The Office of Medicaid Policy and Planning (OMPP) recently announced changes for mental health partial hospitalization coverage effective July 1, 2010. For MHS members, this service will now be provided by our partner – Cenpatico Behavioral Health (Cenpatico).

Cenpatico has prepared and mailed a letter to its Indiana provider network outlining this change.
July 1, 2010 Changes for Mental Health Partial Hospitalization Letter to Providers from Cenpatico (PDF)

OMPP has published a Bulletin (BT201019) reviewing the change: IndianaMedicaid.com Bulletins.

For questions about this benefit change, please contact Cenpatico at (877) 647-4848 or visit www.Cenpatico.com.

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Managed Health Services members, don’t be surprised if you get a new CentAccount card in the mail!

The rewards program works the same. You or your child visit the doctor for check-ups, screenings, and tests and you automatically receive rewards on a pre-paid debit MasterCard®. The difference is you don’t have to call to activate your new card. It’s ready for you to buy health-related items or to use on www.Diapers.com. You can also use it for prescription or future doctor visit co-pays. Once you get your new CentAccount card, your old Healthy Rewards card is no longer active and can’t be used.

If you need to check your balance you can call (866) 809-1091. Follow the directions when you are prompted. For all other CentAccount questions call the CentAccount information line at (877) 259-6959.

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Nationally known author, creator of ‘Thumbs Up Johnnie’ to deliver positive healthy lifestyle messages to Elkhart students Tuesday

As part of Managed Health Services’ statewide campaign to raise awareness about the dangers of childhood obesity, a nationally known cartoon character will bring a special message to students in Elkhart on Tuesday (May 18) – one that warns them about the dangers of not being active or living healthy.

Thumbs Up Johnnie is a lovable cartoon character who owns The Longhorn Diner, where all the cowboys and cowgirls in Happy, Texas, gather for the best flapjacks around. He always has his hands full, flipping flapjacks, pouring milk and coffee and catering to his customers – things he couldn’t do if he weren’t physically active and mindful about his own good personal health. The character is the creation of Michelle Bain, who motivates herself as an author to create a world where children can learn through humor and by example.

“As a child, reading fueled my imagination,” said Bain, who created Thumbs Up Johnnie in 2002. “My stories are purposely structured with multi-layered humor, double entendres and idiosyncratic characters to make story lines interesting to many different types of readers.”

Bain will read her latest book, “Super CENTEAM 5: The Adventures of Thumbs Up Johnnie,” to students at two Elkhart schools Tuesday. At 8:45 a.m., she will read to kindergarteners through second graders at Roosevelt Elementary, 201 W. Wolf. At 10:15 a.m., Bain will share her message with third- to fifth-grade students at Hawthorne Elementary, 501 W. Lusher Ave.

Thumbs Up Johnnie will make a personal appearance at each school. Students will receive autographed copies of Bain’s book, character-themed bracelets and will take part in a pre- and a post-presentation test that will be issued by their classroom teachers.

Bain’s appearances are part of the Adopt a School program sponsored nationally by Centene Corp. and in Indiana by Centene-owned Managed Health Services (MHS), one of the state’s healthcare providers for Hoosier Medicaid recipients.

“Childhood obesity is a serious health concern that is wreaking havoc on our Indiana children,” said Dr. Robert Baker, vice president of medical affairs at MHS. “The prevalence of obesity in children ages 2 through 19 has increased up to nearly 18 percent in some age groups from just 20 years ago. Today, 15 percent of Indiana youth in grades 9-12 are overweight and another 14 percent are obese. Those numbers are far too high.”

MHS is currently in the midst of raising awareness about the dangers of childhood obesity among its membership throughout the state and promoting physical activity, an increased consumption of fruits and vegetables and a decline in the time youth spend watching TV and playing video games.

Elkhart schools are actively promoting the consumption of more fresh fruits and vegetables in all schools as well, including a free fruits and vegetables program in place in its three middle schools and two high schools.

Paid for from the district’s Food Service budget, students can select among apples, peaches, pineapple, pears and mixed fruits as a morning boost and green beans, corn, mixed vegetables, peas and carrots at lunchtime or in the afternoons.

“The program is becoming more and more popular every day,” said Pam Melcher, director of food service with Elkhart Community School Corp.

The free fruit and vegetables program was implemented this year. More fresh fruits and vegetables are being offered in the district’s elementary schools as well; the program will fully expand to elementary schools next year, Melcher said.

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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. In the first quarter 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 survey results for the first quarter 2010 for key provider-related questions reflected:

• Members were highly satisfied with the MHS program and indicated they were happy with the outcome of the phone calls they placed to MHS (86%), happy with their MHS doctors (86%) and were likely to keep MHS in the future (84%).
• Members indicated their doctors were compassionate and genuinely cared about their well being. The small group of members reporting lower levels of satisfaction were unhappy with the distance they had to travel to the doctor’s office, unhappy with the wait times at the office or trying to make an appointment or unhappy because the doctor couldn’t assist them with their condition.
• Members were satisfied with the amount of time they had to wait for an appointment (88%). Overall, members indicated they could get same-day appointments (10%).
• Only three in ten members thought their visit to their doctor could have been better. The reasons most often given were long office wait times and that the doctor could have spent more time with them or could have done a better job explaining their condition and treatment plan.
• 39% of members reported using tobacco.
• 74% of those who indicated current tobacco use reported being advised by their doctor to stop tobacco use or receiving information regarding cessation.
  MHS recommends referring members who want to stop using tobacco to the Indiana Quitline at 1-800-QUIT-NOW, www.indianatobaccoquitline.net

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.

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Vaccines save lives. They protect both vaccinated individuals and entire communities by preventing the spread of infectious diseases.

National Infant Immunization Week is April 24-May 1.This year’s theme is, “Love them. Protect them. Immunize them.” The awareness campaign highlights the importance of protecting infants from vaccine-preventable diseases and celebrates the achievements of immunization programs and their partners in promoting healthy communities.

Managed Health Services, which provides affordable healthcare to more than 211,400 Hoosiers who receive health insurance through the Hoosier Healthwise program, is stressing the importance of infant and child immunizations this last week of April by encouraging members to schedule well-baby and well-child visits for their children and ensure their immunizations are current.

“Parents, healthcare providers and the media are important partners for promoting National Infant Immunization Week,” said Dr. Robert Baker, vice president of medical affairs at MHS. “These groups are all key stakeholders in ensuring children are fully immunized by two years old. The resounding message to parents on the MHS healthcare plan is to set aside 15 minutes now, schedule pediatrician and physician appointments and have their children immunized.”

Because of the success of vaccines in preventing disease in the U.S., parents are often unaware that their children are at risk for so many serious and life-threatening diseases, Baker said.

“Infants are particularly vulnerable to infectious diseases. Nearly 12,000 babies are born here each day and they will need to be immunized against 14 vaccine-preventable diseases before they reach age 2,” Baker said.

Raising awareness about the importance of infant and childhood immunizations is another step MHS is taking to get its members throughout the state to focus on living healthy lives. With a focus on infants and children, MHS hosts quarterly Health Check Health Days throughout Indiana, geared toward providing members the opportunity to complete recommended well-baby and well-child examinations. MHS reminds parents to keep their children’s immunizations up to date through birthday-card reminders and outreach calls. MHS is also in the midst of conducting Healthy Lifestyles events in several Indiana communities which offer important blood pressure, glucose and cholesterol screenings free of charge to its members.

Immunization schedules that parents can follow are posted on Managed Health Services’ Web site at www.managedhealthservices.com. Parents can visit the Web site and click on the Community Events tab to learn about Health Check Health Day and Healthy Lifestyles opportunities in their community.

MHS is headquartered in Indianapolis in the Landmark Center at 1099 N. Meridian St. MHS is a wholly-owned subsidiary of St. Louis-based Centene Corp., a leading, multi-line healthcare enterprise that offers both core Medicaid and specialty services.

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Managed Health Services’ (MHS) first Healthy Lifestyles event in 2010 was Sunday, March 28. The event took place at Emmanuel Missionary Baptist Church on Indianapolis’ East side.
MHS’ Healthy Lifestyles events are health fairs that offer health screenings and health information. There is also a cooking demonstration to show you how to cook a fun, tasty, and healthy meal! Employees from MHS are always at the events to answer any questions about the Hoosier Healthwise program, a healthcare program available to people living in Indiana. The events are always open to the community and free of charge.
On Sunday, more than 70 people had blood pressure, glucose and cholesterol screenings for free! Our healthy recipe for Sunday was a delicious salmon and spinach pasta dish with a spinach side-salad.
Keep up-to-date with MHS events.

View more pictures of MHS events on event images.

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What is HEDIS (Healthcare Effectiveness Data and Information Set)?
HEDIS is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) which allows comparison across health plans. HEDIS gives purchasers and consumers the ability to distinguish between health plans based on comparative quality instead of simply cost differences. HEDIS reporting is a required part of many State contracts. Through HEDIS, NCQA holds Managed Health Services (MHS) accountable for the timeliness and quality of healthcare services (acute, preventive, mental health, etc) delivered to its diverse membership. HEDIS consists of over 36 Effectiveness of Care type measures as well as Access to Care and Use of Services measures. These rates are calculated based on claims/encounter data and/or medical record review data. The rates are reported to NCQA and to the state if required by contract.

Why are HEDIS scores used ?
As both State and Federal governments move toward a healthcare industry that is driven by quality, HEDIS rates are becoming more and more important, not only to the health plan, but to the individual provider as well. State purchasers of healthcare use the aggregated HEDIS rates to evaluate the effectiveness of a health insurance company’s ability to demonstrate an improvement in preventive health outreach to its members. Physician specific scores are being used as evidence of preventive care from primary care office practices. These rates then serve as a basis for physician incentive programs such as pay for performance and quality bonus funds. These programs pay providers an increased premium based on their individual scoring of quality indicators such as those used in HEDIS.

How are HEDIS rates calculated?
HEDIS rates can be calculated in two ways: administrative data or hybrid data. Administrative data consists of claim or encounter data submitted to the health plan. Measures typically calculated using administrative data include: annual mammogram, annual Chlamydia screening, annual PAP test, treatment of pharyngitis, treatment of URI, appropriate treatment of asthma, cholesterol management, antidepressant medication management, access to PCP services, and utilization of acute and mental health services. Hybrid data consists of both administrative data and a sample of medical record data. Hybrid data requires review of a random sample of member medical records to abstract data for services rendered but that were not reported to the health plan through claims/encounter data. Accurate and timely claim/encounter data reduces the necessity of medical record review. Measures typically requiring medical record review include: comprehensive diabetes care, control of high-blood pressure, immunizations, prenatal care, and well-child care.

Who will be conducting the Medical Record Reviews?
MHS has contracted with MedAssurant, a national medical record review vendor, to conduct the medical record reviews on our behalf. Medical record review audits are usually conducted March through May each year. At that time, you may receive a call from an MedAssurant representative if any of your patients are selected into HEDIS samples for MHS. Your prompt cooperation with the MedAssurant representative is greatly needed and appreciated.

What about HIPAA?
As a reminder, Protected Health Information (PHI) that is used or disclosed for purposes of treatment, payment or healthcare operations is permitted by HIPAA Privacy Rules (45 CFR 164.506) and does not require consent or authorization from the member/patient. MedAssurant has signed a HIPAA compliant Business Associate Agreement with MHS which allows them to collect PHI on our behalf.

How can I make HEDIS season less stressful?
We realize early spring can be a time of increased stress in the provider office with multiple organizations requesting copies of medical records in addition to the increased incidence of sick visits. We are pleased to be able to contract with MedAssurant, who is able to offer several medical record correspondence options including confidential fax, traditional mail, or onsite review by qualified staff. These various options allow you as the provider to choose the most convenient method for your practice.

What can be done to improve my HEDIS scores?

1. Understand the specifications established for each HEDIS measure.
2. Submit claim/encounter data for each and every service rendered. Chart documentation must reflect services billed. All providers must bill (or report by encounter submission) for services delivered, regardless of contract status. Claim/encounter data is the most clean and efficient way to report HEDIS. If services are not billed or not billed accurately they are not included in the calculation. Accurate and timely submission of claim/encounter data will positively reduce the number of medical record reviews required for HEDIS rate calculation.

Who should I contact at MHS for Assistance?
If you have any questions, comments, or concerns related to the annual HEDIS project or the medical record reviews, please contact MHS Quality Improvement (877) 647-4848.

CAHPS 2010
The Consumer Assessment of Healthplan Providers and Systems (CAHPS) is a nationally administered survey overseen by the Agency for Healthcare Research and Quality (AHRQ). Per State requirement, each MCO conducts a yearly CAHPS survey. The survey allows members the opportunity to rate their satisfaction with Managed Health Services (MHS) as well as with our service providers. The survey is sent to a random sample of MHS members that meet certain requirements for continuous eligibility with MHS. Our 2010 survey will be mailed to members in March.

Members who receive the survey will rate us in eight main categories including
Rating of Health Plan, Customer Service, Getting Needed Care, Rating of PCP, Rating of Specialists, Getting Care Quickly, Communication with Physicians, and Rating of Healthcare. CAHPS scores are considered by the National Committee on Quality Assurance (NCQA) when a health plan seeks NCQA accreditation. As you know, MHS is seeking NCQA accreditation, so it will be eligible to re-bid on our State contract for 2011. CAHPS is worth 13 of the 100 possible points MHS can receive towards NCQA accreditation.

Results from the 2009 Adult Survey revealed opportunities to improve our scores for several areas, including Rating of Personal Doctor, Rating of Specialists, Getting Needed Care, Rating of the Health Plan, and Communication between members and providers. MHS internal CAHPS workgroups have developed multiple initiatives to improve MHS’ 2010 CAHPS scores.

Providers are encouraged to: ensure members are getting appropriate care and getting care quickly, ensure that members’ questions about their health are fully addressed and understood; even soliciting questions during each office visit, and ensure that members feel like they are treated with courtesy and respect by the doctors and their office staff. If a member mentions to you that they have received a CAHPS survey, please encourage them to complete it and put it in the mail. Thanks for your support.

You can also find information about HEDIS on our Quality Improvement pages.

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When MHS employees learned about The Civic Projects 50-day, 50-state civic project is in support of a non-profit that provides long-term supportive housing shelter for pregnant teens and teen mothers, Project Home Indy they knew it was a non-profit they wanted to support. Employees determined the goal would be to provide 15 items to Project Home Indy in honor of MHS’ 15th anniversary year serving the Hoosier Healthwise population. On January 28, MHS employees gave seven crib mattresses, seven baby care packages, and one check to The Civic Projects participant Kirsten L’Orange to deliver to Project Home Indy.

MHS was the second of seven stops in the day-long pick-up and delivery of much needed items for the non-profit. Kirsten began her day accepting donations from RJE Business Interiors, a full-service furniture and design company located in downtown Indianapolis. RJE Business Interiors donated office furniture, desks, chairs, bookcases and a dining room table. Other donations for Project Home Indy included new baby cribs from Plews Shadley Racher and Braun, and smoke detectors, fire extinguishers and a $2,500 gift card from The Home Depot.

“MHS admires the dedication and efforts of Tim Malcolm and Kirsten L’Orange of The Civics Projects and is grateful for the opportunity to support their initiative and assist Project Home Indy,” said MHS President and CEO Patrick Rooney. “Project Home Indy is an incredible venture to provide critically needed programs and services to pregnant teenagers and teenagers with babies and we at MHS are excited to support its cause.”

More About Project Home Indy…
Project Home Indy is an Indianapolis-based, non-profit organization that provides a nurturing residential environment that assists homeless teenage girls who are pregnant or parenting in building self-sufficiency. The organization creates opportunities to expand life skills, access healthcare and realize greater educational success. This summer, the organization began renovation on a historic home located on the campus of Trinity Episcopal Church, located at 32 E. 32nd St., to begin providing living arrangements for families later this year.

To learn more about the travels of Malcolm and L’Orange during their 50-day, 50-state journey for The Civics Projects, visit www.thecivicprojects.org.

Click on a thumbnail to view the full-size image in a new window.
Project Home Indy Employee Donation, Thursday, January 28, 2010

View more images on our event images page!

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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.

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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.

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