Managed Health Services Blog

Beginning January 2010, members identified as high utilizers in need of specialized intervention will be enrolled into the Right Choices Program (RCP), formerly the Restricted Card Program. As RCP participants, members will be assigned to one (1) primary medical provider (PMP), one (1) pharmacy and one (1) hospital. Based on thresholds established by the State, some members will be reviewed by a clinical team at MHS and possibly placed in the RCP. The PMP will serve as the member’s primary lock-in physician and will be able to manage his or her care and coordinate service delivery. More detailed information about the RCP will be coming from your county’s designated Provider Relations Specialist.

MHS Letter to PMPs (PDF)
IHCP Provider Monthly News – RCP Article (PDF)
MHS RCP Frequently Asked Questions (FAQ) for Providers

You can also find information about the RCP in our most recent Provider Newsletters:
Provider Watch January 2010
The Communicator Winter 2010

This entry is filed under News, Providers.

In 2009 Managed Health Services’ (MHS) annual member satisfaction survey CAHPS, reflected lower ratings than anticipated for member perceptions of how well doctors communicate. Other informal surveys conducted by MHS in 2009 also identified member concerns about the effectiveness of communication during office visits. Members expressed a desire to build stronger relationships with their doctors and have better dialogue about their healthcare.

We know that in a busy office some visits may appear to be rushed or hurried to a patient. Sometimes patients may appear to understand your advice but not actually comprehend it. Here are a few proven tips that we’d like to share with you. They are taken from the article, “Improving Patient Communication in No Time”, published in Family Practice Management.

• Don’t omit the pleasantries. Smile, say hello, and sit down.
• Don’t appear rushed, even if you are. Don’t look at your watch and keep both hands off the door knob.
• Keep conversations on track. Gently guide the member back to the health matter at hand.
• Communicate with a dual purpose. When asking a patient about his or her children, also ask if they are current on their immunizations.
• Listen without interrupting. Studies show a doctor interrupts every 18 seconds. Allowing the patient to speak for three to four minutes without interruption will yield 90 percent of the reason for the visit.
• Relate with your eyes. Don’t stare at a chart or computer screen. Engage with the member.
• Manage patient expectations. Explain to patients what is realistic and discuss any expectations you have of them.
• Educate your patients at a level they can understand. One way to provide more information to your patients without a larger time commitment is to integrate patient education materials into the office visit and have a staff member go over it with them. Ensure patients have a clear understanding of any next steps before they leave the office. Ask them to recite any directions back to you to be sure the member comprehends.
• Make an extra effort to build trust. If you tell the patient you are going to call with lab results, make certain that you do just that. Doing this the first time will show your patients they can count on you.
• Empower your patients. Use a participatory model of care (i.e., the doctor serves as educator, shares in decision making and encourages patients to participate in their care).

Source: “Improving Patient Communication in No Time.” Family Practice Management, 1999, May;6(5):23–8.

This entry is filed under Blog, Members.

Updated 12/22/09

Effective December 31, 2009 the Office of Medicaid Policy and Planning will assume responsibility for the administration of the Hoosier Healthwise managed care organizations and Healthy Indiana Plan pharmacy benefits. Hewlett Packard (HP – formerly EDS) will process all outpatient pharmacy claims and manage pharmaceutical services for drugs and some drug-related medical supplies and medical devices provided by enrolled Indiana Health Coverage Programs pharmacy or durable medical equipment providers.

IHCP Provider Bulletin BT200948
MHS Pharmacy Benefit Changes Fax Blast (PDF)

Provider Manual and Quick Reference Guide
New versions of the MHS Provider Manual and Quick Reference Guide (QRG) effective 12/31/09, have been uploaded.
MHS Provider Manual
Chapter 8: Pharmacy has been replaced with Chapter 9 from the IHCP Provider Manual.
MHS Provider Quick Reference Guide

Pharmacy Preferred Drug List and Forms
Pharmacy manuals and forms are now located at the Indiana Medicaid and Indiana Pharmacy Benefits management Web sites.
Indiana Medicaid Preferred Drug List
Indiana Medicaid Pharmacy Forms

This entry is filed under News, Providers.

The State of Indiana has issued notice of an impending emergency rule change and released a corresponding provider bulletin BT200943 regarding payment of inpatient and outpatient hospital rates. The bulletin can be found on the Indiana Medicaid Web site, www.indianamedicaid.com.

In response, MHS has prepared and released a clarifying letter to Indiana hospitals:

Letter to Indiana Hospitals (PDF)

Any questions should be directed to your MHS Provider Relations Specialist at (877) 647-4848.

This entry is filed under News.

Managed Health Services (MHS) began conducting semi-formal, intermittent surveys of its members during the third quarter of 2009 in an effort to improve MHS’ Consumer Assessment of Healthplan Providers and Systems (CAHPS) member satisfaction survey ratings for 2010. Members responded to questions developed to assess their perceptions with regard to their happiness with MHS doctors, their likelihood to remain MHS members, interaction with the MHS call center, access to medical care, and outreach and counseling received on tobacco product cessation.

The results of the third quarter key provider-related questions reflected:

• •68% of MHS members are “very happy” with their MHS doctor
• •18% percent reported being “somewhat happy” with their doctor
• •36% reported using tobacco
• •43% of those who indicated current tobacco use reported being advised by their doctor to stop tobacco use or receiving information regarding cessation of tobacco use.

There are opportunities for doctors to improve patient perceptions of care received. In addition, there are opportunities to increase efforts to discuss tobacco cessation with members and offer counseling or medication options to assist members who want to quit. MHS recommends referring these members to the Indiana Quitline at 1-800-QUIT-NOW. www.indianatobaccoquitline.net/

The survey also presented members with multiple choice questions and allowed for free-form comments. Overall, member comments were positive regarding relationships with their MHS doctors and the care they receive.

When asked what aspect of their relationship with their MHS doctor members most wanted improved, the most common response was shorter wait times in doctor’s offices during an appointment and shorter timeframes to see the doctor when scheduling appointments.

As a reminder, we ask MHS doctors to schedule appointments within the Indiana Medicaid programs’ guidelines, based on the patient’s medical condition, as listed below:

MHS thanks you for your efforts to provide quality care to MHS members. Together, we can continue to improve the health of Hoosiers. If you have any questions or comments regarding the above appointment standards, please contact your MHS Provider Relations Specialist, or call us at (877) 647-4848.

This entry is filed under Blog, Providers.