MD’s Corner: Obesity in the United States

Obesity poses a major public health challenge that significantly raises the risk of morbidity and is a major contributor to preventable deaths in the United States. . . read more

According to the CDC, the rate of obesity in Connecticut is 25 – 30% of all residents; the national rate is currently 34.9%.

Adults who are obese are more likely to be at risk for a number of serious medical conditions, including1:

  • Hypertension
  • Coronary heart disease
  • Type 2 diabetes
  • Stroke
  • Gallbladder disease
  • Sleep apnea
  • Certain cancers (endometrial, breast, colon, kidney, gallbladder, and liver)
  • Osteoarthritis

Obese youth are more likely to be at risk for2:

  • Heart disease
  • Type 2 diabetes
  • Sleep apnea
  • Asthma
  • Depression
  • Social discrimination
  • Low self-esteem:

Body Mass Index (BMI), a person’s weight in kilograms divided by the square of height in meters, can be used as a screening tool for obesity. All overweight and obese adults (ages 18 and up) with a BMI of ≥ 25 are considered at risk for developing associated morbidities. Individuals with a BMI of 25 to 29.9 are considered overweight, while individuals with a BMI ≥ 30 are considered obese.3

Providers are encouraged to screen for obesity at every periodic health evaluation visit. BMI calculators are available on the Centers for Disease Control and Prevention (CDC) web site; please click here to access these CDC tools. In addition to BMI, it is recommended that providers perform additional health assessments to further evaluate an individual’s health status and risks. These assessments might include blood pressure, measurement of waist circumference and relevant family history. It is important to consistently record weight and BMI in the medical record for ongoing health risk assessment and monitoring of weight loss efforts.

BMI is interpreted differently for children and adolescents. Children and adolescent’s BMI are age and gender-specific; the amount of body fat differs between girls and boys and changes with age. The CDC BMI-for-age growth charts take into account these differences and visually show BMI as a percentile ranking, click here for the CDCs data and tools on child and teen BMI. Obesity among 2-19 year olds is defined as a BMI at or above the 95th percentile of children.4 Beginning at age two (2), providers should record height, weight, and BMI percentile in the medical record as either a value (e.g, 85th percentile) or plotted on an age-growth chart during well visits.

In addition to obesity screening, it is important to include anticipatory guidance and counseling related to nutrition and physical activity during all periodic health visits. Providers should include evaluations of current eating habits, weight management (including weight loss as applicable), exercise programs, and sports participation as part of this discussion.

Providers should persuade individuals to follow a healthy diet that includes plenty of vegetables, fruits, whole grain foods, lean protein, and low fat or fat-free dairy products along with adequate water intake.5 Children and teens should be encouraged to participate in at least 60 minutes of physical activity daily. Adults should be encouraged to do at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity or a combination of both, along with two days of strength training per week.6 Both adults and children should reduce the amount of time spent on sedentary activities such as watching television, playing video games and using the internet. As part of health counseling, providers can supply their patients with educational materials and consider referral to specialist providers as appropriate.

David Wilcox, M.D.

Interim Chief Medical Officer

Community Health Network of Connecticut, Inc.

1 Centers for Disease Control and Prevention. http://www.cdc.gov/obesity/adult/causes.html

2 Centers for Disease Control and Prevention. http://www.cdc.gov/obesity/childhood/causes.html

3 Centers for Disease Control and Prevention. http://www.cdc.gov/obesity/adult/defining.html

4 Centers for Disease Control and Prevention. http://www.cdc.gov/obesity/childhood/defining.html

5 Office of Disease Prevention and Health Promotion. http://health.gov/DietaryGuidelines/

6 Office of Disease Prevention and Health Promotion. http://health.gov/paguidelines/guidelines/

Urgent Care Centers, the Alternative to Emergency Room Services

When you aren’t available, urgent care centers provide quick and easy access to quality healthcare. The HUSKY Health Program is committed to ensuring that members know where they can go to get care after normal office hours or when they have an issue which just can’t wait for an appointment. With urgent care centers coming and going so frequently, we’ve made the decision to update our listing of urgent care centers for HUSKY Health members on a quarterly basis.

Click here for the current Urgent Care Brochure and remind your patients that it’s readily available to them anytime online at www.ct.gov/husky or by calling Member Engagement Services at 1.800.859.9889. When members call, they can also follow the prompts to access our 24/7 Nurse Helpline to talk to a nurse about when to go to an urgent care center and when to go to the Emergency Department. Please also remind your patients to follow up with their PCP if they haev been to an urgent care center.

HUSKY Health 24-Hour Nurse Helpline

Remember to remind members about the HUSKY Health 24-Hour Nurse Helpline. Our nurses can provide a quick answer to health issues that don’t require immediate medical attention or a physician visit. To reach a nurse at any time, members can call 1.800.859.9889 and follow the prompts.

ICM Focus: Pre-Conception and Inter-Conception Care

The Intensive Care Management (ICM) Program’s mission is to educate and empower HUSKY members on the benefits of self-care and preventive care, with the goal of improving health and wellness. . . read more

The Healthy Beginnings Program, managed by ICM, provides coaching to HUSKY members on self-care topics related to pregnancy in an effort to improve the health of moms-to-be and promote improved birth outcomes.

HUSKY members are assessed by ICM nurses for gaps in and barriers to care, including:

  • Needs for providers/specialists
  • Knowledge deficits
  • Transportation concerns
  • Interpreter needs
  • Socioeconomic needs

Once needs are identified, ICM staff makes referrals, arranges services, and provides both education and coaching to meet those needs on an individualized basis.

To improve attendance at prenatal and post-partum appointments, the ICM staff offers appointment reminder calls, during which staff may assess any potential barriers members have with attending their appointments. If transportation or a re-schedule is needed, for example, ICM staff will help members get those needs managed.

ICM coaching includes multiple focus areas, including all of the following:

  • Pre-conception care - coaching on the importance of planning for pregnancy and ensuring that both mom and dad are as healthy as possible before having a baby
  • Routine well-care - coaching on enhanced healthcare, including PCP, dental and gynecological care
  • Inter-conception care - coaching on the health benefits of spacing pregnancies at least 18 – 24 months apart and the risks of becoming pregnant too soon

Members in the Healthy Beginnings ICM program receive a package of perinatal materials which includes a helpful checklist of topics to discuss with their providers. These materials reinforce key topics and, paired with ICM coaching, increase member participation in their own care and well-being.

For questions regarding the Healthy Beginnings Program or to make a referral to ICM, please call 800.440.5071, extension 2025, or fax a completed ICM Referral Form to 1.866.361.7242. The ICM Referral Form may be downloaded by clicking here or visiting www.ct.gov/husky. Select “For Providers,” “Provider Bulletins & Forms” then “ICM Referral Form” on the right-hand side of the page.

Telehealth Augmented Face-to-Face Visitation

The Intensive Care Management (ICM) Team is embarking on the use of new technology to expand outreach to members. New telehealth technology is being implemented to provide videoconferencing capabilities between HUSKY Health members and CHNCT’s ICM Care Managers and registered dieticians, as well as our Inpatient Discharge Care Managers (IDCMs). Telehealth videoconferencing augments our reach for face-to-face visits, minimizing both distance and barriers between parties and improving ongoing member engagement by making care management services more accessible to HUSKY Health members. . . read more

Telehealth face-to-face visits will focus on members who need additional support with understanding and following provider treatment plans. These members may have a history of not taking their medications as prescribed, not following a recommended diet, and/or may have one or more of the following diagnoses/conditions:

  • Diabetes
  • Congestive Heart Failure (CHF)
  • Coronary Artery Disease (CAD)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Asthma
  • Pregnancy/Perinatal

To participate in this new telehealth initiative, members who fit the ICM or IDCM criteria for care management services will be assessed for their access to a device which can support the technology, Wi-Fi access, and data usage without incurring additional fees. Members must demonstrate that they have the ability and motivation to participate in telehealth videoconferencing before they can begin participating.

The use of telehealth videoconferencing post-discharge will facilitate care coordination for members who are often in need of additional support and can help reduce hospital readmissions. This new technology will make care coordination services more readily accessible to members and will engage them in a way that members, both young and old, are using more and more in their daily lives.

Care Coordination in the Person-Centered Medical Home (PCMH)

Care coordination is a service many primary care practices provide for their patients; however, care coordination as required by the National Committee for Quality Assurance (NCQA) has a very specific definition for PCMH recognized practices. . . read more

The NCQA defines a PCMH at a high level as “a model of care that strengthens the physician-patient relationship by replacing episodic care with coordinated care and a long-term healing relationship... The medical home is intended to result in more personalized, coordinated, effective, and efficient care.”

What exactly is care coordination? The Agency for Healthcare Research and Quality (AHRQ) defines care coordination as “the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services.”

According to the AHRQ, the PCMH as “the primary care medical home coordinates care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Such coordination is particularly critical during transitions between sites of care, such as when patients are being discharged from the hospital. Medical home practices also excel at building clear and open communication among patients and families, the medical home, and the members of the broader care team”

The foundation of the medical home is based upon three tenets called the Triple Aim. Care coordination as a discipline is a critical factor for each aim.

Aim 1:

Improve Health Outcomes

  • Gaps in care are completed
  • Improved outreach for preventive care services
  • Medical errors are minimized
  • Enhanced efficiency and safety across the continuum of care
  • Management of total patient population

Aim 2:

Enhance Patient Experience

  • Patients are the center of the care team and are actively engaged in their own health care
  • Patients develop a personal relationship with their primary care clinician and their care team
  • Patients receive community resources to help them meet their psychosocial needs and feel supported

Aim 3:

Reduce the Cost of Care

  • Decrease the duplication of tests and services; test results are tracked
  • Reduce unnecessary procedures and services; referrals are tracked
  • Reduce risks of complications
  • Help address behavioral health conditions that can lead to multiple comorbidities
  • Reduce hospital admissions, readmissions, and Emergency Room visits; practices follow up with patients for transitional care

It’s this particular model of care which has made the State of Connecticut DSS PCMH program a success with practices and with achieving improved outcomes using the goals of the Triple Aim and the discipline of care coordination.

To learn more about the benefits of becoming a PCMH, please click here.

Person-Centered Prior Authorization

The HUSKY Health Prior Authorization (PA) process at CHNCT uses a person-centered approach by:

  1. Ensuring that HUSKY Health members receive access to medically necessary, high quality, effective and efficient services to prevent, identify, diagnose, treat, rehabilitate, or ameliorate the individual’s medical condition
  2. Establishing or modifying procedure to support provider efforts to deliver efficient, quality care and by reducing the administrative burden associated with the PA process

. . . read more

Person-centeredness is defined by HUSKY Health as:

  • Providing the member with needed information, education, and support required to make fully informed decisions about his or her care options and to actively participate in his or her self-care and care planning
  • Supporting the member, and their designated representative(s), in working together with his or her non-medical, behavioral health, and medical providers; and with Care Manager(s) to obtain necessary supports and services
  • Reflecting care coordination under the direction of, and in partnership with, the member and his/her representative(s) in a way that is consistent with his or her personal preferences, choices, and strengths; and that is implemented in the most integrated setting

When services are requested, CHNCT applies a person-centered approach by reviewing all member clinical conditions and socio-economic circumstances that may impact care. CHNCT’s PA team seeks all relevant clinical information from each appropriate source, including medical records from the treating provider, primary care provider, therapist, and/or school. Based on person-centered needs, the PA team will assess whether additional clinical services are needed and may refer to the ICM Program for care management services and for identification of community resources as needed.

Throughout the person-centered, medical necessity review process, CHNCT staff reference clinical guidelines, evidence-based utilization guidelines, and recommendations of professional societies or specialty organizations pertaining to requested services. All medical necessity decisions must conform to the state of Connecticut definition of Medical Necessity, Connecticut General Statutes Section 17b-259(b). Click here to review this statute.

During the course of the medical necessity review, the PA team conducts outreach to multiple providers, as necessary, by telephone, email, and/or fax to obtain information in support of PA requests. These efforts are made to ensure CHNCT is following HUSKY Health's person-centered approach and to avoid denials for lack of information.

The information CHNCT reviewers request may include any or all of the following:

  • Progress notes and treatment plans
  • History and physicals
  • Emergency department records
  • Admission notes
  • Physician orders
  • Laboratory and imaging studies
  • Past medical history

In an effort to reduce the administrative burden on providers that multiple requests for information can cause, HUSKY Health modified the PA workflow to ensure consistency among reviewers and to consolidate requests for additional information whenever possible.

Providers may also help to streamline the PA process by remembering and using FORM:

  • Fully complete request forms. The Outpatient Prior Authorization Request Form and the Inpatient Surgery Request Form can be downloaded from the HUSKY Health website by clicking here and selecting the desired form
  • Offer all clinical documentation to support the service at the time the request is submitted
  • Respond to requests for additional clinical information in a timely fashion
  • Medical necessity reviews result in person-centered decisions and require provider support

Prior Authorization requests may be submitted online 24/7 through Clear Coverage for the following services:

  • Inpatient admissions (Clear Coverage online submission required as of June 1, 2015)
  • Home healthcare services (Clear Coverage online submission required as of September 1, 2015)
  • Orthotic and prosthetic devices
  • Oxygen
  • Medical/surgical supplies
  • Hearing aids
  • Durable medical equipment
  • Hospital-based outpatient therapies
  • Physical, occupational, and speech therapies
  • Independent therapies

Requests may also be submitted by faxing completed forms to 203.265.3994, or providers may call 1.800.440.5071 between 8:00 a.m. and 6:00 p.m., Monday through Friday. When requests are submitted via Clear Coverage, providers can attach all supporting documentation, verify eligibility and view the status of all requests at any time.

HUSKY Health is Engaging!

Given our continued emphasis on collaboration, HUSKY Health decided to update the names of the departments which are the primary resources for both providers and members. Provider Relations is now Provider Engagement Services and Member Services is now Member Engagement Services. . . read more

HUSKY Health works with you, our provider community, and our members on a daily basis to improve the health and well-being of Connecticut residents. We are committed to the individuals and families we serve, and we serve them in partnership with you. As we focus on collaboration through engagement, it made sense to transition the names of these departments to better reflect the intent of how we work. Now, when you call us, you’ll be reminded that we are here to engage with you to address any questions or issues you may have.

Call us. Only our names have changed!

Provider Engagement Services – 1.800.440.5071

Member Engagement Services – 1.800.859.9889

Engage with us!

Provider Engagement Services is here to help you. Whether you need help supporting your members or help with the more administrative aspects of collaborating with HUSKY Health, Provider Engagement Services is available for you by phone and in-person. . . read more

We support you with your members by:

  • Locating a CMAP-enrolled PCP, specialist, sub-specialist, or ancillary provider for your HUSKY members
  • Explaining HUSKY benefits and services, including which services require prior authorization
  • Working with DSS when eligibility issues create a barrier to care
  • Contacting members with a history of missed appointments
  • Assisting when other insurance is no longer active but threatens to prevent or interrupt services, including filling prescriptions or claims payments
  • Coordinating with other services, such as behavioral health, transportation, and dental

We support your operations and practice by:

  • Supporting updates to provider profiles on the Provider Directory
  • Providing orientations to review administrative, operational, and financial interests you may have
  • Assisting with enrollment and attestation (enhanced rates) applications
  • Coordinating with the Person-Centered Medical Home, Intensive Care Management, and Prior Authorization programs
  • And much more!

The provider community is 97% satisfied with Provider Engagement Services. Call us at 1.800.440.5071 Monday – Friday, 8:00 a.m. – 6:00 p.m. You can also contact your local Provider Engagement Services Representative who would be available for an in-person visit to your practice.

HUSKY Member Engagement Escalation Unit

The HUSKY Health Member Engagement Escalation Unit (EU) is available to help when your HUSKY members have complex access-to-care issues such as locating providers, making appointments, or coordinating services with multiple providers. . . read more

The services the EU provides include:

  • Locating a hard-to-find provider or specialist your HUSKY member may need
  • Helping members who need multiple providers and appointments
  • Transitioning a member to an alternative provider when indicated
  • Connecting your member with community resources for shelter, food, clothing, utilities, and other free or low-cost services
  • Assisting with getting member medical records and any other documentation for a visit to a new provider

If you have HUSKY members who would benefit from the help of the EU, contact Provider Engagement Services at 1.800.440.5071 and ask for the Escalation Unit. You can also complete and return the Escalation Referral Form by clicking here or visiting www.ct.gov/husky, clicking “For Providers,” “Provider Bulletins and Forms” then “Escalation Referral Form” located on the right hand side of the page. Email the completed form to reachforescalation@chnct.org or fax it to 203.265.3197.

Once the referral is received, the EU will contact the member and begin to work on the request. We will keep in touch to keep you informed as your member’s issue is addressed by the EU.

Do you have patients who are new to HUSKY Health?

If so, these patients may not have an ID card yet, but they should have an eligibility letter.

Here are some ways that you can verify benefits for new members:

  • Temporary ID in the Hewlett Packard Enterprise System: Use the client name, gender and DOB to see if a temporary ID has been assigned; all temporary ID numbers start with "8."
  • Eligibility Letter: Fax the client’s eligibility letter to 1.877.413.4241 then call the Hewlett Packard Enterprise Provider Assistance Center at 1.880.842.8440 to obtain a temporary ID number.
  • Call Provider Engagement Services: We can work with DSS to expedite a patient’s application. Call us at 1.800.440.5071, Monday - Friday 8:00 am - 6:00 pm.

Avoid Payment Interruptions – Keep Your Provider Profile Up-to-Date

Have you updated your profile lately? All demographic changes for you and your practice, including additions and terminations of physicians, nurse practitioners, and physician assistants, need to be made in a timely fashion to ensure the integrity of the provider directory. These updates assist physicians and clinical staff, call center staff, and members when searching for or referring to a provider to access and coordinate care. . . read more

The accuracy of your profile may impact the payment of claims and can also affect misdirected payments, the loss of provider eligibility or the recoupment of previously paid claims.

Any changes in address, licensure, provider specialty, certification, business name or ownership, group/clinic affiliation, and Federal Employer Identification Number (FEIN) of all National Provider Identifier (NPI)/non-medical providers must be communicated to Hewlett Packard Enterprise.

The Provider Manual is located on the DSS website and provides more information about managing and updating your provider profile. You can access the DSS Provider Manual by clicking here or visiting www.ctdssmap.com, clicking “Information,” then “publications.”

Please review and update your profile by logging into the DSS Provider Portal by clicking here or by going towww.ctdssmap.com and clicking “Secure Site” on the left hand navigation menu.

You may also submit any changes, on your letterhead, by mail to:

Hewlett Packard Enterprise
P.O. Box 5007
Hartford, CT 06104

Get to Know Your Provider Engagement Services Representative – We Can Help!

The CHNCT Provider Engagement Services 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, HUSKY Health 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 Enterprise to address any and all inquiries as quickly as possible and facilitate resolutions when necessary.

The CHNCT Provider Engagement Services 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 Engagement Services representative, please call your regional contact listed below:

Nancy Esposito

203.949.4163

nesposito@chnct.org

New Haven

Katherine Sullivan

203.949.4064

ksullivan@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