providerconnection - select health network...sjhs family medicine residency in a full-time capacity....

JANUARY 2018 NEWSLETTER VOL. 6 • ISSUE 1

PROVIDERCONNECTION

CONTINUED ON PAGE 9...

Physician Spotlight

Steve Schrock, M.D. Dr. Steven Schrock is currently an Associate Director of the Family Medicine Residency program at Saint Joseph Health System – Mishawaka. Dr. Schrock completed his undergraduate work at Goshen College, medical education at the University of Cincinnati, residency at the University of Cincinnati Family Medicine Residency, and a Faculty Development Fellowship also at the University of Cincinnati.

Post-graduation, Dr. Schrock began working in private practice in Goshen, Ind. After a few years, he and his wife, also a family physician, moved to Memphis, TN where she completed an operative obstetrical fellowship. During that time, Dr. Schrock became the program director for the University of Tennessee - Memphis Family Medicine Residency Program, which encompassed a 36 resident program, family medicine/obstetrics fellowship and a sports medicine fellowship. After 4 four years, Dr. Schrock and his wife moved back to the Michiana area where he entered private practice with the Goshen Health System in Syracuse, Ind. and also worked in a limited capacity at the Saint Joseph Family Medicine Residency.

Three years ago, Dr. Schrock joined the SJHS Family Medicine residency in a full-time capacity. He truly enjoys taking care of patients and teaching resident physicians and felt he could better combine those

January 2018 Newsletter •

To learn more, call 574.283.5959, toll free at 800.634.9585 or visit selecthealthnetwork.com

In This Issue of PROVIDERCONNECTION

PHYSICIAN SPOTLIGHT - STEVE SCROCK, M.D... .....................................................FRONT

FROM THE MEDICAL DIRECTOR ....................................................................................PAGE 3

CEO UPDATE .........................................................................................................................PAGE 4

CLAIMS CORNER.................................................................................................................PAGE 5

SELECT HEALTH & HEALTH DEPT WELL CHILD LEAD SCREENINGS .................PAGE 6

MDWISE STAR PERFORMER ...........................................................................................PAGE 6

NEW DIRECT EMPLOYER GROUP - ASCENDANT ORTHPEDIC ALLIANCE ...........PAGE 6

SJHS SYSTEM MONITORS PATIENTS RECOVERING AT HOME ..........................PAGE 7

NEW PROVIDERS .................................................................................................................PAGE 7

CARESOURCE MARKETPLACE .......................................................................................PAGE 8

CONTACTS ......................................................................................................................... PAGE 10


In This Issue of PROVIDERCONNECTIONAre you tired of the term Population Health Management (PHM) yet? If so, you better think about switching professions because it will be around for many years. Between the looming physician shortages and the ever-decreasing amount of fee-for-service reimbursement, PHM is only going to grow in importance for the foreseeable future.

As with most phenomena in the United States, money has an outsized influence. Let’s face it, if healthcare costs were not such a big part of the country’s GDP and the average person’s budget, we would not be changing much, if at all. The fact is that PHM should mean improved clinical results (what we all should want) in addition to decreased costs. A white paper was released in early 2016 which summarized the unsatisfactory state of medicine in our country with its skyrocketing costs and mediocre outcomes—from the payor viewpoint. It also outlined the game plan for change. Contrary to what you might think, this is NOT a government-driven document. The participants in the work group represented the major commercial insurers, some huge companies (e.g. Wal-Mart), and some large health systems (e.g. Trinity), as well as the government. It was chaired by the Anthem EVP/CMO. They recognized that providers (doctors and hospitals) would need to make fundamental changes in approach which would be “costly and administratively difficult”. Therefore, in order to effect their desired change,

“a critical mass of public and private payors must adopt aligned approaches and send a clear and consistent message that payors are committed to a population-based health system.” Sounds like collusion, doesn’t it? They admit that this approach with its various alternative payment methods may not achieve the desired goals, but they feel that starting the providers (that’s still us) and forcing a behavior change “makes the most sense”.

PHM starts with the aggregation of (hopefully) all patient data—a Herculean task. Think of patient behavior nowadays. They go anywhere they want, including urgent care, minute clinics, and telemedicine. The providers are often clueless about some of the medications and test results—let alone the complete history, which we learned in medical school was the key to most diagnoses. This is exacerbated by the various electronic medical records which are not able to communicate with each other unless the “ransom” to install (rip-off) interfaces is paid. This scattered health information leads to unnecessary duplication, incomplete data, and dangerous drug interactions.

The next step in PHM is to analyze all the data—which eventually should be more complete—so that both clinical and financial outcomes can be improved. A good IT system is obviously of paramount importance. The analysis looks for gaps in care, inappropriate or inefficient medications, overlooked or duplicative tests, etc. This is especially important for patients with chronic diseases who require more intervention and live at the top of the cost pyramid. On the macro level, this is generalized to the entire cohort for which you and your team of providers is responsible.

To do this well, patients need to be risk-stratified and have robust care management. By now, everyone realizes that social determinants and behavioral health issues influence disease development and treatment—especially for the chronic diseases. How big is your team going to be? It will be extremely difficult for solo practitioners or small groups to make a living with the disappearance of fee-for-service reimbursement. A team could be a large, multi-specialty clinic. However, the larger the team is, the more expenses can be spread and economies of scale can exist: a great IT system, heart failure and diabetic clinics, care managers, home health, pharmacists, behavioral health therapists, and an acute care hospital, are examples of what can be utilized. A great example of a team would be the Select Health Network.

From the Medical Director

Brian Moloney, M.D.Medical Director

CONTINUED ON PAGE 9...



Candace JonesCEO

For me, year-end is always a time for personal and professional reflection. As Select’s new CEO, my evaluation has been not only a matter of educating myself, but a matter of acclimating to the culture, the staff and interworkings of Select. 2017 has presented numerous challenges and accomplishments for Select along with great excitement for the future and a prosperous 2018.

Recently, my leadership team and I reviewed the 2017 - 2020 Corporate Strategic Plan, the 2017-18 Marketing and Sales Plan and our most recent Quality Improvement Plan (which hadn’t been touched in a while). We assessed the strategic goals, their relevancy for ongoing work, and added definition to some of the goals that lacked clarity for our future. We agreed that growth should still be one of our top priorities going forward. I learned that our QI Plan was a preliminary plan designed to summarize the clinical quality operations of Select Health Network and the services we offer to our membership. Finally, we summarized the quality initiatives completed in 2017 and what we want to focus on for 2018.

We want to work toward two major initiatives:

• Solidify SHN as a strong Clinically Integrated Network in the Michiana/South Bend community and,

• Growth The Board of Directors has been engaged in the Corporate Strategic Plan. I am thankful for the work that our Select leadership team has been doing over the past four months. We’ve had great discussion on our future direction and a growing interest in being a bigger part of the decision-making, which happens as a company moves forward. Because of this, we decided to host a Select retreat for Board of Directors and committee members. We are asking all board and committee members if they would like to be engaged in future work groups regarding these two goals. Some of the topics that will be discussed at the retreat involve committees or work groups such as:

• Finance Committee

• Growth (Network, Payor and Geographic Expansion)

• Information Technology and Integration

Please contact me at 283-5947 or Brian Moloney, M.D. at 283-5941 if you or one of your physician colleagues may be interested in participating in the retreat and/or future work groups.

The retreat will be held at Select Health Network, 314 W. Catalpa Dr., Suite A, Mishawaka, IN 46545 on February 3, 2018 from 8:00 am to 12:00 pm.

CEO Update


Happy New Year To You All As we begin 2018 with the usual resolutions of:

• Exercising more

• Eating healthy

• More precise coding and documentation

Fun facts for 2018 include:

• 360 new codes added

• 226 code descriptions revised

• 34 codes changed from valid to invalid The latest and greatest ICD 10 updates were effective on October 1, 2017. It is becoming more common for codes to require the 4th, 5th and sometimes 6th digits to complete the diagnosis coding of your claims for submission. Some of the more sophisticated systems either suggest an edit or simply do not allow for claim submission until all required digits have been entered.

Since we have been working with the ICD 10s for a couple of years, most of the “kinks” in the system have been worked out. However, many are still struggling with the ordering of laboratory test(s) for different diagnosis. It is equally important for claims to be submitted to the laboratory with the same amount of required digits.

Claims Corner

Tammy HinesSupervisor, Claims Resolution

In the New Year, please specifically double check the accuracy of required amount of digits when ordering Laboratory testing so claims can be processed to payment.

Here’s to a great New Year!



In last month’s edition of Provider Connection, Select announced the addition of the quality measure Lead Screening in Children (LSC) into our quality program. This measure is important to our community because elevated blood levels in children are preventable with appropriate screening and education. According to the NCQA HEDIS Technical Specifications, lead screening should be completed on all children 1-2 times prior to the child turning 24 months. In Indiana, only 11% of 12-15-month-old children receive blood lead screening. (ISDH)

Understanding there is significant need for outreach and education regarding the importance of lead screening in our community, Select Health Network will be working closely with the local Health Department this year. Select and the local Health Departments will be offering educational materials, community education, and even lead screenings at our Well Child events.

If you are interested in learning more about these materials or events, please contact Brandyn Blosser, Quality Improvement Manager Select Health Network, at [email protected] or 574-283-5946 for more details.

Select Health Network and Health Department Well Child Lead Screenings

New Direct Employer Group – Ascendant Orthopedic Alliance Employees of Ascendant Orthopedic Alliance will have access to Select Health Network effective January 1, 2018. The Select logo will be on their identification card.

Claims AddressSIHOP.O. Box 1787Columbus, IN 47201

You will find an updated Payor List on Select’s website. Please contact Provider Relations with any questions.

MDwise Star PerformerEach year MDwise recognizes a small number of practices who have gone above and beyond in providing high levels of quality and service to patients. MDwise Select Health would like to congratulate the physicians and staff at Marshall County Pediatric Physicians as the MDwise Star Performer honoree for 2017.

MDwise uses specific criteria when selecting the Star Performer honorees, including achieving measures of clinical performance, best practice implementation, patient outreach and compassion. Also important is having a shared passion for quality throughout the office.

Full details have not been fully released, so look for more information in a future issue of the Provider Connection.

Payer Number77153

Fee SchedulePPO-R

mailto:bblosser%40selecthn.com?subject=well%20child%20lead%20screenings

https://www.selecthealthnetwork.com/system/files/provider_downloads/2017-12_SHN%20List%20of%20Payors.pdf


System Monitors Patients Recovering at Home for Peace of MindA new program from SJHS VNA Home Care helps your patients recovering at home avoid unnecessary hospitalizations or emergency room visits and stay independent and in their homes.

Home Care Connect™ blends talented home care nurses and therapists with advanced technology and 24/7 virtual care to empower patients to achieve their health goals. Home care patients get an easy-to-use computer tablet that allows them to self-report their vital information such as blood pressure, weight and current health symptoms. Speech and text instructions walk patients through the steps. Virtual Care Center nurses monitor data around the clock in near real-time and look for changes in patients’ conditions. Patients and nurses can connect for a virtual visit at any time using two-way video, and nurses can take action as necessary to prevent ER revisits and re-hospitalizations. There is no cost to patients.

Home Care Connect provides your patients and their loved ones peace of mind, and helps people return to what’s important in life. For more information, contact VNA Home Care at 800.962.2554.

New Providers Name Specialty Group Name

Joseph Caldwell, II, M.D. Orthopedic Surgery Orthopedic & Sports Medicine Center of Northern Indiana, Inc.

Brad Dalling, CRNA Nurse Anesthetist Great Lakes Anesthesia

Sean Horner, PA Physician Assistant Elkhart Emergency Physicians

Marcia Kostka-Suvelza, OD Optometry The South Bend Clinic

Nouraddin Nouraddin, M.D. Internal Medicine The South Bend Clinic

Michael Poulsen, NP Nurse Practitioner Saint Joseph Regional Medical Center Palliative Care Program

Adam Simpson, CRNA Nurse Anesthetist Great Lakes Anesthesia



Select Health Network’s agreement with CareSource Marketplace went into effect on January 1, 2018. This agreement does not include CareSource Hoosier Healthwise (HHW) or Healthy Indiana Plan (HIP) plans.

All Select Health Network physicians as well as the following facilities are included in this plan.

Physicians Urgent Care – South Bend, Mishawaka, and Elkhart locations

Saint Joseph Health System – Mishawaka Medical Center

Saint Joseph Health System – Plymouth Medical Center

Saint Joseph Health System Rehabilitation Institute

South Bend Medical Foundation

The South Bend Clinic & Surgicenter

Provider Resources

We realize that there are individuals who will be losing their MDwise and Anthem Marketplace coverage on 12/31/17 and may not have enrolled in a new plan by the 12/15/2017 deadline. If they did not choose a plan by the deadline, they will not have coverage effective 1/1/2018. However, these specific individuals will actually have a Special Enrollment Period to enroll in a new plan by February 28, 2018.

Please continue to remind your patients that you AND Saint Joseph Health System are participating in Marketplace through CareSource.

Please contact Cindy Bradberry at 574-283-5925 with any questions.

CareSource Marketplace Meetings Select will be holding CareSource Marketplace provider meetings on Wednesday, January 10, 2018, at 11:00 am and 3:00 pm. Please click on the link to register and learn more about the CareSource Marketplace plan and meet the CareSource Provider Relations Representatives. Information regarding the CareSource provider portal, claims, and authorizations will be presented and snacks will be provided. (Please only attend one session)

Tickets can be found here

Provider Services 1-866-286-9949

Medical Management Fax 1-877-716-9480

Prior Authorization Phone 1-866-286-9949

Electronic Funds Transfer (EFT) InstaMed: 1-877-755-3392

Electronic Claims Submission INCS1

Claim Address P.O. Box 3607 Dayton, OH 45401-3607

Timely Filing 365 days from date of service or discharge

CareSource Marketplace

https://www.eventbrite.com/e/caresource-marketplace-meeting-tickets-41609224310


Medical Director Continued...

Dr. Schrock Continued...

So what is the bottom line? We will be responsible for a population of people who somehow get attributed to us. We will be responsible for their care and the related costs whether or not they ever came to our offices. To do this well, we need to be part of a team that can be proactive and intervene to close gaps in care, practice preventative medicine, and try to ameliorate the burden of behavioral health co-morbidities. We will need to consistently apply guidelines and best practice standards to decrease variability, partner with loads of care managers, and scads of physician extenders. Of course we will need an IT system to be able to capture, aggregate, and report the data to the payors. And we will probably have to remember to tell everyone, “Have a nice day.”

As you should know by now, Select has a new CEO, Candace Jones. She had been at a successful PHO in Michigan for over a couple decades. Her organization was more cohesive than Select has been, participated in every worthwhile risk contract, and met quality goals so their outcomes were better, costs were controlled, and the physician bonuses were routinely 5 figures, occasionally in the 6 figure range. Select is going to start becoming a larger but more cohesive network.

efforts in one location. “I am continually challenged by patients, residents, and students. This combination of teaching and providing care for patients keeps me engaged, teaching and learning in a group setting. I really enjoy working with training physicians - impacting their careers and how they view the profession they have entered. I try to pass on some of my experience and skills to the training residents.” Note to current residents: if you want to get on his good side, he likes snickerdoodle cookies and the Cleveland Indians. If you are going to buy him a snack, choose the chips and salsa. He would much rather eat that than chocolate any day.

Outside of work, Dr. Schrock enjoys time with his family. He and his wife, Kim, have two children. Rachel (12) is active in volleyball, softball and drama, and Joshua (15) is very active in soccer, playing the cello and school. All schedules considered, the Schrocks are always very busy.

When thinking about the future of healthcare, Dr. Schrock marvels at forthcoming “medical advancements driven by computers and technology.” Computers have already changed the practice of medicine, and he believes medicine will continue to evolve.

“These changes have positive and negative repercussions. Currently, computers also allow us to easily monitor information. This has encouraged health care organizations to track more data. While in a lot of ways this is helpful on a large scale, it drives physicians and providers to spend significantly more time entering data. I appreciate metrics, but also experience decreased work satisfaction as a result of data entry. In the next 10 to 20 years, data must be more easily acquired without the effort and cognitive burden placed on the individual care giver. This is especially true in primary care settings, where the resources tend to be limited, but the data requirements more onerous than in specialized medical areas. Unfortunately for patients and the healthcare system alike, this is one dynamic in outpatient primary care medicine that must change in order to support work satisfaction and ironically, the patient care that the metrics are meant to measure and improve.”



The Provider Connection Can BeDownloaded at selecthealthnetwork.com

Log in Here

Click on Provider Newsletter

Enter your Username & Password(call Select if you need assistance)

PROVIDERCONNECTIONProvider Connection is published by Select Health Network and distributed to the offices of our participating providers. We hope by reading the content you become more informed advocates of Select Health Network.

EDITORIAL BOARD

Candace Jones Chief Executive Officer

Brian Moloney, M.D. Medical Director

Brandyn Blosser, MSW, LHFA Manager, Quality Improvement

Julie Porter Manager, Provider Relations

Sarah Snyder Coordinator, Administrative Services

Want to receive the Provider Connection via email?

Simply send an email to [email protected] with the following information:

Subject Line: Provider ConnectionBusiness NameRecipient NameRecipient Title

Always remember to update your contact information with Select Health Network at: [email protected]

CONTACTS

ADMINISTRATION

Candace Jones, CEO ............................................................... 574-283-5947

Brian Moloney, M.D., Medical Director ................................... 574-283-5941

Liz Thomas, Manager, Administrative Services ......................574-283-5912

PROVIDER RELATIONS

Anne Laverty, Director, Contracts & Operations .................... 574-283-5923

Julie Porter, Manager, Provider Relations .............................. 574-283-5926

Cindy Bradberry, Provider Relations Representative ............. 574-283-5925

CREDENTIALING

Chris Stefaniak, Provider Relations Representative .............. 574-283-5927

CLAIMS CUSTOMER SERVICE

Customer Service Department ............................................... 574-283-5918

MEDICAL MANAGEMENT

Laura Linn, Director, Medical Management ........................... 574-283-5928

Robin Hart, Supervisor, Case Management ........................... 574-283-5914

selecthealthnetwork.com

mailto:[email protected]

providerconnection - select health network...sjhs family medicine residency in a full-time capacity....

Documents