thecompassMichigan | March 2016

Community Plan

The Compass: MI - March 2016

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In This Issue...• Blood Lead Screen and Management

• Michigan Quality Improvement ConsortiumClinical Practice Guideline Update

• Human Papillomavirus Vaccination Report: Michigan

• Human Papillomavirus Vaccine Effectiveness

• Cervical Screening Criteria

• Colorectal Cancer Awareness Tool Kit

• Receive HEDIS Reports by Email

• Automated Messages May Encourage Preventive Care

• Earn Rewards with Health Michigan Plan HRAs

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BLL >5 ug/dLChildren with capillary results of 5 ug/dL and higher must have a confirmatory venous blood draw. Families should receive guidance, nutrition counseling, instruction on safe cleaning techniques and appropriate follow-up care.

In-home services, including case management and environmental investigations, are available for children with lead levels greater than 5 ug/dL. Please refer these patients to the Genesee County Health Department for these services.

Children with confirmed venous testing results greater than 5ug/dL within the past 18 months must be retested based on Medicaid policy and AAP guidelines or as soon as possible.

BLL > 44 ug/dLChildren with capillary results of 5 ug/dL and higher must have a confirmatory venous blood draw. Lead levels over 44 ug/dL may require hospitalization. Consult with an expert for additional guidance.

Families should receive guidance, nutrition counseling, instruction on safe cleaning techniques and appropriate follow-up care. In-home services including case management and environmental investigations are available for all children with lead levels greater than 5 ug/dL.

Children with confirmed venous testing results greater than 5ug/dL within the past 18 months must be retested based on Medicaid policy and AAP guidelines or as soon as possible.

Reminder: All children covered by Michigan Medicaid must be tested at age 1 and older or before age 2.

Source: Genesee County Health Department., Retrieved from: http://www.gchd.us/flint_drinking_water_resources.php

Blood Lead Screening and ManagementAs a primary care provider, you play a critical role in caring for children and families exposed to lead and managing the potential health impacts of lead poisoning. You have the unique opportunity to identify early symptoms and provide needed testing. Following are some reminders to support your efforts.

Identifying SymptomsChildren suffering from lead poisoning don’t always show outward symptoms. However, early clinical symptoms can include anemia, anorexia, abdominal pain and constipation. And since lead is a neuro-toxin, exposure can result in violent and aggressive behavior, learning disorders, cause Attention Deficit Hyperactivity Disorder (ADHD) and even affect reduce IQ by as many as 5-8 points.

The blood half-life of lead is approximately one month but the bone half-life can extend to decades.

Guidelines for blood lead levelsBLL < 5 ug/dLA lead level of less than 5 mcg/dL is not typically cause for concern. Provide education and guidance to help ensure lead levels do not rise. Consider retesting in 12 months based on risk factors or concerns.

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Michigan Quality Improvement Consortium Clinical Practice Guideline UpdateIn January, the Michigan Quality Improvement Consortium released changes to the Primary Care Diagnosis and Management of Adults with Depression guideline. Please refer to the complete guideline for all updated recommendations. http://mqic.org/pdf/mqic_primary_care_diagnosis_and_management_of_adults_with_depression_cpg.pdf

Clinical Guidelines for Children Special Health Care Services Following are links to nationally recognized clinical practice guidelines for conditions that may be found in members receiving Children Special Health Care Services:

• Bipolar Disorder Children and Adolescents: AmericanAcademy of Child and Adolescent Psychiatry http://www.jaacap.com/article/S0890-8567(09)61968-7/pdf

• Hemophilia and von Willebrand Disease: NationalHeart Lung and Blood Institute: http://www.nhlbi.nih.gov/guidelines/vwd/vwd.pdf

• Sickle Cell Disease, National Heart Lung and BloodInstitute: https://www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/sickle-cell-disease-report.pdf

Human Papillomavirus Vaccination Report: MichiganIt is estimated that up to 93% of cervical cancers could be prevented by the Human Papillomavirus (HPV) vaccination and cervical cancer screening. HPV vaccination helps prevent infection from the types of HPV that cause most cervical cancers.

The HPV vaccination is recommended for adolescents ages 11-12. Nationally, HPV vaccination coverage lags behind other adolescent vaccination coverage estimates and remains far below Healthy People 2020 targets of 80% coverage.

69 National Cancer Institute (NCI) cancer centers recently issued a joint statement to endorsing HPV vaccination as a cancer prevention measure. Find this statement and other information at: https://www.mdanderson.org/content/dam/mdanderso n/documents/prevention-and- screening/NCI_HPV_Consensus_Statement_012716.pdf.

The Michigan Department of Health and Human Services recommends some of the strategies below to increase HPV vaccine coverage rates:

• Arm patients with information on how the HPVvaccine can reduce the incidence of cervical cancer.

• Include HPV vaccine education as part of otherregularly scheduled immunizations.

• Provide parents with resources on HPV vaccination.You can find tips at uhccommunityplan.com/MIKids.

• Consider adding HPV education to your on-holdmessages. You can find samples here: http://www.cdc.gov/vaccines/who/teens/for-hcp/adolescent-messaging.html

• Participate in AFIX (Assessment, Feedback,Incentives, and eXchange) visits. For moreinformation, visit http://www.cdc.gov/vaccines/programs/afix/index.html?s_cid=cs_748.

• Collaborate with your health plan or communitypartners on ways to increase HPV vaccination.

• Learn more about national initiatives suchas the National HPV Vaccination Roundtableat: http://www.cancer.org/healthy/informationforhealthcareprofessionals/nationalhpvvaccinationroundtable/i ndex.

Source: Michigan Department of Health and Human Services, http://www.michigan.gov/mdhhs/0,5885,7- 339-71550_2955_2975_65691---,00.html

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HPV Vaccine EffectivenessOver the past decade, the HPV vaccine has reduced the virus’s prevalence in teenage girls by almost two-thirds. Women in their early 20s, a group with lower vaccination rates, the most dangerous strains of human papillomavirus, or HPV, have also been reduced by more than a third.

Despite the vaccine’s proven effectiveness, immunization rates remain low — about 40 percent of girls and 20 percent of boys between the ages of 13 and 17. That is partly because of the implicit association of the vaccine with adolescent sexual activity, rather than with cancer prevention. Only three states require the vaccine, Michigan does not.

About 14 million Americans become infected with HPV each year, and the vast majority will clear the virus. But some strains persist and can cause genital warts, as well as cervical, anal, penile, and mouth and throat cancers. The American Cancer Society estimates that in the United States, more than 4,000 women will die of cervical cancer in 2016.

There are several obstacles to greater coverage rates, including the fact that the vaccine is given in three doses. An immunization advisory committee to the CDC is convening to learn more about the efficacy of the lower dose.

Studies show that many primary care providers either do not recommend the vaccine to parents and patients or do so halfheartedly. They may instead want to use their limited appointment time for health topics that parents may be more willing to engage in.

Dozens of cancer centers endorse the HPV vaccine as a safe, effective prevention strategy against types of cancer that result in 27,000 cases a year. The latest HPV vaccine protects against nine strains of the virus. Many doctors are pressing for primary care providers to strongly recommend the HPV vaccine.

Sources: New York Times article, Jan Hoffman, author, Feb. 22, 2016, Retrieved from: http://www.nytimes.com/2016/02/22/health/vaccine-has- sharply-reduced-hpv-in-teenage-girls-study-says.html?_r=0Michigan Cancer Consortium, March 2016 newsletter, Retrieved from: http://files.ctctcdn.com/6d972e83401/a7e0e5e8-86c2- 43db-9943-72315bc3fb44.pdf

Cervical Screening CriteriaHEDIS Cervical Cancer Screening CriteriaThe percentage of women ages 21–64 who were screened for cervical cancer using either of the following criteria:

• Women ages 21–64 who had cervical cytologyperformed every 3 years

• Women ages 30–64 who had cervical cytology/HPVco-testing performed every 5 years

Hysterectomy ExclusionEvidence of a hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix any time during the member’s history through Dec. 31 of the measurement year. Documentation of complete, total or radical abdominal or vaginal hysterectomy meets the criteria for hysterectomy with no residual cervix. The following also meet criteria:

• Documentation of a vaginal pap smear in conjunctionwith documentation of hysterectomy.

• Documentation of hysterectomy in combination withdocumentation that the patient no longer needs paptesting/cervical cancer screening

• Documentation of hysterectomy alone does not meetthe criteria because it is not sufficient evidence thatthe cervix was removed

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Hysterectomy Exclusion Coding

Q51.5 [Q51.5] Agenesis and aplasia of cervix ICD10CM

Z90.710 [Z90.710] Acquired absence of both cervix and uterus ICD10CM

Z90.712 [Z90.712] Acquired absence of cervix with remaining uterus ICD10CM

0UTC0ZZ [0UTC0ZZ] Resection of Cervix, Open Approach ICD10PCS

0UTC4ZZ [0UTC4ZZ] Resection of Cervix, Percutaneous Endoscopic Approach ICD10PCS

0UTC7ZZ [0UTC7ZZ] Resection of Cervix, Via Natural or Artificial Opening ICD10PCS

0UTC8ZZ [0UTC8ZZ] Resection of Cervix, Via Natural or Artificial Opening Endoscopic ICD10PCS

UnitedHealthcare Community Plan offers $30 to PCPs who are on the P4P contract for completion of cervical cancer screening. The claim must include one of the following procedure codes:

Measure Procedure Code (CPT) I Diagnosis Code (ICD-10) I Description Age Incentive

Cervical Cancer Screening

88141-88143 88147 8814888164-88167 88174-88175 G0101 Q0091 24-64 Years $30 one per quality

measurement period

Colorectal Cancer Awareness Tool KitMichigan Cancer Consortium’s Tool of the Month features credible, quick, and ready-to-use information and data to promote awareness of colorectal cancer and the importance of screening. The kit includes:

• Sample newsletter article/press release• Quick, easy-to-use data on colorectal cancer• Easy-to-access colorectal cancer resources for

providers and patients• Ready-to-use social media posts

Also find the tool of the month on the MCC homepage and here: http://michigancancer.org/PDFs/ToolOf TheMonth/March2016.pdf.

Receive HEDIS Reports by EmailYou can receive these Healthcare Effectiveness Data and Information Set (HEDIS) care opportunity reports by secure e-mail:

1. Quality incentive receivables and caremanagement fee

2. Member education and outreach efforts3. Improve your practice’s HEDIS outcome rates

If you have not already done so, please fax the following information to 888- 960-3830, including the provider name, TIN, NPI, two business email addresses to ensure coverage, and contact name. Call Customer Service at 800-903-5253 with any questions.

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Community Plan

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Automated Messages May Encourage Preventive CareUnitedHealthcare Community Plan’s Primary Care Physician (PCP) Pay for Performance Incentive Program rewards PCPs who deliver timely preventive care and screenings as reflected by their Healthcare Effectiveness and Data and Information Set (HEDIS®) scores.

We would like to invite you to participate in a program to help influence your patients to obtain timely preventive care and screenings.

The doctor-patient relationship has been and remains a keystone of quality care. Patients want to receive health guidance from their doctor, who they trust. Knowing this, we would like you to record automated messages to encourage your patients, who are due for services to schedule appointments. You will be able to record the message in the comfort of your own office or home. The message may be recorded in English or any language of your choosing.

Hearing your voice and the friendly reminder might be all your patient needs to encourage them to seek timely care. This program requires minimal time of your office and is offered at no charge. Please contact HEDIS Project Coordinator Marisela Reyes at 248-728-9016 to participate.

Earn Rewards with Health Michigan Plan HRAsAn important part of the Health Michigan Plan (HMP) is to help ensure completion of a Health Risk Assessment (HRA) for all HMP members. Primary care providers can earn:

• $50 incentive per member who completes an HRAwithin 150 days of enrollment

• An additional $5 per member if your practice hasmore than 25 HMP members and at least 90 percentsubmit their HRAs within 150 days of enrollment.

The HRA form will be sent to all UnitedHealthcare Community Plan members. HRA forms will also be available at www.uhccommunityplan.com. All HMP members must schedule an appointment within 60 days of enrollment to see their PCP, within 150 days of entering into the HMP.

UnitedHealthcare Community Plan will reach out to each HMP member to explain the importance of completing the HRA as well as helping to coordinate scheduling of a PCP appointment.

PCPs play an integral role in this process. All completed HRA forms must be signed by the member’s assigned PCP and returned to the health plan. Signed HRA forms for UnitedHealthcare Community Plan’s HMP members can be faxed to 855- 237-1213.

Michigan NewslettersMembers:http://www.uhccommunityplan.com/mi/medicaid/community-plan/member-information.html

Providers:http://www.uhccommunityplan.com/healthprofessionals/mi/provider-news.html

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