Don’t forget that your contract with us requires your cooperation with all quality improvement activities we undertake. These can include disease management programs, adopted clinical practice guidelines, medical record reviews, focus studies, provider profiling and performance monitoring. It is also important that you allow us to review and use provider/practitioner performance data to inform and ensure the success of all quality improvement programs.

As required by the Affordable Care Act (ACA), Qualified Health Plan members who purchase coverage through the Health Connector and who receive federal subsidies must be given a 90-day grace period after the premium payment deadline to make the required payments. During this 90-day period, health plans are not allowed to terminate coverage for non-payment, so those members would still be indicated as eligible for coverage when you conduct eligibility determinations. If they do not pay their premiums by the end of the 90-day grace period, their coverage will be retroactively terminated back to the first day of the second month of this 90-day period. Please understand that this federal requirement may directly affect your payments for covered services.

In accordance with ACA, we will continue to process and pay claims for covered services you deliver during the three month grace period, but will notify you accordingly that the second- and third- month claims are subject to later denial and payment retraction if the member does not pay his or her premium by the end of the grace period. You’ll receive the notification in your Remittance Advice and the Electronic Remittance Advice (835). If the member does not pay the premium by the end of the grace period, once we are notified by the Health Connector, we will terminate the member retroactively to the first day of the second month of the 90-day period. As a result, we will retract payment for all claims for services rendered during the second and third months of the 90-day period. Claims that were paid for services provided during the first month of the grace period will remain paid.

Please note that these requirements do not apply to our MassHealth members.

For additional important details, please go to section 9.3 of our Provider Manual.

Providers and community based organizations can receive free co-branded Lucite literature racks to hang in waiting rooms, exam rooms or any other appropriate high traffic area. The racks are available in different sizes and configurations, can be wall mounted or placed on tabletops, and if you need assistance with hanging a rack, we can also provide that service free of charge.

For details or to place an order, please email Julie.Nations@bmchp.org.

One of the focuses of our 2014 prenatal and postpartum care initiatives was encouraging providers to submit to us ACOG or other prenatal assessment forms. As a result, there were a number of instances when our receiving the forms directly impacted the care of pregnant members. In one case, a prenatal form helped our Sunny Start care manager offer emotional and medical support to a member who lost a current pregnancy in addition to having a history of lost pregnancies. This was possible because a provider submitted the ACOG/prenatal assessment form to us. From these forms we can identify high-risk pregnancies and provide appropriate care coordination from our Sunny Start program care managers.

Because of the positive impact, we will continue this initiative. For each form submitted, providers will receive a $25 reimbursement fee. For more information, please click here.

Managing patients who take antidepressants can be challenging, so we want to offer you some support with the following practical tips that can help increase successful treatment and compliance, and foster communication between you and those patients.

• Make sure your patient has clear instructions about the medication, especially if it’s new. You can even ask the patient to repeat back to you the information such as what the medication is for, how and when to take it and how long to take it.
• Your patient needs to understand that it may take several weeks before the antidepressant begins to work, and that he or she should not stop taking it without first consulting you.
• Antidepressant users can experience side effects ranging from mild to severe, so make sure your patient understands what to look for and when to contact you if there is a problem.
• Suggest that he or she use a pill box to ensure the medication is taken every day at the same time.
• There are instances when antidepressant dosages need to be adjusted or changed, or medication added. Be sure to discuss this with your patient at the outset of a course of treatment.
• Always schedule a follow-up visit to monitor your patient’s progress. You should make this appointment at the end of the initial appointment.
• Your staff can also offer reminders to your patient about the proper use of antidepressants and what the patient can expect.
• Recommend that your patient asks his or her pharmacy to sign up for automated reminders about refilling their medication.
• If you prescribe an antidepressant to a pregnant patient, make sure she is comfortable with the information and understands the medication is safe to take.

If you have BMC HealthNet Plan members you believe would benefit from behavioral health services or behavioral health care management, please contact Beacon Health Strategies (our behavioral health partner) at 800-444-5155. For additional information, please review the guideline endorsed for Adult Depression in Primary Care.

Do your patients really need antibiotics for respiratory tract infections?

Public health professionals, doctors and patients are increasingly concerned about the overuse of antibiotics. According to research as far back as 1997^*, more than half of the antibiotics prescribed for acute respiratory infections – such as acute bronchitis – are unnecessary because the infection is viral.

In Massachusetts, antibiotics are still over-prescribed for acute bronchitis. According to statewide information published by the Massachusetts Health Quality Partners (MHQP), antibiotics are used appropriately in only 24% of cases of acute bronchitis^**.

So what do you do when patients with acute viral bronchitis ask for antibiotics? You may need to tell them that:

• When acute bronchitis is from a virus, antibiotics will not help.
• Antibiotics can cause harm if used when not needed because bacteria can become resistant and develop “super bugs.”
• Antibiotics can cause side effects such as headaches and rashes.

To help you educate your patients about proper antibiotic use, the Centers for Disease Control and Prevention offers free tools, including a viral prescription pad. You can link to the information from our website.

^*Gonzales, Ralph MD MSPH, Steiner, John MD MPH, Sande, Merle MD. “Antibiotic Prescribing for Adults with Colds, Upper Respiratory Tract Infections, and Bronchitis by Ambulatory Care Physicians.” The Journal of the American Medical Association. September 17, 1997. Volume 278. Number 11.

**“Medication Management: Correct Use of Antibiotics for Acute Bronchitis.” Massachusetts Health Quality Partners. Web. Quality Reports. http://mhqp.org/quality/clinical/cqMASumm.asp

HPV vaccine is safe and can save lives

According to the Centers for Disease Control, each year nearly 17,000 women and 9,000 men are affected by human papillomavirus (HPV)-related cancers. That is why BMC HealthNet Plan supports the Massachusetts Department of Public Health recommendation for administering HPV vaccinations for preteen girls and boys, ages 11 or 12, before they become sexually active. Girls and young women, ages 13 through 26, should also get HPV vaccines if they have not received any or all doses when they were younger. Studies continue to show that the vaccines are safe, so providers caring for young people should discuss this life-saving topic with parents/guardians.

Teaching your patients who have asthma how to identify and avoid triggers can help prevent asthma attacks. Some common triggers include:

• Pollen
• Mold
• Certain foods (e.g., milk, peanuts)
• Hair
• Pets/animal fur/dander
• Dust mites
• Cigarette smoke
• Perfume, household cleaners

Make sure your patients know their triggers and understand that keeping away from them is key to staying well.

Asthma Control Test

To help your patients monitor their asthma, BMC HealthNet Plan and the American Lung Association recommend the asthma control test (ACT), a brief test that your patients can download, print and complete.  And make sure you review and discuss the results with your patients.

As always, please refer to the Asthma Clinical Practice Guidelines that we have endorsed. If you have BMC HealthNet Plan members with asthma whom you believe would benefit from care management, please contact us at 1-866-853-5241. We will conduct assessments for these members, develop an individualized care plan, and our care managers will provide educational materials and overall support.

BMC HealthNet Plan has endorsed the following clinical practice guidelines:

• National Heart Lung and Blood Institute (NHLBI) and National Asthma Education Prevention Program (NAEEP) asthma guidelines
• Institute for Clinical Systems Improvement Prenatal Care Guidelines
• Prenatal Care
• Major Depression in Adults
• Attention Deficit Hyperactivity Disorder
• American Diabetes Association: Standards of Medical Care in Diabetes - 2015

These and all guidelines adopted by BMC HealthNet Plan can be found in the Patient Care section. If you do not have Web access, please contact your Provider Relations Consultant for copies.

We strongly support providers’ efforts at working with their patients to stop smoking. That’s why we recommend QuitWorks, a free, evidenced-based program developed by the Massachusetts Department of Public Health, and an all-inclusive resource for you to help engage your patients who smoke to kick the habit.

Remember, too, that we provide coverage for over-the-counter and prescription smoking cessation treatment. Our formulary is available on the Pharmacy page. Quantity limits may apply.

The information you need – including step-by-step instructions on what to do – is detailed on the QuitWorks website.