always, thank you for partnering with us to keep your patients and our members on the path to healthy.