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Michigan | Summer 2017

Community Plan

Practice Matters: MI – Summer 2017 Provider Services Center: 877-542-9235

Important information for health care professionals and facilities

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In This Issue...• New Campaign Seeks to Help Parents Protect

Children from Vaccine-Preventable Diseases

• Creating a Culture of Gentleness Webinar

• myHealthLine Helps Members Stay Connected

• Grants Awarded to Help Prevent and Reduce Tobacco Use

• Member Rights and Responsibilities

• Communication between PCPs and Specialists is Key to Well-Coordinated Care

• Reviews Help Ensure Members Receive Proper Care

• Get Updated Clinical Practice Guidelines

• A Member’s Right to Culturally Competent Care

• Where to Get Pharmacy Updates

• Case Management Program

We hope you enjoy this edition of Practice Matters. In this issue, you can read about a campaign to protect children from vaccine-preventable diseases, CME credit at UHC On Air Michigan, tobacco use prevention, and much more.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33681

Community Plan

Practice Matters: MI – Summer 2017 Provider Services Center: 877-542-92351

Important information for health care professionals and facilities

Creating a Culture of Gentleness WebinarUHC On Air will air a webinar called Creating Creating a Culture of Gentleness on Aug 25. Led by MORC, Inc., this one-hour presentation is designed to help care providers deepen their understanding of what a Culture of Gentleness is and how these practices can improve outcomes for members.

To access UHC On Air:1. Log in to Link and select the UHC On Air tile2. Select Michigan channel3. Scroll through video listings or use search bar to find

specific topic4. Select desired program and watch

If you aren’t registered for UnitedHealthcareOnline.com and Link, please go to UnitedHealthcareOnline.com and select New User in the top right corner.

myHealthLine Helps Members Stay ConnectedAbout six in 10 of Medicaid members say they use mobile technology to get information about their health. With that in mind, UnitedHealthcare now offers members MyHealthLine, a program that gives them the tools to take action on personal health.

New Campaign Seeks to Help Parents Protect Children from Vaccine-Preventable DiseasesMichigan, national health experts, physicians, hospitals and a private foundation have launched the I Vaccinate public health education campaign to help parents protect their children from vaccine-preventable diseases that can cause serious illnesses and even kill.

The campaign provides facts that parents need to make informed decisions about vaccinations. Vaccination is one of the best ways parents can protect infants, children and teens from 16 potentially harmful diseases. But Michigan’s childhood immunization rate is among the nation’s worst — ranking 43th lowest for children ages 19 to 35 months, according to the 2015 National Immunization Survey. Data from the Michigan Care Improvement Registry show that only 54 percent of children ages 19 to 35 months and 29 percent of teens ages 13 to 18 are up-to-date on all recommended immunizations. The Centers for Disease Control and Prevention estimates that vaccinations in the United States will prevent more than 21 million hospitalizations and 732,000 deaths among children born in the last 20 years, saving nearly $1.4 trillion in total societal costs.

Through easy access to evidence-based vaccine information, the I Vaccinate campaign strives to improve Michigan’s pediatric immunization rate to reach the Healthy People 2020 goal of 80 percent coverage (this goal includes coverage for 4 doses of Diphtheria, Tetanus, and Pertussis; 3 doses of Polio; 1 dose of Measles, Mumps, and Rubella; 3 doses of Haemophilus influenzae type b; 3 doses of Hepatitis B; 1 dose of Varicella (Chickenpox); and 4 doses of Pneumococcal Conjugate Vaccine among 19-35 month olds). Currently, the state is at 74.9 percent for this vaccine series.

UnitedHealthcare Community Plan wants care providers to inform members to use the IVaccinate.org website as a resource for information to protect Michigan children against vaccine-preventable diseases.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33682

Community Plan

Practice Matters: MI – Summer 2017 Provider Services Center: 877-542-92352

Important information for health care professionals and facilities

MyHealthLine extends the federal Lifeline benefit, a no cost mobile service program that includes device options and monthly voice, data and text services. myHealthLine provides UnitedHealthcare Community Plan members access to a smartphone, service plans and an interactive digital health application to support personal health. Clinical staff can engage directly with members using new, secure, person-to-person text capabilities. Members can subscribe to UnitedHealthcare clinical-text programs, including Tex2quit, Care4life and Text4Baby. All texts and calls don’t count against members’ minutes.

Member can apply online at uhcmyhealthline.com.

Grants Awarded to Help Prevent and Reduce Tobacco Use UnitedHealthcare Community Plan awarded $120,000 total in grants to four community organizations to support programs that prevent and reduce tobacco use and eliminate exposure to secondhand smoke.

The awardees, which each received $30,000, are: • Leaders Advancing and Helping Communities

(lahc.org/) in Dearborn and Detroit to provide more than 500 high-school students with culturally competent Botvin LifeSkills Training (LST), a research-validated substance-abuse prevention program; classes on the harmful effects of smoking for expecting mothers and their partners; and tobacco-cessation programs for other adults.

• District Health Department #10 (dhd10.org/) in Newaygo County implemented an educational campaign targeting 4,000 students and residents, as well as tobacco-cessation programs.

• Spectrum Health Foundation (give.spectrumhealth.org/) in Grand Rapids to provide tobacco-prevention education to more than 800 students in six Kent County elementary, middle and high schools.

• United Community Family Services/Chaldean American Ladies of Charity (calconline.org/) in Sterling Heights to provide tobacco and hookah prevention and cessation workshops for more than 800 children and their parents.

Tobacco use is the leading cause of preventable death in the United States. According to the 2015 America’s Health Rankings® report, more than 21 percent of Michigan residents smoke, compared with just over 18 percent nationally. About 12 percent of Michigan high school students reported smoking cigarettes. The 2016 America’s Health Rankings Health of Women and Children report showed nearly 30 percent of Michigan children from birth to age 17 live in households where someone uses cigarettes, cigars or pipe tobacco.

“Tobacco use remains a public health threat nationwide, especially in Michigan, where nearly 30 percent of children live in homes where people smoke,” said Dennis Mouras, CEO of UnitedHealthcare Community Plan of Michigan. “UnitedHealthcare is grateful for the opportunity to support these organizations that are working on the frontlines to prevent and reduce tobacco use in our communities and our homes.”

Member Rights and ResponsibilitiesAs a reminder, the UnitedHealthcare Community Plan Member Rights and Responsibilities can be found in the Provider Manual. The Provider Manual is located at UHCCommunityPlan.com/health-professionals/mi/provider-admin-manual.html. Member Rights and Responsibilities are distributed to new members upon enrollment. On an annual basis, members are referred to their handbook to review their Member Rights and Responsibilities.

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Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33683

Community Plan

Practice Matters: MI – Summer 2017 Provider Services Center: 877-542-92353

Important information for health care professionals and facilities

Communication between PCPs and Specialists Is Key to Well-Coordinated CarePrimary care physicians (PCPs) and specialists share responsibility for coordinating care and communicating essential patient information on consultations, treatment plans and referrals. Lack of communication can negatively affect quality patient care.

Relevant information from the PCP to the specialist should include the patient’s history, diagnostic tests and results, and the reason for referring the member to the specialist for a consultation. The specialist is responsible for timely communication of the results of consultations to the PCP, and ongoing recommendations and treatment plans.

Information exchange between care providers should be timely, relevant and accurate to facilitate ongoing patient management. The partnership between the PCP and specialist is based on the consistent exchange of clinical information, which is a critical factor in providing quality patient care.

Reviews Help Ensure Members Receive Proper CareUnitedHealthcare Community Plan performs concurrent reviews on inpatient stays in acute, rehabilitation and skilled nursing facilities, as well as prior authorization reviews of selected services. A listing of services requiring prior authorization is available at UHCCommunityPlan.com/health-professionals/mi/provider-admin-manual.html.

A physician reviews all cases in which the care does not appear to meet guidelines. Decisions regarding coverage are based on the appropriateness of care and service and on existence of coverage. We do not provide financial or other rewards to our physicians for issuing denials of coverage or for underutilizing services.

If a service is denied, the treating physician has the right to request a peer-to-peer discussion with the reviewing physician and a copy of the criteria used in the review.

The denial letter contains information on how to request materials and how to contact the reviewer. Members and practitioners also have the right to appeal denial decisions.

Appeals are reviewed by a physician who was not involved in the initial denial decision and is of the same or similar specialty as the requesting physician.

Get Updated Clinical Practice GuidelinesClinical Practice Guidelines are available at UHCCommunityPlan.com. UnitedHealthcare Community Plan promotes the use of nationally recognized evidence-based clinical guidelines to support care providers in making decisions about health care. Guidelines are available for diabetes, asthma, perinatal care, preventive services, Attention Deficit Hyperactivity Disorder, depression and many other conditions.

To view a complete list of the most current guidelines, go to UHCCommunityPlan.com > For Health Care Professionals > Michigan > Clinical Practice Guidelines.

Practice Matters: TX - Summer 2013 Customer Service Center: 888-362-33684

Community Plan

Practice Matters: MI – Summer 2017 Provider Services Center: 877-542-92354

Important information for health care professionals and facilities

A Member’s Right to Culturally Competent CareWe work to try to identify gaps in care related to member’s language and cultural needs. To help reduce those gaps and improve culturally competent care, we are reminding care providers that UnitedHealthcare Community Plan’s members have a right to receive care that is culturally appropriate and respects their cultural and ethnic background and origins. Upon enrollment, information regarding a member’s primary language is obtained and members may receive assistance in choosing a PCP who will meet their needs.

UnitedHealthcare Community Plan provides access to a language line for translation of communications for our non-English speaking members. The language line is available to help ensure that the cultural, ethnic and linguistic needs of our members are being met. If you need assistance in communicating with one of our members you may call customer service for assistance at 800-905-5253.

Where to Get Pharmacy UpdatesPharmacy updates are available at Link or by visiting UHCCommunityPlan.com > For Health Care Professionals > Select your Michigan > Pharmacy Program, where you can find:

• A list of covered pharmaceuticals, including restrictions and preferences

• Pharmaceutical management procedures• Explanations on limits or quotas• How to submit and support an exception request• Generic substitution, therapeutic interchange and

step-therapy protocols

If you have questions or need assistance related to pharmacy, you may call Provider Services at 877-842-3210. Remember to get a tracking number for future reference. You may also visit the website at UHCCommunityPlan.com/health-professionals/mi/pharmacy-program.html.

Case Management ProgramThe UnitedHealthcare Community Plan Case Management program is a holistic approach to care for members with complex needs, especially those with chronic conditions. The goal is to keep our members in the community with the resources necessary to maintain the highest functional status possible.

Here’s what our case managers can provide to your eligible patients:

• Telephone contact with members and home visits as needed

• Condition specific programs such as diabetic disease management and our maternity program, Healthy First Steps

• Health education and educational materials• A health assessment with stratification of diagnosis

and severity of condition and psychosocial needs• Referral to community resources as needed• Assistance with medical transportation• Arrangements for durable medical equipment and

ancillary services• Outreach to members to help them keep

appointments• Work with members to identify and address barriers

to seeking health care and following their medical treatment plan of care

For more information or to make a referral, call our referral line at 800-903-5253.

P.O. Box 2127

Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network.

Michigan

practicematters

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