Connect Archives

March 2007

Thursday, March 1, 2007

Coverage Benefits for the HPV Vaccine

Health First Network has recently been notified by the Agency for Healthcare Administration, that,
effective on and after April 1, 2007, coverage benefits for the HPV vaccine for Medicaid eligible
recipients, including HealthEase members, has changed.

Medicaid will reimburse the administration fee only for CPT 90649, human papilloma virus vaccine,
for 9-18 year olds. The vaccine is available through the Vaccine for Children Program (VFC) for
9-18 year olds. Reimbursement for CPT 90649 is $10 for physicians, $8 for ARNP and PA, and $5 for
county health departments and federally qualified health centers. Reimbursement for the vaccine and
the administration fee will continue for 19-20 year olds with CPT 90649-HA. Please follow the
commendations of the Advisory Committee on Immunization Practices for use of this vaccine for
Medicaid recipients 9-20 years old. Reimbursement is not currently available for
Medicaid recipients 21 years of age and older.

Predictive Modeling Results

Recently, representatives from Health First Network--including key leadership, physicians,
and case managers--convened to review the organization’s first round of predictive modeling
results, which included 27 months worth of data covering 25,000 patients enrolled in Medicare,
Health Ease, and Healthy Kids.

These representatives could hardly believe their eyes. “I must admit, people walked into
the room skeptical,” said Charles Brewer, Executive Director of Health First Network.
“Well, seeing is believing. The data was highly accurate, and every last one of us walked
out with the realization that predictive modeling is a legitimate and powerful tool when
it comes to health care.”

The data was broken down into two years, beginning with a base year that was analyzed to predict
who would likely become sick in the subsequent year. The second year validated whether
these predictions were on target…and, indeed, they were.

“We had cases where patients had $1,000 worth of claims, no emergency room visits, and
no hospital admissions in the base year, but were predicted to become ill and incur $25,000
worth of costs in the subsequent year,” said Brewer. “And, the data was right on. It was really
quite impressive.”

Accurate and useful data begs the question: “What next?” Well, this is the issue Health First
Network plans to tackle next. “We now know fi rsthand that predictive modeling works,” said
Brewer. “Now, we have to determine the most effective way to use this data to benefit patients
and the network.”

As a first step, Health First Network is looking into coaching models, which offer ways to approach
patients, determine the most suitable candidates, and so forth. The ultimate vision is to expand
case and disease management to include patients that are sick AND those predicted to become
ill. “Bottom line, I’d like to double our number of patients in case management […] to double
our impact by being very proactive and deliver the best care at the lowest cost,” said Brewer.

Health First Network to Present Pain Management Seminar

Pain is real. And, for some patients, it is all too real. Physicians must be prepared to help manage pain, and Health First Network wants to, in turn, offer support. Recognizing that chronic, moderate to severe pain management is an intricate subject on many levels, the organization will host a seminar “Managing Chronic Pain…Clinical, Ethical, and Lawful Solutions” on Friday, May 4, 2007, at the Andrews Institute.

This program will focus on the practical management of drug-seeking patients with an emphasis on recognizing, documenting, and treating legitimate pain, as well as effectively and safely prescribing pain medication. It will also touch on ways to develop positive relationships with pharmacists and the lawful aspects associated with pain management.

“Managing Chronic Pain…Clinical, Ethical, and Lawful Solutions” will offer CME and AAFP credits and is open to physicians, physician assistants, and nurse practitioners.

Health First Network to Send Strong Anti-Smoking Message

For a state that’s known by all as the Sunshine State, there’s certainly a black cloud hanging overhead: SMOKE! Health First Network is hoping to help remove this cloud by bringing Patrick Reynolds,
grandson of the founder of RJ Reynolds and nationally recognized anti-smoking speaker, to town. Under the theme “Breathe Life, Not Tobacco,” Reynolds will address 10,000 students and 5,000 sailors regarding the inherent risks of using tobacco.

Reynolds’ visit, scheduled for March 27, 28, and 29, comes on the heels of Florida’s voters approving a constitutional amendment to restore funding to Florida’s tobacco prevention program. This passage and events such as the Reynold’s lecture are important if Florida hopes to improve its “State of Tobacco Control Report Card,” put out by the American Lung Association.

Florida’s 2006 grades were as follows:
Smokefree Air: B
Youth Access: D
Tobacco Prevention & Control Spending: F
Cigarette Tax: F

Health First Network is pleased to join the fight against smoking, especially when it comes to kids. Watch for a follow-up story about Reynold’s visit in the next issue of Connect.

Earn CME Credits…Fast

How’s this for a way to earn CME credits over the Internet! That’s right. MECOP offers online home study courses that cover these requirements: End of Life and Palliative Care, AIDS/HIV, Prevention of Medical Errors, and Domestic Violence.

Related Links

Connect eNewsletter…Online

Good-bye paper. Hello computer. Beginning with the next issue, Health First Network will transform Connect into an electronic newsletter distributed via e-mail. So, physicians and office managers should be sure to check their e-mail inboxes instead of their mailboxes.

Welcome New Members

Health First Network would like to welcome the physicians who recently joined the Network:
• Ulrike Benny, M.D. – Pediatrics
• Jeffrey B. Comitalo, M.D. – General Surgery
• Mark Fannin, M.D. – Anesthesiology
• Jeffrey E. Friedman, M.D. – General Surgery
• Howell J. Martin, M.D. – Urology
• Terry A. Neill, M.D. – Neurology
• Odette Oliveras, M.D. – Hospitalist
• Scott A. Tezza, M.D. – Anesthesiology, Gastroenterology
• Mark A. Wehry, M.D. – Pediatric Urology