ADMINISTRATIVE INFORMATION

Injectable/Immunization Fee Schedule Update As outlined in your market basket fee schedule, the fees for injectables and

immunizations are subject to quarterly updates. The quarterly injectables

file has been posted on the Provider Portal and will be effective November

15, 2013. Please find the Injectable Fee Schedule by selecting the Fee

Schedules link located under the Library on the Provider Portal.

2014 ClaimCheck Updates In the first quarter of 2014, HealthPartners will implement the 2014 NCCI

and ClaimCheck Edit updates. This update incorporates the changes in the

American Medical Association’s 2014 CPT and 2014 HCPCS Level II code

updates.

Make It OK You may have seen some ads on TV recently about “Make It OK.” This is a

community campaign to reduce the stigma about mental illness.

Go to www.makeitok.com to find information about things to say and

things to avoid saying when someone tells you they have a mental illness.

Silence hurts, but you can “Make It OK” to talk about mental illness.

Go to

http://www.mnvideovault.org/mvvPlayer/customPlaylist2.

php?id=25345&select_index=0&popup=yes#0 to view a 26

minute production by Twin Cities Public TV about the impact of stigma and

what you can do to eliminate it. Please watch for more information and tools

as the “Make It OK” campaign continues.

INSIDE THIS ISSUE

Administrative Page

Injectables 1 ClaimCheck Updates 1 Make It OK 1 MNsure 2 2014 MSHO Benefits 2 Important Information

HEDIS Audits 3 3

Fraud, Waste, and Abuse 4

Clinical Mental Health Hospitalization Follow Up

4

Evidence-Base Medicine Measures

4-5

Annual Monitoring Reminders 5 Clinical, Medical, DME Policy Updates

5-6

Pharmacy Updates 7-8 New Immunization Laws 9 ICSI Guidelines 9 2013 Innovation Awards 10-12 Preventive Care Screening Recognition Awards

13

Patient Perspective

Cost Estimator 13

NOVEMBER 2013

Fast Facts November 2013 2

HealthPartners Presence on the Minnesota Health Insurance Exchange, MNsure The Minnesota Health Insurance Exchange, MNsure, is now available for Individuals and Small Groups to purchase comprehensive health care coverage for 2014. Individuals, who purchase coverage through MNsure, may be eligible for an income based subsidy when purchasing their coverage. HealthPartners is offering the following Individual Commercial Products, the HealthPartners Key Individual and HealthPartners Key HSA Individual, on the Exchange. The group names for these products are:

HealthPartners Key Exchange – Group #0045 HealthPartners KEY EMP HSA EXC – Group # 0046.

These plan offerings have a smaller network of providers than regular open access plans. Reimbursement for services under these plans will be the same as your existing commercial rates. At this time, HealthPartners is not offering a Small Group plan on the exchange. To verify you are in a Member’s network of providers you can call Member Services at 1-800-883-2177 or go to link below and search under the HealthPartners Key Open Access Network. http://www.healthpartners.com/public/find-a-provider/individual/ Please note members who are qualify for Medical Assistance (Medicaid) plans may select a HealthPartners Public Programs product on MNsure and those plans are reimbursed at HealthPartners Public Programs rates, per your contract.

HealthPartners Minnesota Senior Health Options 2014 Supplemental Benefits The MSHO plan provides comprehensive coverage for seniors covered by Medicare and Medical Assistance. HealthPartners also offers supplemental benefits to MSHO members. These benefits may change each year.

The Supplemental Benefits for 2014 are as follows: Dental:

Second annual visit for cleaning and exam

Adult fluoride

Scaling and root planing

Full mouth debridement

Periodontal maintenance

Root canals on molars

Denture services: tissue conditioning

Porcelain crowns, up to $2,000

Bridges, up to $2,000

Electric toothbrush (one per lifetime)

Three replacement electric toothbrush heads

Vision: Second pair of eyeglasses

Tints and coatings on eyeglasses (applies to both pairs)

Orthotics and Medical Equipment: Second pair of orthotics and/or orthotic shoes

Light therapy lamp

Additional hearing aid set per calendar year (coverage above the basic benefit)

Up to $1,000 for home safety devices and installation (non-Elderly Waiver community members only)

In-home personal emergency response system (non-Elderly Waiver community members only)

Health and Wellness: Silver&Fit Exercise and Healthy Aging Program (health club membership or home fitness kit)

Safety/falls kits for members living in the community (one per lifetime)

10,000 Steps program with pedometer

Health education classes

Home delivery meals following an inpatient hospital stay (non-Elderly Waiver community members only)

Up to six routine foot care visits (non-Elderly Waiver community members only)

Transportation to/from supplemental benefit covered services

Fast Facts November 2013 3

HealthPartners Quality and Utilization Management Programs and Important Information Information is available for your review regarding key HealthPartners programs, policies and procedures, important member information, and other pertinent information at http://www.healthpartners.com/provider-public/ To directly access information regarding:

Quality Improvement and our Annual Evaluation on meeting our goals

Utilization Management

Quality and Utilization Management Program descriptions

Clinical Guidelines and Guideline Updates >> Click here: Quality Improvement & Utilization Management To access administrative policies including:

Medical Record Standards

Utilization Management Coverage Criteria Policies

How to Contact a Medical Director regarding UM

Member Rights & Responsibilities

Member Complaint Processes and Procedures

Access to UM Staff >> Click here: Administrative policies To access Confidentiality/Privacy policies: >> Click here: HealthPartners - Privacy & Confidentiality

Privacy Practices for Providers

Healthcare Effectiveness Data and Information Set (HEDIS) Audits HealthPartners collects data to support the quality measurement component of the Healthcare Effectiveness Data and Information Set (HEDIS). Reporting these national rates is a required part of our health plan accreditation process. In addition, HealthPartners is required to submit these rates to the Minnesota Department of Health (MDH) and Centers for Medicare & Medicaid Services (CMS). We also audit select measures on behalf of MN Community Measurement (MNCM). In order to ensure a smooth process and meet the required deadlines, please share this information with your medical records staff.

What is the timeline HealthPartners will have for HEDIS audits? HEDIS medical record reviews begin in early February and continue through March and early April. All reviews must be completed by mid-April.

Will the review always be done by an onsite review? If there are fewer than five records to review at a clinic location, HealthPartners will usually request the information via Fax

Is the HealthPartners medical record abstractor required to scan or copy records?

HealthPartners is required to participate in a HEDIS validation audit by an external audit firm. This may require us to request copies of audited medical records, receiving them by fax or having an abstractor return to your clinic within a very short timeframe; often 24 hours. If your medical record request process cannot accommodate short turnaround times, our abstractors will have a secure flash drive that can be used at the time of the audit or they could print copies of medical records to alleviate the possibility of our request in early May. Please work with the abstractor assigned to your clinic to establish the best plan for you.

Will there be additional requests for medical records after the initial medical record review?

HealthPartners pursues missing data elements from all audited medical records. If a claim indicates a service has been done at your clinic we may send additional medical record requests.

Can a clinic copy and send records (via Fax or other) instead of having someone audit onsite?

Yes, work with the HealthPartners HEDIS contact. This information will be included in the communications letter and list of members needing to be reviewed.

Who do I bill for the copies?

Providing requested records upon request is required per your provider contract. Neither copy centers nor providers can charge for these records.

Fast Facts November 2013 4

Fraud, Waste, and Abuse: Impacts the Affordability of Health Care HealthPartners is committed to preventing, detecting, and reporting Fraud, Waste, and Abuse (FWA). Fraud, waste, and abuse

adversely impacts health plans and other payers, hospitals, medical and dental groups, patients, and members. The National

Health Care Anti-Fraud Association (NHCAA) estimates a range of 3% to 10%, or $67 billion to $230 billion, of health care

spending is lost each year to fraud, waste or abuse.

HealthPartners' policy on Preventing, Detecting & Reporting Fraud, Waste & Abuse contains information on the laws and

regulations designed to combat fraud, waste, and abuse, the definitions of fraud, waste, and abuse, and ways to report your

suspicions. Examples of fraud, waste, and abuse include, but are not limited to:

Misrepresenting or misusing insurance or other identification information

Billing for services not provided or for more expensive services than were provided

Diverting controlled substances

Performing medically unnecessary services

Offering or receiving remuneration for referrals

Anyone can report possible fraud, waste, or abuse. To report suspected fraud, waste or abuse, you may call the HealthPartners

Integrity and Compliance Hotline at 1-866-444-3493, or the HealthPartners Fraud and Abuse Hotline at 952-883-5099, or send

an e-mail to reportfraud@healthpartners.com.

Please review the Preventing, Detecting & Reporting Fraud, Waste & Abuse policy at: HealthPartners Provider

Administrative Policies and share it with others within your organization who may be need to be aware of this information.

>> Feel free to call Steve Bunde, Senior Director, Integrity and Compliance at 952-883-6541 if you have any questions or concerns.

CLINICAL

Follow Up within 7 Days after Mental Health Hospitalization Follow up after mental health hospitalization presents unique complexities and patient needs. The best care transitions for hospitalized patients are achieved when:

Patients are seen by a mental health specialist within 7 calendar days of discharge.

Visits are scheduled before the patient goes home.

In order to accomplish this high quality of care, mental health providers should make space for existing patients to have follow-up visits within 7 days of discharge. Making space for new patients that need this care is also valuable. Coordination between the mental health specialist, hospital staff, and the patient’s Primary Care Provider is essential. More information about strategies to reduce readmissions is available at: http://www.rarereadmissions.org/documents/Recommended_Actions_Mental_Health.pdf

New: Comparative Evidence-Base Medicine (EBM) Measures for Specialty Care Practicing evidence-based medicine requires a good process, is important to patients/members and leads to quality health care. Comparative specialty process measures have been produced using HealthPartners claims data from 2010 – 2012 to help inform your practice on high-performance as well as target areas of opportunities for quality improvement.

Fast Facts November 2013 5

If your specialty is listed below, your group’s results are displayed if there were at least 30 unique patients for the measurement year. Technical specifications are listed for each measure.

Allergy & Immunology

Cardiology

Endocrinology Obstetrics & Gynecology

Orthopedics

Otolaryngology

Pulmonology

Rheumatology

Urology The report is available on the secure provider portal between November 15 – December 31, 2013 for review. If you have any questions about the measures, or would like to provide feedback on any of the measures please send an email to quality@healthpartners.com. To access:

Right click on the following hyperlink to open for: Secure Provider Portal for 2013 Specialty Measurement Report

1. You will be asked to logon with your secured name/password. 2. Click on “Quality” in the top green bar for a drop down box

3. Click on “Provider measurements” under the Quality and measurement

Section located on the top left side of the drop down box 4. The report will be listed in the table of contents at the top of the page.

If you don’t already have secured access to HealthPartners Provider Portal you can register at: HealthPartners

Provider Registration . Please specify you need to access the “Provider Measurements” role.

Members on ACE/ARB and Diuretics – Annual Monitoring Reminders for November 2013 In early November, HealthPartners will send letters to members on ACE/ARBs and/or diuretics who appear to be behind on annual potassium level and kidney function testing. Customized letters will be sent to commercial members on these medications who do not have a claim for these monitoring tests 1/1/13 to 8/31/13. Members are referred to their doctor’s office to make an appointment. The letter is signed by Terry Crowson, M.D., Associate Medical Director. >> If you have any questions regarding this initiative, please contact us at quality@healthpartners.com

Medical, Durable Medical Equipment (DME) & Medical Dental Coverage Policy Updates 11/15/2013 Please read this list of new or revised HealthPartners coverage policies. HealthPartners coverage policies and related lists are available online at http://www.healthpartners.com pathway: Provider/Coverage Criteria. Upon request, a paper version of revised and new policies can be mailed to clinic groups whose staff does not have Internet access. Providers may speak with a HealthPartners Medical Director if they have a question about a utilization management decision.

Medical Coverage Policies Comments / Changes

Allograft transplant for orthopedic procedures of the knee (e.g., DeNovo®NT)

New policy requires prior authorization effective immediately. This procedure is considered investigational and not covered. Prior authorization is required because a miscellaneous code is used for this procedure at this time.

Fast Facts November 2013 6

Autism Treatment – Behavioral Health Available on the HealthPartners Coverage criteria policies website on 1/1/14.

There is a new Behavioral Health policy created to define coverage criteria for Intensive Autism Treatment for members up to the age of 18 years, under the new Minnesota mandate, effective 1/1/14. This coverage policy applies to group health large group fully insured benefit plans that are subject to the Minnesota statues Section 256B.0949 (section 14). It does not apply to small group, individual plans or self-insured benefit plans. It does not apply to Medicaid plans. This criterion does not apply to speech therapy, physical therapy, and occupational therapy. Prior authorization is required for intensive levels of programmatic intervention of more than 15 hours per week. Up to six months of coverage will be authorized when medically necessary and with confirmation of adequate progress as determined by ongoing independent evaluations. In the absence of adequate progress, consideration will be given to providing coverage for alternative modalities or approaches. Prior authorization is not required for Autism services which do not total to 15 hours per week.

Birth Centers New policy for commercial products effective immediately. Prior authorization is not required.

Glaucoma treatment: minimally invasive glaucoma surgery devices

Revised policy: iStent (0191T) technology is now covered, effective immediately. Prior authorization is not required.

Implantable Vagus Nerve Stimulation (VNS)

Policy criteria revised, prior authorization continues to be required for non-covered indications. Effective immediately.

Investigational Services – List of non covered services

This policy has been updated effective 11/15/13, adding the following non covered services:

G0456 – G0457 - Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session.

Please remember that the services included on this policy will deny to either provider or member liability based on use of the GA modifier.

Speech Therapy - habilitative This policy has been revised, effective 1/1/14, to accommodate the criteria for coverage per the new Minnesota mandate for coverage of Autism treatment. Habilitative care continues to require prior authorization.

Ventricular Assist Device and Total Artificial Heart

This policy has been revised, effective immediately. Policy name has been changed from Ventricular Assist Device to Ventricular Assist Device & Total Artificial Heart. Total Artificial Heart criteria have been added for both Adult and Pediatric members. Prior authorization continues to be required.

DME Coverage Policies Comments / Changes

Eyewear for Children New policy to comply with the Affordable Care Act. Effective 01/01/14. This benefit applies to some Small Employer groups and Individual plans. Check with member Services for benefits.

Negative Pressure Wound Therapy (NPWT) Policy revised: 1. Name change (previously Vacuum-assisted wound closure

therapy (V.A.C.); 2. NPWT single use, canister free PICO® system is considered

investigational and not covered. G0456-and G0457 will be set to automatically deny depending on the GA modifier used per the Investigational Services List on Non Covered Services policy. It does not require prior authorization. Effective 1/1/14

3. Standard NPWT is covered and does not require prior authorization.

>> Contact the Medical Policy Intake line at 952-883-5724 for specific patient inquiries. >> For general policy and process questions contact 952-883-6333 or email medicalpolicy@healthpartners.com

Fast Facts November 2013 7

Medical Policy Announcements - Pharmacy

November 2013

Pharmacy Policies Intra-Articular Hyaluronan (Viscosupplements)

Revised policy and policy title change. Previously titled, “Hyaluronate”. Off-label utilization requires prior authorization from Pharmacy Administration. Coverage will only be provided for Synvisc, Synvisc One and Euflexxa. http://www.healthpartners.com/public/coverage-criteria/hyaluronate/ No prior authorization is required when used in the following manner: 1. After failure to respond to both of the following conservative therapy approaches:

a. Simple analgesics such as NSAIDs unless there is a contraindication to use, and b. Conservative nonpharmacologic therapy such as strengthening, low-impact aerobic exercises, and

neuromuscular education. 2. Repeat courses in patients with a documented response to previous intra-articular viscosupplementation and

with courses spaced at least six months apart. Prior authorization is required when injection therapy is used to treat osteoarthritis in joints other than the knee and for any other off-label use. Coverage will only be provided for Synvisc, Synvisc One and Euflexxa. No coverage will be provided for Gel-One, Hyalgan, Orthovisc, and Supartz. Claims that do not meet these standards may be denied effective 1/1/14.

Degarelix (Firmagon)

Removed policy. Prior authorization is no longer required for use.

Pertuzumab (Perjeta)

Revised policy. Updated to include new labeled indication. http://www.healthpartners.com/public/coverage-criteria/pertuzumab-perjeta/ Pertuzumab (Perjeta) is generally covered when used in combination with trastuzumab and docetaxel

(1) for treatment of patients with HER2-positive metastatic breast cancer who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease, OR

(2) as neoadjuvant treatment of patients with HER2-positive, locally advanced, inflammatory, or early stage breast cancer (either greater than 2 cm in diameter or node positive) as part of a complete treatment regimen for early breast cancer.

Recently FDA-Approved Medications Coverage Policy

Reminder that select new drugs require prior approval. http://www.healthpartners.com/public/coverage-criteria/fda-

approved-medications/

Prior authorization from Pharmacy Administration is required for newly approved, professionally-administered specialty medications. A complete and up-to-date list of drugs impacted by the policy is available on healthpartners.com at the following link. http://www.healthpartners.com/ucm/groups/public/@hp/@public/@cc/documents/documents/dev_058782.pdf As drugs are approved for use, Pharmacy Administration will identify impacted drugs. Effective dates of the prior authorization requirement for each drug will be clearly stated. This list of impacted drugs is subject to updates without further notice. Claims received without prior authorization may be denied effective 1/1/12 as this policy was published in November 2011.

Significant Formulary Updates Include:

ADHD Medications

Quantity limits are being updated to reflect FDA-approved maximum doses.

Quantity limits are being added to all controlled substances including ADHD medications, to limit excessive quantities and the risk of diversion, and to document additional monitoring for off-label doses. Limits will be updated January 1, 2014 for Commercial and Medicaid members.

For example, the daily quantity limit for Adderall XR 30mg is decreasing from #3 capsules per day to #2 capsules per day, per the FDA maximum daily dose of 60mg.

Coverage for members affected by these changes is available through December 31, 2013. These members and their providers are receiving additional communications from HealthPartners, notifying them of changes, and giving time to make changes or request authorization for the higher dose.

Higher doses will be approved when medically necessary. Required information includes evidence of monitoring (for improved response and for side effects), and an assessment of the risk of abuse and diversion.

Fast Facts November 2013 8

Pregabalin (Lyrica) Quantity limits are being added to all controlled substances including Lyrica, to reflect FDA-approved maximum doses (600mg daily for Lyrica). Lyrica is also being limited to a maximum of #3 capsules per day. Limits will be updated January 1, 2014 for Commercial and Medicaid members.

Two examples are given below:

• The daily quantity limit for Lyrica 50mg will be #3 capsules per day. Members receiving prescriptions for #6 50mg capsules each day are encouraged to use 100mg capsules.

• The daily quantity limit for Lyrica 300mg will be #2 capsules per day (600mg).

Coverage for members affected by these changes is available through December 31, 2013. These members and their providers are receiving additional communications from HealthPartners.

Higher dosages will be approved when medically necessary. Required information includes evidence of monitoring (for improved response and for side effects), and an assessment of the risk of abuse and diversion.

Nitrofurantoin

A quantity limit is being added for elderly members >= age 65, allowing up to #28 capsules per prescription. Limits will be added January 1, 2014 for Commercial and Medicaid members.

Nitrofurantoin is less effective in the elderly and in patients with renal impairment, with a risk of serious adverse events with chronic use. Additional communications have been sent to affected providers and members.

Preferred Drug List (Drug Formulary) Drug Formularies are available at www.healthpartners.com/formulary. See these sites to verify formulary status.

Quarterly Formulary Updates and additional information such as Prior Authorization and Exception Forms, Specialty Pharmacy information, pharmacy newsletters, and Pharmacy and Therapeutics (P&T) Committee policies are available at http://www.healthpartners.com/provider-public/pharmacy-services/policies-and-forms/

Pharmacy Customer Service is available to providers (physicians and pharmacies) 24 hours per day and 365 days per year:

Fax - 952-853-8700 or 1-888-883-5434. Telephone - 952-883-5813 or 1-800-492-7259.

HealthPartners Pharmacy Services, 8170 33rd Avenue South, PO Box 1309, Mpls, MN 55440.

HealthPartners Customer Service is available from 8 AM - 6 PM Central Time, Monday through Friday. After hours calls are answered by our Pharmacy Benefit Manager.

Acetaminophen combinations Providers should be aware of plans to discontinue prescriptions products with acetaminophen amounts greater than 325mg (such as Vicodin 500). The FDA announced this in January 2011, giving a 3-year notice. Drug companies have until January 14, 2014 to limit the amount of acetaminophen in oral prescription products to 325mg per dosage unit.

HealthPartners is continuing coverage for Commercial and Medicaid members until supplies are depleted. Providers are encouraged to review order sets and prescribing patterns, to minimize member impact.

» Please contact your HealthPartners Service Specialist, if you have further questions. clinical practice of your medical group. Complete copies of all ICSI Guidelines, Protocols and Order Sets are available on the ICSI

web site at (http://www.icsi.org) or call ICSI at (952) 814-7060 to obtain a hard copy.

Compounded Prescriptions HealthPartners is updating the coverage policy for compounded prescriptions, to add additional oversight of high-cost and experimental medications. Authorization will be required for compounded products that exceed $200 per prescription, starting January 1, 2014 for Commercial and State Programs.

Standard criteria will be used for reviews, based on diagnosis, products previously tried, evidence of efficacy, and medical necessity. Additional communications have been sent to affected members, providers, and pharmacies.

Pharmacy Quality Measures

Diabetic Patients with Hypertension: ACE inhibitors and ARB Medications Guidelines recommend the use of ACE inhibitors (such as lisinopril) and angiotensin II receptor blockers (ARB medications such as losartan) to control blood pressure, prevent and slow the progression of diabetic nephropathy and microalbuminuria, and slow the progression to end-stage renal disease in diabetic patients with hypertension. The use of ACE inhibitors and ARB medications in diabetic patients with hypertension is also assessed as a Medicare quality measure.

HealthPartners is sending letters to providers and members regarding the prescribing of ACE inhibitors and ARB medications to patients with diabetes and hypertension.

Providers are asked to review drug therapy in diabetic patients with hypertension, and to utilize an ACE inhibitor or an ARB medication if appropriate.

Fast Facts November 2013 9

New Immunization Laws for School, Child Care, and Early Childhood Programs On September 1, 2014, changes to the Minnesota’s Immunization Law will take effect for schools, child care, and early childhood programs. The changes were made to be more closely aligned with the current Advisory Committee on Immunization Practices (ACIP) recommendations. Medical and conscientious exemptions are still allowed under the law. New vaccines requirements include: • Hepatitis B – For all children over 2 months old enrolled or enrolling in child care or an early childhood program. • Hepatitis A - For all children over 12 months old enrolled or enrolling in child care or an early childhood program. • Tdap - For all students entering seventh grade. Students in eighth through 12th grade must show documentation if the

school requests it. This replaces the Td immunization requirement. • Meningitis (meningococcal) - For all students entering seventh grade. Students entering eighth through 12th grade must show documentation if the school requests it. The law also now includes School-Based Early Childhood Programs that provide instructional or other services to support children’s learning and development and:

Serve children from birth to kindergarten.

Meet at least once a week for at least six weeks or more during the year. These programs will follow the same requirements as child care.

>> For more detail on all the changes to the law, see the attached fact sheet or visit the MDH website at www.health.state.mn.us/divs/idepc/immunize/immrule/index.htmlt

ICSI Guidelines – New & Revised Guidelines

November 2013 Institute for Clinical Systems Improvement (ICSI) healthcare guidelines represent the most appropriate medical practice for a

range of common preventive services, chronic diseases and acute conditions.

A Health Care Protocol is a step-by-step statement of a procedure routine used in the care of individual patients to assure that the

intended effect is reliably achieved.

Order Sets are a standard set of orders for in-patient care for particular conditions.

Health Care Guidelines that have been recently developed or updated:

Depression, Adult in Primary Care

Preventative Services for Adults

Preventative Services for Children and Adolescents

Order Sets and Health Care Protocol that have been recently developed or updated:

None

Our goal in communicating these updates is to promote the use of guidelines/protocols/order sets that are based on the best available evidence. Please review the above list and determine if it is appropriate to implement some or all of them within the clinical practice of your medical group. Complete copies of all ICSI Guidelines, Protocols and Order Sets are available on the ICSI web site http://www.icsi.org at or call ICSI at (952) 814-7060 to obtain a hard copy.

Contact: Kiki Toledo, Quality Consultant, Quality Measurement and Improvement Department at (952) 883-6184 or quality@healthpartners.com

Fast Facts November 2013 10

2013 Innovation Awards Announcement Six progressive innovative approaches, aimed at improving health, patient experience, and controlling the total cost of care, received HealthPartners’ sixth annual Innovations in Health Care Award. The Innovation awards, presented at our annual Partners in Excellence dinner, had 25 diverse applicants overall. They demonstrated how the response to delivering care in our community has been and are -- innovative, continuous in rapid improvement, and deeply committed to the Triple Aim of quality outcomes, excellent patient experience and affordability. We recognize and appreciate all the efforts each of you are making in achieving the Triple Aim on behalf of our members, your patients. Full detail including contact information on the Innovation winners and all applications are available below as well as on our provider website under Partners in Quality on our provider website.

Thrifty White Pharmacy Medication Synchronization: The value of an appointment based model How many of us have family members on multiple medications and who have difficulty in keeping everything straight? Which ones need to be refilled and when? Did you know that up to 73% of patients are non-persistent to their meds over time? Thrifty White Pharmacy has developed a medication synchronization appointment model in which patients, who choose to enroll, make a single monthly trip to the pharmacy for a consultation with a pharmacist to ensure that there are no gaps in their therapy and are receiving all of their meds on the same day. In addition, there are two to three monthly calls or emails in-between these visits. 33,000 patients are now enrolled in this program. It has resulted in better communication with the care teams, 84 more days of medication per year per patient, and up to 6.1 times greater odds of adherence. >> For further information: Matt Schroeder mschroeder@thriftywhite.com

Courage Kenny Advanced Primary Care Clinic – Allina Health Maximum Health and Minimal Cost – Advanced Primary Care Clinic for Adults Living with Disabilities Patients with significant disabilities and complex health conditions may not have easy access to comprehensive medical care. Consequently, they often must use costly and non-integrated care in emergency rooms and hospitals. This not only contributes to this group of patients being in the top five percent of health care cost population but more importantly compromises their health. Courage Center Sister Kenny engineered a comprehensive primary care clinic that focused on health, not just health care, with a comprehensive care coordination component where patients take an active role in their own health. It has resulted in 50% more healthy days for those enrolled, and an average of a two-point decrease in the PHQ9 depression scale. Patient Activation Measure increased by 2.5 points in the first year. Hospital days were reduced by 71% and the 30-day readmission rate decreased by 50%. Ninety one percent of the patients would recommend the clinic to others and the patient.

>> For further information: Jennifer Thompson jennifer.thompson@couragecenter.org

Children’s Respiratory and Critical Care Specialists WICU – Well-Defined ICU Children’s Respiratory and Critical Care Specialist knew that the serious and life threatening events were being recognized and addressed. It was the less dramatic ones, the near misses, which were not being reported or not reported in a timely fashion. In order to address this issue, the intensive care group employed two college graduates to be Quality Safety Analysts (QSA). These QSAs did not have formal medical experience and were trained to make daily rounds on canvassing for safety events. Through the efforts of the QSAs, the quality safety events reporting increased fourfold. They identified 854 safety events in the first year. The staff increased their voluntary/learning reporting by 36%. These two employees were involved in 22 Quality Improvement projects including things like a safety dashboard, check lists for high-risk procedures, and a standardized protocol for securing endotracheal tubes.

>> For further information: John Stamm stamm@crccs.com

Fast Facts November 2013 11

Physicians’ Diagnostics & Rehabilitation (PDR) Cognitive Behavioral Coaching (CBC): A Common Sense, Collaborative Approach to Lowered Costs and Improved Outcomes in Chronic Neck and Back Care

Fundamental in the treatment of patients with chronic pain is to address the psychological impact as well as the biological one to ensure progress is made. Physicians’ Diagnostics and Rehabilitation Clinics (PDR) knew that Cognitive Behavioral Therapy is an effective way to address the thoughts, beliefs, and coping skills of chronic pain patients and found limited access in the community. They develop a Cognitive Behavioral Coaching (CBC) program and paired it with formal Educational Support Groups facilitated by a licensed social worker. At each visit, the patient experiences cognitive behavioral coaching with every physician or therapist. Of the first 83 patients who have gone through the program, 85% completed their full rehabilitation program. They have preliminary data to show that overall recovery for these chronic patients averaged seven out of ten on the total perceived recovery score. Patients achieved clinically significant functional improvement per their oswestry disability scores and were reported high satisfaction in their care. (Five out of five satisfaction scores)

>> For further information: Tracy Rheineck tracyr@pdrclinics.com

Allina Health Improved Opioid Prescribing: Keeping Us All Safe

We have all seen in the press and in healthcare journals the overuse or misuse of prescription opioids in the United States. It’s been called a national public health crisis. Allina Health did something about their practice of opioid prescribing. They incorporated a system that helps to guide physicians in their prescribing practice, including high dose alerts when 8 prescriptions have been written, an opioid dose converter, and a physician education program with coaching. They measured variation among their physicians, developed talking points with patients, developed and openly shared physician prescribing patterns within their practice. They also instituted in compliance with the ICSI guideline a patient controlled substance abuse agreement in which the patient knows who the back up to the prescriber is and when they can request refills.

>> For further information: Kathleen Keller kathleen.keller@allina.com

Children’s Hospital – St Paul Implementation of cue-based feeding in the stable, growing, preterm infant

One of the stressors for young families that have their growing pre-mature babies in NICUs is the desire to take them home when they seem ready but are not at their desired discharge weight. Each day that the baby is there to grow is an emotional burden to the family. Childrens Hospital – St Paul instituted cue-based feedings for babies in this situation. They measured feeding readiness using a quality scale and encouraged the baby to feed when ready rather than using a corrected gestational age benchmark. So these babies ate when ready, dictated both the time and the amount they would eat. As a result of the cue-based schedule, they were discharged two days earlier than predicted with an average cost saving of over $1,000.

>> For further information: Robyn Gizzi missjava.gizzi@gmail.com

We would like to thank our providers who submitted an Innovation. Allina Health Pap Hub: A Win for Patients, Providers and RNs >> For further information: Erica Colvin erica.colvin@allina.com

Allina Health Follow-up in Five: Preventing Readmissions >> For further information: Jana Beckering jana.beckering@allina.com

CDI Vascular Care High Quality, Patient-centered Solutions for Interventional Radiology >> For further information: Michael Cumming michael.cumming@cdirad.com

Children’s Hospitals and Clinics of Minnesota “ZAP-VAP” >> For further information: Breanna Jacobs breanna.jacobs@childrensmn.org

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Chiropractic Care of Minnesota, Inc. Functional Ability Tracking and Outcomes Program >> For further information: Renee Jernander rjernander@chirocaremn.org

Crutchfield Dermatology Critical Skill Development and Measurement Initiative >> For further information: Tim Quesnell tquesnell@crutchfielddermatology.com

HealthPartners Neurosciences Demonstrated Cost Savings within a Medical Spine Model >> For further information: Kyle Grunder kyle.j.grunder@healthpartners.com

HealthPartners Orthopaedic and Sports Medicine Open Training Room >> For further information: Ryan Larson Ryan.A.Larson@HealthPartners.com

Integrity Health Network Care Continuum Initiative Guidelines >> For further information: Bruce Penner bpenner@ihnhealth.com

Minnesota Gastroenterology, P.A. EXTREME Patient Experience Customer Service Program >> For further information: Lisa Belak lisa.belak@mngastro.com

Minnesota Gastroenterology, P.A. Pay-One-Price Colonoscopy Program >> For further information: Lisa Belak lisa.belak@mngastro.com

North Memorial Health Care — Community Paramedics Primary Care Expanded >> For further information: Peter Carlson peter.carlson@northmemorial.com

Park Nicollet Health Services Pediatric Preventive Initiative >> For further information: Erin Huberty hubere@parknicollet.com

Regions Hospital - Neurosurgery Department Vancomycin Powder Significantly Reduces Revision Surgery Rates in Posterior Spinal Surgery >> For further information: Osa X Emohare osa.x.eohare@healthpartners.com

Regions Hospital Cardiovascular Services and Emergency Medicine Low Risk Heart Failure Protocol for Early Discharge from the Emergency Department >> For further information: Chad House chad.m.house@healthpartners.com

Regions Hospital Cardiovascular Services, Emergency Medicine, and Internal Medicine

Low-risk Chest Pain Protocol >> For further information: Chad House chad.m.house@healthpartners.com

Summit Orthopedics OrthoQuick — Orthopedic Walk-in Clinic >> For further information: Paul Bruning pbruning@summitortho.com

Tria Orthopaedic Center Arthroscopic Training Program for Orthopedic Residents >> For further information: Megan Reams megan.reams@tria.com

University of Minnesota Medical Center, Fairview and University of Minnesota Amplatz Children’s Hospital Reducing Central Line Associated Blood Stream Infections (CLABSI) in Blood and Marrow Transplant Patients >> For further information: Melinda Baxter mbaxter1@fairview.org

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NEW: 2013 Preventive Care Screening Recognition Awards Announcement Partners Obstetrics & Gynecology, PA and CentraCare were presented the first-year Preventive Care Screening Recognition award at our annual Partners in Excellence dinner. They demonstrated high-performance results in preventive care improvement which address the health of the population. The Preventive Care Screening Recognition award will be open to application online for 2014. This program recognizes primary care and specialty groups that report their quality improvement initiatives and results that demonstrate significant performance improvement in four preventive care screenings as relevant to the patient population served.

Chlamydia

Breast

Colorectal

Cervical

We recognize and appreciate on behalf of our members, your patients, all the effort each of you is making in achieving the Triple Aim. Full details on applications will be available under Partners in Quality on our provider website. tool. Please contact your HealthPartners Service Specialist, if you have further questions.

PATIENT PERSPECTIVE

The cost of healthcare is a growing concern for patients today. Patients are contacting their insurance company as well as providers to determine the cost of a service prior to the service being performed. One way to help patients determine their financial responsibility for services they receive is to utilize the Claim Estimator tool available on the HealthPartners Provider Portal. This HealthPartners Claim Estimator web tool allows providers to enter a patient’s anticipated services and receive an estimate based on the information available when the request is processed (submitted services, member benefits and contractual information). Not only can providers find out how much the member responsibility may be, they can also the HealthPartners estimated payment. Some of the features include: • Professional medical claim estimation for a CMS 1500 claim

• Dental claim estimation (ADA Dental Claim)

• Summary of claim estimation results including member liability

• Capabilities to print an estimate summary

While the Claim Estimator tool is simple to use, we have created a short video for you that walks through the process of receiving a claim estimate. You can view it under the ‘Help’ section of the Provider Portal. Register now if you are new to the HealthPartners Provider Portal or contact your Site Administrator for access to this valuable tool. Please contact your HealthPartners Service Specialist, if you have further questions. If you have questions regarding the content of this newsletter, please contact the person indicated in the article or call your HealthPartners Service Specialist. If you don’t have his/her phone number, please call 952-883-5589 or toll-free at 888-638-6648. This newsletter is available on-line at healthpartners.com/provider (pathway: Log into the Provider Portal).

Fast Facts Editor:

Kim Schulte, Hospital & Regional Network Management 952-883-5843 or kimberly.a.schulte@healthpartners.com

Fast Facts Co-Editor:

Tara Sutherland, Professional Services Network Management 952-883-5657 or tara.a.sutherland@healthpartners.com