ACN Advance: Provider Newsletter

As another challenging year comes to a close, we want to share an enormous “Thank You” to your practice and staff for participating with ACN, and for your tireless efforts toward keeping our community healthy during these trying times.

We know the combination of COVID, flu season, inflation, and staffing challenges continue to impact your practice and patients. Please know our team is here and ready to do our very best to support your team.

Supporting your success is the most important and fulfilling work we do, and we know your practice will find reward with us in 2023 and beyond:

• Transitioning to the Medicare Shared Savings Plan (MSSP) Enhanced ACO model in 2023 offers increased financial flexibility, more attainable benchmarks, and fewer program burdens for participating primary care providers.
• Provider Rewards Program improvements for 2023 (more information in this newsletter and during Q1)
• Support and promote ACN’s specialist community through available Neighborhood Referral Maps (updated quarterly), “Find-a-Provider” patient referral cards (coming in early 2023), and actionable data in our specialist quarterly reports.
• Care Coordination and clinical teams of dedicated health care professionals ready to support your patient care plan and assist with complex care needs
• Dedicated quality team that can support your practice by helping close primary care gaps

You may always contact your dedicated Clinical Performance Consultant to provide your practice with information and education that supports your success.

As we move toward 2023, I hope that you have opportunities to enjoy time with your family and friends. On behalf of your Board of Managers and executive leadership team, we wish you a wonderful holiday season.

Thank you for participating with ACN!

Todd Ricotta
CEO

As ACN transitions from the Global and Professional Direct Contracting Model (GPDC) toward the Medicare Shared Savings Plan Enhanced (MSSP) model for 2023, here are some important updates and upcoming mailings for ACO participating practices and their beneficiaries:

Why MSSP Enhanced?

The Center for Medicare and Medicaid Services (CMS) will sunset the GPDC program on Dec. 31, 2022. ACN had the option of transitioning into the Reach ACO model, or MSSP Enhanced model for 2023.

After careful deliberation during the summer, ACN’s Joint Venture Board approved ACN leadership’s proposal to participate in MSSP Enhanced, citing various ACO Reach program requirements/investments, financial model limitations, and potential impact on participating providers.

What’s Next for Providers and Practices?

• Participation in MSSP Enhanced begins Jan. 1 for eligible Primary Care Providers
• CMS requires printed signs be posted in every participating TIN’s location(s) for a beneficiary to read if desired
  • ACN will provide each participating TIN location with a notification document and poster (English and Spanish)
  • Copies of the notification must be made available to a beneficiary upon request

What’s Next for Beneficiaries?

• A notification letter will be mailed to all impacted Beneficiaries by Jan. 1
• A verbal or written follow-up communication (written, email, verbal, telephonic) is required no later than the next visit following the initial beneficiary notification or, if no subsequent visit, within 180 days from the initial beneficiary notification
  • This communication gives beneficiaries an opportunity to ask questions about MSSP Enhanced and its benefits
  • ACN will provide materials to your staff to help answer beneficiary questions and that can be shared with your Medicare beneficiaries at their second visit, or pushed through your patient portal
  • ACN will send a subsequent notification to beneficiaries that have not had a subsequent visit within the 180-day timeframe

Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org with any questions or feedback.

ACN is thrilled to recognize and reward the high quality, cost-efficient care participating practices earned through the first three quarters of the Provider Rewards Program (PRP) in 2022, and as a participant in the value-based agreement between ACN and Mercy Care and UnitedHealthcare for the 2021 performance year.

ACN will deliver more than $1.5 million in gainshare checks to participating practices in December. Per your Board of Managers’ policy, these distributions are made at the TIN Level. The leadership of each medical group or practice determines their own internal distribution policies.

Congratulations to all participating practices on your successes! These gainshare incentives are a testament to your practice’s dedication, hard work, and proactive approach toward patient care.

Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org with any questions or feedback about the PRP or gainshare opportunities.

In building upon the significant changes to the 2022 Provider Rewards Program (PRP), a few additional improvements are coming in 2023 to reward eligible primary care practices for improvements in quality and coordinating care with ACN’s participating specialists.

Many of the current PRP features are being proposed for 2023, including:

• incentives for Well Child Visits;
• Annual Wellness Visit (AWV) incentives for our Medicare ACO participants; and
• quality performance benchmarks.

The 2023 PRP will be structured toward network successes within ACN’s various value-based arrangements through:

• increased performance in quality outcomes for ACN members;
• reducing costs through in-network care coordination; and
• continually building provider and member engagement.

Upon final approval from ACN’s Board of Managers, your Clinical Performance Consultant will share a complete overview and printable details of the 2023 PRP to eligible participants during Q1 of 2023.

Please contact your CPC or email practicetransformation@azcarenetwork.org with any questions or feedback you may have about the 2023 PRP.

Arizona Care Network’s Board of Managers completed the process of electing and appointing physicians for board roles in 2023 were finalized during December’s board meeting.

Longtime board member Kevin Theodorou, MD (Internal Medicine of the Valley) was electedwill transition to Board Chair for beginning in 2023 after serving as Vice Chair in 2022. Theodorou replaces Monte Swarup, MD, who will remain an active Board member.

Deepanshu Garg, MD (Med-Cure Internal Medicine) was elected Vice Chair and will transition to Board Chair beginning in 2025 at the conclusion of Dr. Theodorou’s tenure as Chair.

Additionally, the Board of Managers will welcome Dr. Srivani Srikantiah (Srivani Srikantiah, MD, PLLC) as its newest board member. Dr. Srikantiah is also a member of the Post-Acute Care Committee.

Physicians who are interested in learning more about becoming a member of one of ACN’s three governance committees – the Network Committee, the Post-Acute Care Committee, or the Quality & Payer Contracting Committee – can email governance@azcarenetwork.org for additional information.

To help your practice stay connected with important news, new initiatives, and other updates throughout the year, Arizona Care Network is requesting your provider(s) email addresses to improve ACN’s outreach efforts.

By sharing your provider(s) email addresses, they will receive the quarterly ACN Advance Provider Newsletter, along with regular network updates, fee schedules, and other important communications that support your practice and patient care throughout the year.

Simply click on the Provider Update Form (below) to enter your provider(s) contact information. You may also use this link to update your provider(s) and staff listings, email addresses, and phone numbers at any time.

Provider Update Form

Email address information shared with Arizona Care Network will never be shared with any outside organization and will not be used to attempt to market or solicit any product. This is strictly for informational purposes, directly from ACN.

To further support your patient care and improve population health, Arizona Care Network is aligning our value-based contract quality measures with various focuses throughout 2023. This supports the network in putting our performance in a favorable position for potential increased shared savings.

ACN’s Quality Data Abstractors (QDA), Clinical Performance Consultants (CPC), and Care Coordination teams will assist through multiple touch points to help your practice identify members with specific care gaps and facilitate your patient’s visit with you.

Quality focuses include:

• Hypertension (HTN)
• Diabetes
• Well Child Visits
• Pain management
• Prevention

View the 2023 Quality focuses (.PDF)

Watch for additional content and shareable resources via Bulletin email communications, this newsletter, and our Resources blog that emphasizes a particular quality measure each month.

Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org with any questions or feedback.

Hierarchical Condition Category (HCC) is an ICD-10 based, diagnosis categorization/classification system. HCCs are used by Centers for Medicare & Medicaid Services (CMS) and other payers to establish financial benchmarks and premiums that improve quality. Each risk-adjusting diagnosis code has a risk adjustment value, where diagnoses that are more severe have a higher value. These scores are used to forecast a patient’s future health costs.

By accurately reflecting and communicating the complexity of our patient population to payers by submitting missing ICD-10 codes, we are ensuring our performance is represented by the care we deliver to our patient population.

One of the more common ICD-10 code quality gap closure opportunities is Peripheral Vascular Disease, Unspecified: ICD-10-CM I73.9:

• I73.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
  • Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient’s condition. Specific diagnosis codes should not be used if not supported by the patient’s medical record.
  • The ICD-10-CM code I73.9 can also be used to specify illnesses or conditions such as:
    • arm claudication
    • arterial insufficiency of flap
    • arteriospasm
    • dermatosis resulting from vascular insufficiency
    • dietetic microangiopathy
    • gangrene due to peripheral vascular disease, etc.
    • Intermittent claudication
    • Peripheral angiopathy NOS
    • Spasm of artery
  • Do not use I73.9 for diagnosis of the following Vascular Disease conditions:
    • atherosclerosis of the extremities (use ICD-10 codes I70.2–I70.7)
    • chilblains (T69.1)
    • frostbite (T33–T34)
    • immersion hand or foot (T69.0)
    • spasm of cerebral artery (G45.9)

Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org with any ICD-10 code billing and documentation questions.

Medication adherence is vital in disease management and a factor that your patients may have the most control in managing successfully.

With the hectic and often stressful Holiday travel in full swing, here are some tips your patients may find helpful while traveling through airports with medications:

• It is strongly recommended patients keep all medications in carry-on luggage.
• Patients may bring pill or solid-form medications in unlimited amounts.
• Only patients traveling with liquid medications need to notify TSA staff
  • Liquid medication of more than 3.4 ounces is allowed in carry-on bags.
  • It is not necessary to place medically required liquids in a sealable (Ziplock) bag.
  • Patients should notify TSA staff of medically necessary liquids at the start of the screening process.
  • Medically required liquids will be subject to additional screening that could include being asked to open the container.
• TSA does not require passengers to have medications in prescription bottles (pill boxes are acceptable).
  • TSA Pre-check can greatly improve the security and screening process (enrollment fee and background check are required
• A patient who does not want a medication X-rayed may ask for a visual inspection instead.

Patient Resources

• TSA Pre-Check
  • https://www.tsa.gov/precheck
  • https://www.nerdwallet.com/article/credit-cards/credit-cards-bypass-airport-security
  • https://www.tsa.gov/precheck/credit-cards-offer
• Medication Travel Tips
  • https://azcarenetwork.org/resource/stay-on-top-of-your-medications-while-traveling-this-holiday-season/
  • https://www.tsa.gov/travel/travel-tips/can-you-pack-your-meds-pill-case-and-more-questions-answered

As Arizona Care Network continues to introduce new partnerships and expand our footprint throughout Maricopa and Pima Counties, here’s a quick overview of payer organizations who have value-based arrangements with ACN in 2023:

• Aetna (PPO, HMO, Medicare Advantage)
• Alignment Health Plan (Medicare Advantage PPO/HMO)
• Cigna (LocalPlus)
• Employers Health Network (EHN) (Whole Foods Market employees)
• Humana (Commercial and Medicare Advantage)
• Intel (Connected Care HDHP/PPO/PCP
• Medica (Pinnacle Gold/Silver/Bronze)
• Medicare Shared Savings Plan Preferred (MSSP) (Medicare Fee-For-Service)
• Mercy Care
• UMR (Dignity Health employees Preferred/Premier)
• UnitedHealthcare (Choice Plus PPO Navigate/Nexus ACO)

Members within these plans who visit an ACN-participating provider(s) are automatically eligible for Care Coordination and other included, in-network support services as part of their coverage benefits.

A quick reference guide featuring ACN partners’ member ID card samples and claims information will be available from your Clinical Performance Consultant during Q1 2023. Please contact your CPC or email practicetransformation@azcarenetwork.org to receive copies of this document.

• Follow us on Facebook, Twitter, and LinkedIn for additional news, health-related content for providers and patients, organizational updates, and more.
• Learn more about ACN’s Care Coordination program and services designed to partner and support your practice in achieving healthy, cost-effective patient outcomes in this video.
• ACN’s improved Specialist Performance Reports and Medical Neighborhood Maps are available to your practice anytime. Additionally, Physical Therapy and Radiology listings quick reference guides are also available. Contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org to receive any of these reports and/or maps, all of which are updated quarterly.
• Quality measure tip sheets are available from your Clinical Performance Consultant, including colorectal cancer screening, depression screening and follow-up, diabetes (A1C, Eye Exam, Nephropathy), Social Determinants of Health (SDOH), and Tobacco screening. These 1-page tip sheets (.PDF) include best practices, documentation requirements, and codes for your practice to help close quality gaps. Contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org to receive any or all tip sheets
• A 1-page Payer ID Card Quick Reference document will be available to your practice in early 2023. This document contains samples of ID Cards from ACN payer partners, as well as contact information. Contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org if your practice would like copies of this document.
• Krystal Sommerville is ACN’s newest Clinical Performance Consultant. She works with practices throughout the Biltmore and North Scottsdale areas, and can be reached at krystal.sommerville@azcarenetwork.org.
• Abrazo Arrowhead Campus will undergo a $14 million expansion of the hospital’s neonatal unit for preterm babies. The 8,500 sq. ft. addition will increase the neonatal unit from 21 to 35 beds, as well as support enhanced capabilities to pursue certification as a higher Level IIIB Neonatal Intensive Care Unit for more complex maternal and neonatal medical conditions, obstetric and fetal complications. The new addition will be built adjacent to Abrazo Arrowhead’s existing Level IIIA perinatal care center. Expansion construction is expected to be finished in late 2023.
• Dignity Health is hosting a CME opportunity for PCPs, PAs, NPs, EDs, Cardiologists and Hospitalists related to the diagnosis and treatment of Atrial Fibrillation on Wednesday, Feb. 1, 2023, from 12-1:30 p.m. at the Morrison Auditorium in Chandler. Lunch is included for on-site attendees. More information and a registration link is available here.

• Desert Foothills Family Medicine (Chandler)
• Digestive Health Clinic (Peoria, Sun City West)
• Hall Medical (Gilbert)
• Mountain View Medical (Sun City West)
• Paradise Valley Heart and Rhythm (Phoenix)

You can also view a list of provider organizations no longer participating with ACN.