ACN Advance: Provider Newsletter

As Arizona Care Network continually seeks to improve coordination of care for patients and reduce the average cost-of-care for inpatient and outpatient services, the physician-led Board of Managers approved updated participation requirements for physicians practicing in certain designated specialties, effective Jan. 1, 2025.

This updated guideline builds upon the specialist participation requirements originally adopted in 2023 and expanded in 2024 to ensure care is more affordable for our payer partners and patients accessing the network:

Effective Jan. 1, 2025: Physicians who treat patients at in-network facilities less than 50 percent of the time (with a minimum of 5 direct admissions at inpatient and outpatient facilities on a 12-month rolling basis) will no longer be eligible to participate with ACN.

Individual physicians who do not meet these new requirements will be removed from ACN’s primary care provider- and member- facing directories effective the first day of an upcoming quarter. These physicians will also be removed from rosters ACN sends to its payer partners for removal from the network, effective 90 days later (270 days later for OB-GYN providers and 365 days later for Oncology providers) to ensure continuity of care for patients.

The impacted provider’s organization will receive a notification via traditional mail and from its dedicated Clinical Performance Consultant informing them of the status change.

If you have any questions about these participation requirements, or wish to receive additional guidance and tools to ensure the physicians in your practice meet this new participation requirement, please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org.

As part of ACN’s MSSP Enhanced participation, the Centers for Medicare & Medicaid Services (CMS) requires beneficiaries attributed to participating primary care practices to be notified that his/her primary care provider participates with ACN as part of the MSSP Enhanced program.

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 in English and Spanish gives beneficiaries an opportunity to ask questions about MSSP Enhanced and its benefits.
  • ACN can provide materials to your staff to help answer beneficiary questions that can be shared with your Medicare beneficiaries during his/her second visit, or pushed through your patient portal (Note: If your organization participated in the MSSP Enhanced program with ACN in 2024, the 2025 notifications are identical).
  • ACN will send a subsequent reminder notification to beneficiaries in late Spring or early Summer that have not had a PCP visit within the 180-day timeframe.

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

ACN and NextCare Urgent Care have strengthened its long-standing, Valley-wide partnership by collaborating to educate patients and providers between Urgent Care and Emergency Room (ER) services.

These care decisions may significantly reduce:

• • • unnecessary or repeated ER visits;
    • waiting room times for care;
    • out-of-pocket costs for patients; and
    • unnecessary or extraneous tests/services.

NextCare is considered a Tier 1 in-network service for patients covered under ACN’s various value-based and narrow/exclusive network arrangements. NextCare is also contracted with a wide range of additional payers to support your broader patient population.

In addition to injury and illness diagnoses capabilities, NextCare services include:

• • Online appointment scheduling
  • Virtual and telehealth care availability
  • Extended hours (many locations are open until 8 p.m. and on weekends)
  • Physicals (sports, employment, school)
  • Prescribing certain medications
  • Pediatric care
  • X-rays
  • Lab and blood services
  • STD testing
  • Antibody testing (strep throat, Valley Fever, and more)
  • Immunizations and vaccines (COVID, flu, hepatitis, tetanus, and more)

Patients and providers can find the nearest NextCare Urgent Care location map around the Valley, or by using ACN’s
Find a Facility search tool.

Each year, ACN must report on the CMS Quality Measures for practices that participate in the Medicare Shared Savings Plan (MSSP) Enhanced program.

We report these measures to CMS through an audit called the Group Practice Reporting Option (GPRO). The audit runs from January through March.

Beginning in 2025, ACN is transitioning from GPRO toward Innovaccer and supplemental data feeds as our sources of Quality information and potential gap closure opportunities.

However, for organizations who participated in our Medicare ACO in 2024, the GPRO audit fulfills your MIPS Quality Reporting requirement. The audit also impacts ACN’s gainshare opportunity for the 2024 reporting year. We take the audit very seriously and commit extensive ACN resources to ensure successful reporting.

ACN makes every effort to abstract data with minimal disruption to your office staff. Here are a couple things to consider moving forward as we transition the auditing process:

• All EMRs have audit roles available for provisioning. If you have any questions, please contact provisioning@azcarenetwork.org.
• A designated point of contact within your practice or organization to work with minimizes office staff disruption. If you haven’t already done so, please help us identify the best point of contact for your dedicated ACN Data Abstractor moving forward by sending us your point-of-contact name and email address to quality@azcarenetwork.org.

As always, ACN greatly appreciates your cooperation and support.

To further ease your practice’s staffing and administrative burdens, Arizona Care Network can support your patient care through secure, remote access to your organization’s supplemental data feed.

Access to your practice’s supplemental data feed supports faster, more efficient data abstraction to identify coding opportunities and potentially close quality gaps through:

• • reduced administrative workload for your practice/staff,
  • efficient data abstractions that alert your providers of a patient’s potential gap closure opportunities before his/her appointment,
  • secured, accountable data review; ACN cannot change, edit, or otherwise impact any data within your EMR,
  • improved coding documentation accuracy and quality gap closures,
  • improved outcomes toward meeting important quality gap closure targets; and
  • increased potential earned shared savings incentives.

Additional Resources

In addition, Quality measure tip sheets are available for you to print, or from your Clinical Performance Consultant. These 1-page tip sheets (.PDF) include best practices, documentation requirements, and codes for your practice to help close quality gaps:

• • Blood pressure
  • Breast cancer screening
  • Cervical cancer screening
  • Chlamydia screening
  • Colorectal cancer screening
  • Depression screening and follow-up
  • Diabetes (A1C, Eye Exam, Nephropathy)
  • Immunizations
  • Medication adherence
  • Opioid usage
  • Social Determinants of Health (SDOH)
  • Tobacco screening, and more.

Please contact your Clinical Performance Consultant or email practicetransformation@azcarenetwork.org to begin the supplemental data sharing process, or if your practice would like to receive any/all of these tip sheets.

• Follow us on Facebook, Twitter, LinkedIn, and YouTube 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. Additional listings are also available, including:
  • • Behavioral Health
    • OB/GYN
    • Ophthalmology/Optometry
    • Physical Therapy
    • Radiology
    • Women’s Health
      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/all tip sheets.
• A Payer ID Card Quick Reference (.PDF) document for 2025 contains samples of ID Cards from ACN payer partners, as well as contact information. Contact your CPC or email practicetransformation@azcarenetwork.org if your practice would like copies of this document.
• Abrazo Arrowhead Campus launched its new Artis Q neurointerventional biplane system. The machine employs dual X-rays to generate high-resolution, 3-D images of blood vessels in the brain and spinal cord, enhancing capabilities in stroke care, interventional radiology, and neurology.
• Abrazo Arrowhead Campus also received a new StealthStation S8 surgical navigation system. This state-of-the-art surgical platform has an intuitive interface, improved patient registration software, and advanced visualization to navigate neurosurgery, spine, and brain procedures, including biopsy tumor resection, catheter placement, deep brain stimulation lead placement, spine decompression or fusion, spinal or pelvic fixation, and spinal or sacral trauma.
• Alignment Health Plan offers monthly HCC Coding and Documentation webinars available to all providers and staff.
  The 1-hour webinars occur during the last Tuesday of each month at 7:30 a.m. PDT, as well as the last Wednesday of each month at Noon PDT. April’s monthly HCC webinar information is available here. You may also email providerrelations@ahcusa.com for more information and to receive Virtual invitations to participate in these monthly webinars.
• Alignment Health Plan offers two virtual care systems for members:
  • • Virtual Care Center (VCC): Members can call this service 24 hours per day, which is staffed by an Alignment-employed clinician, who uses the Alignment Virtual Application (AVA) to access key data points, including recent lab results and prescriptions. The VCC can handle medication refills and prescriptions, discharge planning and transitions of care activities, psychosocial support and assessments, and the assessment and treatment of acute symptoms. Members may call the VCC anytime at 1-833-402-5803.
      The Care Anywhere (CAW) program supports vulnerable patients with 24/7 access to care through an interdisciplinary care team that conducts in-home and virtual visits. Providers may refer their Alignment Health members by
      calling 1-833-902-1665, Monday through Friday from 8 a.m.-5 p.m., PDT.
• Cigna offers CME credits through its Lifestyle as Medicine and Food as Medicine Essentials course. The course is available for free through September, and is designed for all providers (PCP and Specialist), as well as medical assistants and nurses. More information and a link to register is available here.
• Cigna created a Safety Toolkit surrounding health care workplace violence and other incidents. The toolkit contains information and clickable resources for prevention, training, security, and more to foster staff conversation and documented action plans for these unfortunate situations.
• Phoenix Children’s President and CEO Robert Meyer announced his retirement this spring after leading PCCN for the past 22 years. PCCN’s Board of Directors has begun a national search for Meyer’s successor when he plans to officially step down later this summer.
• Phoenix Children’s has pioneered the use of an esophageal string test (EST), a minimally invasive tool offering a sedation-free alternative to traditional methods for monitoring inflammation in eosinophilic esophagitis (EoE) in children. EoE is a progressive condition that can cause difficulty swallowing, pain and damage to the esophagus. The standard diagnostic method, esophagogastroduodenoscopy (EGD) with biopsies, requires sedation and more time away from school and work. The EST eliminates sedation by collecting esophageal secretions through a swallowable capsule containing a nylon string, providing critical assessment biomarkers.
• Valleywise Health was re-verified as a Level I trauma center by the American College of Surgeons (ACS). Verified trauma centers must meet the essential criteria that ensure trauma care capability and the highest level of institutional performance, as outlined by the ACS Committee. Achieving verification means that Valleywise Health has voluntarily met 122 standards outlined by ACS.
• Valleywise Health also received its first verification by the American Burn Association for its new location inside Valleywise Health Medical Center in Phoenix. The 4th-floor Burn Center includes 16 ICU beds, 24 adult acute care beds, 10 pediatric acute care beds, playrooms for young children and teens with burn injuries, and a large wellness area for physical and occupational therapy. Verified burn centers must meet a series of stringent criteria that ensure burn care capability and institutional performance. The Burn Center also is verified as a Burn Fellowship Program to train the next generation of burn surgeons.

• • • 1st Care Wound Clinic
    • Bridge Consulting Services
    • Cardiovascular Clinic of Arizona
    • Sameer Chopra, MD
    • Foot Envy
    • Foothills Podiatry
    • Paul M. Francis, MD
    • Integralife
    • Mental Health Center of America
    • Precision Urology
    • Premier Heart and Vascular
    • Scottsdale Rheumatology Center
    • The Heart Rhythm Institute of Arizona
    • Valley Allergy

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