Connect Archives

February 2015

Wednesday, February 18, 2015

HEALTH FIRST NETWORK, INC. HAS ACHIEVED FULL URAC HEALTH NETWORK AND CREDENTIALING ACCREDITATION

Health First Network, Inc. was awarded Full Health Network and Credentialing Accreditation by URAC this past week with an on-site review of procedures, documents, and staff interviews.

Not only is this a prestigious award, but HFNI passed with a score of 100% in the 40 Core standards, and 100% in all Network and credentialing standards.

The survey on the Credentialing standards was an especially impressive accomplishment under the direction of Deborah Gant, RN, BSN, MSN Director of Health Services. This was for the first time Ms. Gant and staff took the entire credentialing process in-house. Many credentialing files were reviewed and found to meet the rigorous standards for approval by URAC.

Jenny Caillouet and staff performed outstanding services in provider relations, and contracting.

Sharon George took on all Human Resource standards, and did an exceptional job at it!

The URAC surveyor at the end of the second day in her departing conference commented on what a “Quality” organization HFNI is, and capitalized all of the staff for the hard work, knowledge, and professionalism that they bring to the organization.

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REGULATORY UPDATE

There have been several recent high-profile cases where the OIG has recovered large sums from providers based on the provider “knowingly” employed an excluded individual or contracted with an excluded entity. HFNI performs monthly reviews of the OIG exclusion data base for it employees, physicians, contractors, and vendors. The exclusion data can be queried through the link below.

The OIG has developed a Compliance 101 website to help providers become familiar with federal regulatory requirements.

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PHYSICIAN LEADERSHIP OPPORTUNITIES

We encourage our network physicians to consider becoming a part of HFNI’s leadership. If you are interested in holding office on Health First Network’s Board of Directors or serving on one of our Committees, please contact Michelle Hamilton by email at MHamilton@hfni.com.

By contributing your time and expertise to HFNI, you can promote our mission to move healthcare forward by advocating and providing high value health care delivered by quality providers with effective and integrated delivery of management services.


JENNY CAILLOUET RETIRES FROM HFNI

After 17 years of service with Health First Network, Inc., Jenny Caillouet has retired from her position as Director, Network Development/ Provider Relations.

On her decision to retire, Mrs. Caillouet said “The last seventeen years have been an incredible journey and I appreciate all the opportunities I have had as a result of my employment with this company. I look forward to watching from the sidelines as Health First Network, Inc. works towards services that will assist the provider community as well as beneficiaries under health plans in our community”.

Jenny will join her husband Clyde enjoying life as retirees. Although, Jenny’s main focus of retirement will be her two granddaughters.

The Board of HFNI and staff would like to thank Jenny for her many years of service. We wish Jenny the best in her retirement.

HFNI WELCOMES NEW STAFF MEMBER

Jackie Murph is HFNI’s new Director of Provider Relations, Network Development and Credentialing.

Jackie has twenty five years’ experience in our local health care community and has past experience working with Health First Network, Inc. Jackie’s knowledge of the Healthcare field starts at the early age of eighteen, where she grew as a leader in all areas including insurance billing, provider offices and the introduction of EMR technology.

Jackie will be responsible for recruiting healthcare providers to participate in a health insurance organization’s network of preferred providers. She will provide resources, support and direction to committee members and provider office staff. She will ensure optimal provider recruitment, education, and service, completion of plan initiatives, and the establishment of an adequate panel of providers for medical care that meets member geographic needs with cost effective contracts.

HFNI CONTRACTED PAYORS

Currently, Health First Network, Inc. is contracted with the following insurance companies:

• ACO of Northwest Florida – A Medicare Shared Savings Plan entity.
• Coventry Commercial - HFNI provides the network and credentialing.
• WellCare Medicare Advantage - HFNI provides the network and credentialing.
• HealthSpring Medicare Advantage - HFNI is responsible for the network, credentialing and some of the administrative functions relating to this product.
• Staywell Kids - HFNI provides the network and credentialing for this product.
• Humana Medicaid - HFNI provides the network and credentialing for this Managed Medical Assistance product.
• Sunshine Health - HFNI provides the network and credentialing for this specialty Medicaid product.
• Clear Health Alliance - HFNI provides the network and credentialing for this specialty Medicaid product.

If you are currently contracted with Health First Network, Inc. for these products, you do not need to sign another contract directly with the payor. If you are not contracted, but would like to be, please call Jackie Murph (HFNI, Director of Provider Relations, Network Development, and Credentialing) at 850-438-4487.


THE ROLE OF CARE COORDINATORS IN IMPROVING CARE COORDINATION

The prevalence of chronic illness and increasing life expectancy is forcing all nations to consider models of care delivery that achieve desired outcomes at affordable costs. Nearly half of all Americans live with chronic conditions. One in 4 patients with a chronic condition will see at least 3 physicians. People with chronic conditions are at high risk of poor care coordination, leading to test duplications, medical errors, and adverse health outcomes.

Promising solutions to improve care coordination include providing easy access to care when patients need it, establishing a stable relationship and effective communication between patients and their primary care practice, and using multidisciplinary care teams that include care coordinators to manage the care plan.

Using data from a 2010 survey (Commonwealth Fund International Health Policy Survey) they reported on what effects having a care coordinator, better access to primary care, and strong health care provider-patient communication have on care coordination. They found that having a care coordinator reduces the risk for all non-acute and post-acute coordination problems independent of accessible care and a strong health care provider-patient relationship. Patients with a care coordinator were less likely than patients without one to say their care was poorly organized and coordinated, their test results or medical records were not available at their scheduled appointment, they received conflicting information from different providers, someone failed to follow up about their tests results, and that information was not being shared among providers about their care.

Among hospitalized patients, those lacking a care coordinator were more likely to report that no one made arrangements for a follow-up visit with a physician after discharge and that their regular physician was not informed about the care they received while they were hospitalized or had an ER visit.

Having accessible care was also associated with lower rates of experiencing coordination gaps. At the same time, patients with a strong health care provider-patient relationship had about half the odds of experiencing coordination gaps related to medical records or repeated tests and the lack of follow-up after a hospital and or ER discharge.

The practice of medicine is changing rapidly. As the United States considers delivery and payment reforms made possible by the Affordable Care Act, it’s noticed that having care coordinators as part of the care team has drastically reduced the overuse of services, medical errors, and poor outcomes for their most complex patients.


Sited Reference: JAMA Internal Medicine.2012;172(7):587-588.

EHR REPORTING DEADLINE APPROACHING

If you are an eligible professional participating in the Medicare EHR Incentive Program, you have until February 28, 2015 to attest to demonstrating meaningful use of the data collected during your EHR reporting period for the 2014 calendar year. If you are participating in the Medicaid EHR Incentive Program, please refer to your state’s deadlines for attestation information.

The CMS Attestation System is open and fully operational, and includes the 2014 Certified EHR Technology (CEHRT) Flexibility Rule options. Medicare eligible professionals can attest any time to 2014 data until 11:59 p.m. ET on February 28, 2015.

Reminder: You must attest to demonstrating meaningful use every year to receive an incentive and avoid a Medicare payment adjustment.

Payment Adjustments
Payment adjustments were applied beginning January 1, 2015 for Medicare eligible professionals that did not successfully demonstrate meaningful use in 2013 (or 2014 for first-time participants) and did not receive a 2015 hardship exception.

Medicare eligible professionals that did not successfully demonstrate meaningful use in 2014 and do not receive a 2016 hardship exception will have payment adjustments applied beginning January 1, 2016. The application period will open in early January 2015. For more information, please review the payment adjustment tip sheet.

If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid.

If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.

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INFORMATION FROM THE CENTERS FOR DISEASE CONTRAL AND PREVENTION REGARDING MEASLES: WHAT YOU NEED TO KNOW

With the ongoing multistate measles outbreak, it is imperative to review what we know about this highly infectious but vaccine-preventable disease.

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25% DISCOUNT ON ALL GILMORE SERVICES FOR NETWORK PROVIDERS

As previously announced, we have a strategic relationship with Gilmore Services. As a valued Health First Network, Inc. member, you are immediately eligible for 25% savings on:

• Document Shredding
• Secure Document Storage
• Retention Management
• Records Compliance
• Document Imaging
• Commercial Moving

To find out more about this offer follow the link below and find out how professional document management can help you save time, money and resources, while elevating your compliance processes.

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NEW PHYSICIANS JOINING THE NETWORK

Health First Network. Inc. would like to welcome the most recent physicians to join the Network:

Julia Lagow, D.O. OB/GYN
Heidi Barker, D.O. Pediatrics
Matthew Steiner, M.D. Pediatric Cardiology

To determine which health plans each physician is participating in check the “Find A Doctor” section on the HFNI website.

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