MD’s Corner: The HUSKY Health Pain Management Program

Chronic pain affects millions of Americans. Over the past several decades, the use of opioid therapy to treat non-cancer pain has increased dramatically, resulting in an increase in deaths related to overdose, addiction, misuse, and diversion. In addition, the incidence of Emergency Department visits related to opiate abuse has been increasing. . . read more

The HUSKY Health Pain Management program is in development and will take a comprehensive, multi-dimensional, and multi-disciplinary approach to the safe management of chronic pain. Pain management involves a team of healthcare providers who work directly with patients and utilize a variety of assessments, interventions, and strategies. The HUSKY Health Pain Management program will offer an array of tools available to Connecticut Medical Assistance Providers (CMAP) providers for the treatment of pain and management of opioid therapy.

Provider Toolkit

A provider “toolkit” will be available on the HUSKY Health website later this fall to assist CMAP providers in the safe and effective treatment of chronic pain. The toolkit will include:

  • Pain Assessments
  • Opioid Monitoring Tools
  • Patient Contract and Agreement Templates
  • Links to Free Continuing Education Offerings
  • Links to External Pain Management Resources

Intensive Care Management (ICM) Program

Providers may refer members to the HUSKY Health Intensive Care Management (ICM) program at any time. ICM offers opportunities to improve the health status of patients with high-risk and chronic conditions through coordinated care management. Licensed Care Managers will work directly with the provider to share resources, coordinate care, and assist in making specialist referrals. To refer patients to the ICM program, providers may call 1.800.440.5071 and select the prompt for Intensive Care Management. Providers may also complete the ICM Referral Form, which can be downloaded here. Completed forms may be faxed to 1.866.361.7242.

Provider Notification Program

A provider notification program will be implemented in November 2015 for the purpose of notifying CMAP primary care providers (PCPs) about HUSKY patients who are utilizing higher levels of opioid medications than might be considered within normal limits.

Connecticut Prescription Monitoring and Reporting System (CPMRS)

The Connecticut Prescription Monitoring and Reporting System (CPMRS) is a web-based tool available to all providers with a Connecticut Controlled Substance Registration issued by the State of Connecticut, Department of Consumer Protection. The tool provides comprehensive prescription information for Schedule II through Schedule V drugs to assist providers with safely prescribing medications that have a high potential for abuse and overdose.

All Connecticut prescribers with a Connecticut Controlled Substance Registration are required to register as a user. To register, go to www.ctpmp.com and click “Register” to become a member.

Once registered, providers can access comprehensive patient controlled substance prescription records; review their own prescribing history; post alerts on particular situations or patients concerning misuse, diversion or abuse of controlled substances; and access a patient’s controlled substance history from other states.

Additional information about the CPMRS is available at: http://www.ct.gov/dcp/cwp/view.asp?q=411378.

I look forward to working with providers to ensure the safe and effective management of chronic pain for our members. Collaboration is the key to ensuring the success of the HUSKY Health Pain Management Program in reducing the inappropriate utilization of opiate medication and related emergency department visits.

Waldemar Rosario, M.D., F.A.A.P.

Senior Vice President and Chief Medical Officer

Community Health Network of Connecticut, Inc.

Living Well with Sickle Cell

Sickle Cell Disease (SCD) is the most common inherited blood disorder in the United States, affecting approximately 100,000 Americans, according to the National Institutes of Health (NIH). Our ICM Living Well with Sickle Cell program supports our HUSKY Health members living with SCD and their families. . . read more

The CHNCT ICM nurses who administer and manage the Living Well with Sickle Cell program partner with members and providers to coordinate culturally sensitive, individualized care to best manage this challenging and frequently misunderstood disease. When members are referred to ICM for this program, they receive coordinated care to address the health concerns of our adult community, as well as affected children who are still learning about what it means to live with SCD.

New Sickle Cell Training for ICM Nurses

SCD has a distinctive social history since it is known to affect certain ethnicities and regions. To better serve our members with SCD, all ICM team nurses completed recent training focused on SCD pathophysiology, treatment, research, and cultural sensitivity.

Part of the multi-disciplinary training was led by a charge nurse from the Sickle Cell Unit of the Tropical Medicine Research Institute in Jamaica, where SCD affects 1 in 300 people. Through a live stream broadcast, the charge nurse shared her unique perspective on cultural sensitivity, discussed current research, and outlined uncommon strategies that have been proven effective for individuals living with SCD in Jamaica. She stressed building a rapport with people living with the disease, focusing on individualized care, and providing education. Her approach aligned well with CHNCT’s member-centered approach and reinforced the importance of comprehensive and coordinated treatment for members with SCD. Additional SCD training for ICM nurses is planned for this fall.

Raising Awareness of SCD in Connecticut Communities

Building awareness of and sensitivity to SCD out in the community is another important component of the Living Well with Sickle Cell program. The ICM team shares information about managing SCD by highlighting important facts on Twitter and Facebook and attending events in the community. ICM strives to get out into the local community at every opportunity to distribute educational tools and to raise awareness about resources available to the public.

September is National Sickle Cell Awareness Month

Did you know? People who carry the sickle cell trait are believed to be less prone to severe forms of malaria.

On-going Education of CHNCT Staff

In addition to community outreach, ICM also focuses on raising awareness of SCD within CHNCT. The president of Citizens for Quality Sickle Cell Care attended the first CHNCT Employee Health Fair to share information with all employees.

As the administrators of the Living Well with Sickle Cell program, the ICM nurses are the internal champions for members with SCD through their work directly with those members, their providers, the Connecticut community, and within CHNCT.

Referring Members with SCD to CHNCT’s Intensive Care Management Team

You can refer members with SCD to our ICM team by:

  • Faxing the ICM Referral Form to 1.866.361.7242. Download the ICM Referral Form by clicking here; or
  • Calling 1.800.440.5071, extension 2024.

Provider Collaborative Outreach Initiative:

CHNCT’s New Approach to Assisting Practices

CHNCT, on behalf of the Department of Social Services, is offering a new format for sharing information in support of your practice’s operational, administrative, and clinical functions. . . read more

The Provider Collaborative Outreach Initiative will team CHNCT subject-matter experts with you and your staff onsite at your practice to discuss the topics of your choice. If you are interested, please call Rebecca Aldrich in Provider Relations at 203.626.7265 or email her at raldrich@chnct.org. Once Provider Relations has your request, we will coordinate with your office to arrange a time that is convenient for you and your staff.

The CHNCT team that works with your practice will consist of representatives from Provider Relations, ICM, Utilization Management, Network Management, Community Practice Transformation, Member/Provider Call Center, Prior Authorization, and Community Support Services. Provider Relations has held a number of these collaborative meetings to date and we have received great feedback from the practices so far!

Don’t delay. Contact Rebecca at 203.626.7265 or raldrich@chnct.org to start coordinating your practice’s participation with CHNCT’s Provider Collaborative Outreach Initiative.

ICD-10 Compliance Codes Are In Effect!

The ICD-10 compliance implementation date was October 1, 2015. This implementation applies to entities covered under the Health Insurance Portability and Accountability Act (HIPAA). The ICD-9 code sets for medical and inpatient procedures have been replaced with ICD-10 code sets. . . read more

There are two parts to ICD-10:

  • ICD-10-PCS inpatient procedure coding for inpatient hospital settings
  • ICD-10-CM diagnosis coding for healthcare settings

Claims submitted for dates-of-service provided on or after October 1, 2015 must be submitted with ICD-10 diagnosis codes.

For more details on submitting claims using the ICD-10 code set, please refer to DSS Provider Bulletin 2015-61.

Did You Know?

  • You can learn more about ICD-10 and find helpful resources by going to the CMS website at http://www.roadto10.org or visiting the DSS website at www.ctdssmap.com
  • You can also find the ICD-10 codes free-of-charge on the ICD-10 Centers for Medicare and Medicaide Services (CMS) website at www.cms.gov/ICD10

Missed Appointments

Community Health Network of Connecticut, Inc. (CHNCT) has implemented a program to reach out to members who are missing appointments without notice. CHNCT engages members based on information providers submit via the Member Missed Appointments Form.

When a member misses a scheduled appointment without notice, please complete and submit the Member Missed Appointments Form. You may complete this form online by logging onto the HUSKY Health Provider Portal. Completed forms may be faxed to Provider Relations at 203.265.3590, or emailed to raldrich@chnct.org.

Yearly Well-Child Visits

It’s a fact! HUSKY Health covers a yearly well-care visit for school-age children up to the age of 21.

HUSKY Health covers an annual Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) child well-care visit for children ages 3 - 21. Comprehensive well-care visits for children ages 3 - 21 are important and should be conducted annually by PCPs.

ICM’s Healthy Living with Diabetes Program

The Registered Nurses who administer CHNCT’s ICM program focus on providing care coordination and education to help HUSKY Health members with more complex health issues lead healthier lives. ICM’s Healthy Living with Diabetes program provides education, tools and resources for our members living with diabetes. . . read more

The goals of the ICM Healthy Living with Diabetes program include:

  • Addressing healthcare disparities and inequities in the diabetic population.
  • Reducing ED visits and hospitalizations due to hypoglycemia or hyperglycemia and complications of diabetes.
  • Assisting members with attribution to a PCP and/or specialist.
  • Encouraging member compliance with the prescribed treatment plan ordered by the PCP or specialist.
  • Improving member health outcomes and quality of life.

When a provider refers a member with diabetes to ICM, an Intensive Care Manager is assigned. This Care Manager will engage with the member, a dietician, Community Support Services Specialists, and the member’s healthcare team; including the PCP, and specialists. Individualized care coordination is a primary service that members receive when they are referred to ICM.

The other main component of the Healthy Living with Diabetes program is “face-to-face” visits between the member and the Care Manager. During a home visit with a member, the Care Manager assesses any barriers to care along with basic needs (including food, housing and safety), and addresses all of the following:

  • Individualized diabetes education, including S/Sx of hypo/hyperglycemia.
  • Identifying gaps in care, i.e., no attributed PCP or specialist.
  • Monitoring daily blood glucose and HbA1c test results.
  • Adhering to the prescriber’s medication regimen.
  • Creating a healthy meal plan and counting carbohydrates, with a referral to CHNCT Registered Dieticians and Certified Diabetic Educators
  • Keeping scheduled PCP and specialist appointments.
  • Symptom management of when and where to seek appropriate medical treatment.
  • Learning about physical activity and the effect on blood glucose levels.
  • Reducing the risk of complications through daily foot care, a yearly retinal exam, and biannual dental exams.

To help members achieve or maintain their heath goals, the Intensive Care Manager also coaches members on:

  • The importance of maintaining blood glucose target range.
  • Clinical education about the effects of fluctuating insulin production.
  • Medications and the different routes and ways to take them.
  • How to administer insulin injections correctly.
  • Monthly home delivery of diabetic supplies with a CMAP vendor, if needed.

The Care Manager coaches members on their treatment plans and encourages them to address any healthcare concerns with their providers. The care coordination that ICM provides to HUSKY members is, quite literally, intensive. All of these activities together result in greater collaboration between members and their providers to ensure positive health outcomes. Our members living with diabetes have to manage their health and well-being all day, every day, which is why Healthy Living with Diabetes is such a critical ICM program.

To refer members to CHNCT’s ICM program:

  • Call 1.800.440.5071 and choose extension 2024; or
  • Complete the ICM Referral Form and fax it to 1.866.361.7242.

Healthy Beginnings Program & OBP4P: Attention OB Providers!

New Cycle of OB Pay for Performance

The new Obstetrical Pay for Performance (OBP4P) program is available and you can register your practice online. This is the second cycle of HUSKY Health’s OB incentive program, which became effective June 1, 2015. If you are an OB provider and haven’t registered your practice yet, go to our Provider website on www.ct.gov/husky and login through the secure Provider Portal to enroll before time runs out. . . read more

To participate in OBP4P, you will need to:

  • Be an OB provider enrolled in the CMAP network. Provider types include family medicine physicians, obstetrician/gynecologists, obstetric or family nurse practitioners, physician assistants, and certified nurse midwives.
  • Be a registered user of the secure online Provider Portal.
  • Complete an initial practice registration form for the program.
  • Submit OB notification forms online via the HUSKY Health secure Provider Portal from June 1, 2015 through November 30, 2015.

If you have any questions about the OBP4P program, please email: obp4pquestion@chnct.org.

ICM, OBP4P and Healthy Beginnings

ICM is your OBP4P partner! When you enroll your practice in OBP4P and submit OB notifications, you are referring HUSKY members to the ICM Healthy Beginnings program and supporting their improved perinatal health outcomes. ICM contacts all members referred through provider OB notifications to provide coordinated services and care. When you participate in OBP4P, you are collaborating with ICM to increase member adherence to PCP/OB appointments, decrease ED utilization and re-hospitalization, and to provide patient-centered education about OB care.

ICM Care Managers are available to help you manage your OB HUSKY Health members in a variety of ways, including:

  • Assisting members with scheduling and keeping their 6-week postpartum appointments.
  • Improving access to appointments for your patients by minimizing missed appointments.
  • Educating members about the normal postpartum course.
  • Helping members obtain resources for breastfeeding support.

If you are dealing with any of these issues, the Healthy Beginnings ICM team will help. Call ICM any time between 8:00 a.m. and 5:00 p.m., Monday through Friday, at 1.800.440.5071, extension 2025 for assistance.

The Healthy Beginnings Program

Having a baby can be one of the happiest times in a woman’s life, but it can come with physical and emotional challenges as well. To support HUSKY members and the prescribed treatment plan from the obstetrician, ICM nurses work collaboratively with the member and her providers to increase adherence to prenatal postpartum care to improve health outcomes for both the mother and her new baby. The Healthy Beginnings program consists of a regionalized, multidisciplinary team of nurses; a lactation specialist; and a Certified Childbirth Educator.

The ICM staff receives extensive training and practices evidenced-based coaching to provide comprehensive, care coordination and education to HUSKY members during both pregnancy and the postpartum period.

For all members referred to the ICM Healthy Beginnings program, ICM staff will:

  • Provide coaching to reinforce the current plan of treatment and offer trimester-based topics.
  • Make appointment reminder calls to assess for barriers to attending perinatal appointments and minimize missed appointments.
  • Reach out after delivery to offer education on postpartum care and recovery, postpartum depression, newborn care, and lactation support.
  • Complete functional and stress assessments which include screening for depression, substance abuse and domestic violence.
  • Provide information and referrals to various Community Support Services, such as WIC, SNAP, Domestic Violence shelters/Safe Havens, Nurturing Families, and Ages and Stages.
  • Provide information on support services, such as access to a breast pump, the 24/7 Nurse Helpline, CT Behavioral Health Partnership, and transportation to their postpartum visit and other medical appointments.

As your partner working to improve perinatal care and healthy birth outcomes, ICM offers member care coordination and education. ICM has access to a wide range of resources for members and will coordinate assistance as needed for services, including translator services; culturally sensitive, in-person member support; and help with psychosocial needs through community resources.

For more information, or to make a referral, please call us at 1.800.440.5071, extension 2025.

Becoming a Person-Centered Medical Home by Participating in the Glide Path

Earn a 14% additional incentive while qualifying your practice to NCQA standards of care

. . . read more

Designed in 2011 and launched on January 1, 2012, the Glide Path program guides CMAP practices and their providers towards achieving the Department of Social Services’ (DSS) Person-Centered Medical Home (PCMH) recognition through national organizations. These independent national organizations set standards to promote better health outcomes and delivery of care. They also provide PCMH recognition to those practices that meet, or exceed, their defined standards. The National Committee of Quality Assurance (NCQA) has well-defined benchmarks and a process to follow for practices that choose to pursue PCMH recognition. A recognized DSS PCMH practice, must achieve NCQA PCMH Level 2 or 3; the Glide Path program was developed to facilitate the PCMH practice recognition process. The objectives of providing patient-centered care to PCMH national standards are enhanced patient experience and improved patient health outcomes, which in turn, decrease cost per patient.

Practices enrolled in the Glide Path program receive incentives and are identified as those practices that are investing the time and hard work required to achieve NCQA’s PCMH recognition status. When a practice commits to the 18 – 24 month Glide Path program, they will begin earning a 14% additional incentive and will also be assigned a Community Practice Transformation Specialist (CPTS). The 14% incentive payment is based on a list of primary codes. Please click here for a listing of the PCMH Enhanced Reimbursement codes.

The CPTS who will be assigned to your practice is highly experienced with the Glide Path and PCMH programs. Your CPTS will be your practice’s coach and reference throughout the program; providing assistance, resources, tools, and support through your transformation to an NCQA PCMH Recognized practice. The goal of the Glide Path program is to help your practice achieve NCQA PCMH Level 2 or 3 recognition. There is no cost for the program or the CPTS services.

NCQA PCMH Recognition validates that a practice is poised for continuous quality improvement, which leads to achievement of the “Triple Aim”: enhanced patient experience, improved patient health outcomes and decreased cost per patient.

For more information regarding the Glide Path or PCMH programs, please contact Kara Rodriguez at 203.949.4194.

Get to Know Your Provider Relations Representative – We Can Help!

CHNCT's Provider Relations staff is dedicated to working personally with your practice onsite and by phone. Our staff is on the road 4-5 days a week, visiting provider offices to discuss topics such as enrollment/attestation processes, DSS Bulletins and Policies, CHNCT policies and programs, and other important matters. . . read more

Our goal is to establish an open dialogue with you and your practice to promote positive relationships through communication, problem resolution, and education. CHNCT collaborates with our partners at DSS and Hewlett-Packard to address any and all inquiries as quickly as possible and facilitate resolutions when necessary.

The CHNCT Provider Relations staff supports and attends a number of provider conferences held throughout the state each year. When you see us at an event, please stop by to introduce yourself and we will do the same!

To set up an appointment with us or to speak with your local Provider Relations representative, please call your regional contact listed below:

Nancy Esposito

203.949.4163

nesposito@chnct.org

New Haven

Richard Genden

203.949.4064

rgenden@chnct.org

Fairfield

Kimberly Martin

203.949.4106

kmartin@chnct.org

Greater Hartford/Tolland

David Miller

203.949.4141

dmiller@chnct.org

Hartford/Litchfield

Jennie Pinette

203.949.6140

jpinette@chnct.org

Middlesex/New London/Windham

Important Contact Information

  • Behavioral Health1.877.552.8247

Monday - Friday; 8:00 a.m. - 7:00 p.m.
www.ctbhp.com

  • Dental1.888.445.6665

Monday - Friday; 8:00 a.m. - 5:00 p.m.
www.ctdhp.com

Non-Emergency

  • Medical Transportation1.888.248.9895

Monday - Friday; 7:00 a.m. - 6:00 p.m.
www.logisticare.com

  • Medical1.800.440.5071

Monday - Friday; 8:00 a.m. - 6:00 p.m.
www.ct.gov/husky

  • Member Eligibility1.800.440.5071

Monday - Friday; 8:00 a.m. - 6:00 p.m.
www.ctdssmap.com

  • Pharmacy1.800.842.8440

Monday - Friday; 8:00 a.m. - 5:00 p.m.
www.ctdssmap.com