Published October 2023

As a Medicare Advantage Plan and an Affordable Care Act (ACA) Qualified Health Plan, MVP must meet standards for data submission and coding accuracy. To ensure we meet these standards our Chart Procurement Team is currently collecting Medicare records for 2022 and 2023 dates of service. This project will run through the end of December 2023. Additionally, the team is collecting records for the Initial Validation Auditor (IVA) Commercial Audit for 2022 dates of service. The IVA Commercial Audit will run through the end of October 2023. If MVP outreaches your office to request chart collections via fax, phone, or email, please ensure that the request is responded to promptly, as these are time-sensitive requests.

Published October 2023

MVP is committed to providing resources that help you and your patients close gaps in care to ensure good health. Here are some tips to help:

1. Review your monthly Gaps in Care Reports: These monthly reports will help you quickly find which patients still need preventive care services. It may take a couple of months for Members to come off the report, therefore having a system in place that identifies Members that still need care from those who don’t will improve efficiency. If you have any questions, you can contact MVPGapClosures@mvphealthcare.com.
2. Register your MVP Provider online account: Gaps in Care Reports are accessed in your MVP Provider online account. If you don’t already have an account, visit mvphealthcare.com/Providers and Register Now. If you find that you need technical support during the registration process, please contact MVP technical support at 1-888-656-5695 Monday–Friday 8:30 am–5 pm.
3. Submit supplemental medical record data: Follow the instructions in the Gaps in Care Welcome Letter tab so that data goes to the right department for prompt processing.

Published October 2023

Granting MVP remote access to your electronic health records (EHR) allows MVP to help with closing your patients gaps in care and freeing up your staff’s valuable time to work with patients on other important health outcome needs. MVP nurses will be able to access required documentation for Annual HEDIS® medical record reviews, as well as number of other functions that will benefit your patients.

To learn more, visit mvphealthcare.com/Providers and select Resources, then Quality Programs, then Grant MVP remote access to EHRs.

Published October 2023

In 2021, the National Committee for Quality Assurance (NCQA) presented innovative ideas for increasing the use and standardization of electronic clinical data for HEDIS reporting. The NCQA felt the development of the HEDIS Electronic Clinical Data Systems (ECDS) would encourage improved health information exchange, with the secure sharing of patient medical information electronically. This bold strategy enables a digital quality system and aligns with the industry’s move to digital quality measures.

Starting in 2023, New York State and NCQA began implementing ECDS quality measures. This new category of measures will change how we collect information to close gaps in care. ECDS measures allow for four different data sources to contribute to measure performance:

1. Administrative (claims submissions)
2. EHR data feeds
3. Registry data (i.e., HIXNY or HealthE Connections)
4. Case management data

ECDS measures will no longer rely on supplemental data to close gaps in care. The first HEDIS measure that has transitioned to ECDS for measurement year 2023 is breast cancer screening (BCS). Please look out for upcoming communications from MVP on how we will be implementing these changes into our data collection for BCS.If you have any questions about data submission for ECDS quality measures, please contactyour MVP Professional Relations Representative.

Published October 2023

Health care providers are in a unique position to help prevent lead poisoning by identifying high risk children, testing blood lead levels, and referring to appropriate county resources when exposure is identified. The WHO Guideline for Clinical Management of Exposure to Lead recommends a blood lead concentration of five micrograms per decilitre (μg/dL) as a trigger for a thorough review of the ways in which a person is being exposed to lead and for action to reduce or end this exposure. To understand your counties resources, you can find the NYS County Public Health Department at health.ny.gov/environmental then select Lead Exposure & Lead Poisoning Prevention for information.

Published August 2023

New Study Unveils Childhood Vaccine Gaps 

While as a country we’ve made excellent strides in reducing vaccine-preventable diseases through childhood immunizations, efforts are still needed to ensure that we maintain and improve vaccination coverage for our youngest Members.  

A recent study published in PEDIATRICS^® found that one in six toddlers have not completed the childhood 7-vaccine series. The study further revealed that: 

• 1.1% of children were completely unvaccinated 
• 9.9% had not initiated one or more of the combined 7-vaccine series 
• 8.5% were one dose away from completing the combined 7-vaccine series  
• Only 72.9% of toddlers completed the combined 7-vaccine series 
  
  

Furthermore, recent CDC findings show that 93% of kindergarten-age children had received the recommended vaccines during the 2021–22 school year. This is lower than both the 2020–21 school year (94%) and the 2019–20 school year (95%). 

August means back to school prep for many parents, and your office may start to see an increase in well-child visits as well, especially for younger children with school-age siblings. This is a perfect opportunity to make sure their immunizations are up to date. 

Primary care providers play a crucial role in immunizing children. For tips and best practices to help meet these key goals, download the MVP Childhood Immunization Schedule HEDIS provider reference guides. Visit the MVP Provider Reference Library: HEDIS Guides for additional resources. 

Published July 2023

Improving Rates of Preventive Dental Care for MMC Adult Members Ages 21-64 Years

Program Overview

Low-income adults suffer a disproportionate share of dental disease and are nearly 40% less likely to have a dental visit in the past 12 months, compared to those with higher incomes. Poor oral health can increase risks for chronic conditions such as diabetes, heart disease, and tooth decay—currently the most common chronic disease in the US. The NYS Department of Health (NYSDOH) recognizes the importance of annual dental visits and good oral health for the Medicaid Managed Care (MMC) population. The current NYS PIP, Improving Rates of Preventive Dental Care for MMC Adult Members Ages 21-64 Years, aims to help improve preventive dental care rates among this population, by focusing on three areas:

1. Annual dental visits (ADV)
2. Emergency department visits for non-traumatic dental conditions (NTDC-ED)
3. Social determinants of health (SDOH)
   
   

To align with the goals of the NYS PIP, MVP has partnered with Healthplex, facilities, and providers to increase ADVs, reduce NTDC-ED, identify and address SDOH affecting preventive dental care, and improve Member experience and access to appropriate care.

Based on partial 2022 data, MVP Members have made significant progress reducing NTDC-ED, but more work needs to be done to promote ADVs among the MMC population as ADVs are still experiencing a downward trend.

To help better understand some of the SDOH barriers keeping Members from having routine dental care, MVP conducted a survey among Medicaid Members ages 21-64 in the Northeast region. Among those who have not received dental care in the last 12 months, many (59%) noted the COVID-19 pandemic had at least some impact on their dental care. Barriers such as finding childcare, or transportation were mentioned less frequently. Now that the COVID-19 public health emergency has ended, there is an opportunity to help Members get back on track with their routine dental care.

Dental Care is Primary Care

Primary care teams can help Members understand the importance of oral health in the context of their overall health and reinforce the importance of annual dental visits and preventive care. Additionally, PCPs and their teams can leverage their skills, resources, and tools to intervene in the oral disease process by:

• Asking about the Member’s oral health, risk factors, and symptoms of oral disease
• Looking for signs that indicate oral health risk or active oral disease
• Identifying SDOH or local/regional barriers to dental care
• Deciding on the most appropriate response
• Offering preventive interventions, referral for treatment, and/or self-care practices

Published November 2022

MVP encourages the use of CPT II and LOINC codes when submitting claims for Controlling High Blood Pressure (BPD, CBP), Eye Exam (EED), and Kidney Evaluation (KED) measures for patients living with diabetes. 

CPT II codes are not billing codes. They are used for the purpose of quality measurement. They may be submitted to MVP independently of billing codes. They provide results of a service.

LOINC codes are not billing codes. They are used to identify laboratory tests and clinical assessments. They provide results of a lab test.

View CPT II Codes for Eye Exam (EED)

View CPT II and LOINC Codes for Kidney Health Evaluation (KED)

CPT II Codes for BPD, CBP

Published November 2022

An A1c should be completed at least twice a year, or every three months for unstable patients or those with medication changes. CPT II Codes can be used to close this gap.

Members are encouraged to talk to their Provider about scheduling their A1c test, either by calling your practice or during well visits.

Published November 2022

Screening or monitoring for diabetic retinal disease for individuals with type 1 or 2 diabetes is an important testing tool for detection or monitoring of diabetic retinopathy. To close gaps in care for the Eye Exam for Patients with Diabetes (EED) measure, any of the following are needed:

• Retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year.
• A negative retinal or dilated eye exam for retinopathy by an eye care professional in the year prior to measurement year.
• Bilateral eye enucleation any time during the member’s history through December 31 of the measurement year

CPT II Codes can be used to close an EED Gap

Use of Retinal Hand-Held Cameras

Primary Care practices who have point of care services with retinal hand-held cameras can close gaps in care by submitting a claim with the appropriate codes showing that the exam was completed, the results, and noting that the exam and results were read by an eye care professional. Review the Coding Reference Guide for EED.

Primary Care practices without retinal hand-held cameras can help close gaps in care by recommending patients see an optometrist or ophthalmologist and completing the MVP Eye Care Consultation for Diabetic Patients form. This form is also available in Spanish.

Published October 2022

Medication adherence for chronic conditions is an ongoing challenge. One in 2 Americans has a chronic condition1, yet 50% of medications for chronic conditions are not taken as prescribed2. As a result, the estimated annual cost for medication nonadherence in the Unites States is $298 billion3.

To help promote medication adherence for prescribed therapies and to support our Members stay on track with what may be complex medication regimens, MVP is participating in the CVS Caremark™ (CVS) Adherence Program.

Program Overview

As of July 1, 2022, CVS has been notifying prescribers via fax that an MVP Member is late to fill their medication or is considered off therapy.

• Late to Fill communication – Prescribers are notified 10 days past the first refill due date (with no refill claim)
• Off Therapy communication – Prescribers are notified 10 days past the second refill due date (with no refill claim)

Prescriber communications are sent within 72 hours of claim adjudication for Medicaid, Medicare, Commercial, and Marketplace Members with prescribed therapies for:

• Behavioral health
• Benign prostatic hypertrophy (BPH)
• Breast cancer
• Coronary artery disease/ischemic heart disease
• Diabetes
• Heart failure
• High cholesterol
• Hypertension
• Osteoporosis
• Parkinson’s disease
• Respiratory disease

CVS will also outreach MVP Medicare, Commercial, and Marketplace Members directly via direct mail, telephonic outreach, and/or email (if email address is on file):

• 10 days past the first refill due date (with no refill claim)
• 10 days past the second refill due date (with no refill claim)
• 15 days prior to refill due date, if utilizing CVS prescription mail order service

Better Adherence, Better Outcomes

Engaging with MVP Members and prescribers can help to improve adherence and close medication therapy gaps. Automatic refills and alerts can help Members avoid lapses in their medication therapy. By working together to help close medication adherence gaps, prescribers are equipped with evidence-based information to enhance their patient’s drug therapy. Adherence promotion and alignment with our Providers will lead to enhanced support and improved outcomes, and more importantly, a more personal and positive health care experience for our Members, your patients.

1. Cassil, Alwyn. Rising rates of chronic health conditions: What can be done? Center for studying health system change 2008; no.125.
2. https://www.ncbi.nlm.nih.gov/pubmed/22964778.
3. DeVol, R., Bedroussian, A. An Unhealthy America.

Published July 2023

August is Immunization Awareness Month, and a time when parents get their children ready to go back to school.

Some parents may have concerns that vaccines have harmful side effects. As you educate and discuss immunization needs with the parents/child it’s important to remind them that in NYS and Vermont, certain vaccines are mandatory for acceptance into day care, and pre-K—12th grade.

Parents must show proof of a child’s up to date immunizations within 14 days of the first day of school or day care. The only exemption from vaccinations in NYS is a valid medical exemption. To obtain a valid medical exemption in NYS, the NYSDOH Bureau of Immunization/Division of Epidemiology requires the ‘Immunization Requirements for School Attendance Medical Exemption Statement for Children 0-18 Years of Age’ form. (This form is number DOH-5077 and can be found at health.ny.gov/forms/doh-5077.pdf). A NYS licensed physician must complete the medical exemption statement.

In Vermont, exemptions from vaccination requirements are allowed for religious or medical reasons. The medical immunization exempt form is available by visiting healthvermont.gov/disease-control and selecting Immunizations, then Immunization Information for Child Care and School Providers. The form must be completed by the child’s health care Provider.

Recommended for Children and Adolescents:

• Human papillomavirus (HPV)-Initial dose of the HPV vaccine after they turn nine years old
• Flu - Children (over six months old) should get their flu shot each year
• COVID-19 - The CDC recommends children (over six months old) get their primary series of COVID-19 vaccines and receive a booster dose when eligible

Source sites: 

1. healthvermont.gov/disease-control/immunization/immunization-information-child-care-and-school-providers 
2. health.ny.gov/prevention/immunization/schools/school_vaccines

Published October 2022

Blood glucose control remains a critical component of managing diabetes and avoiding complications. This summer, MVP communicated with Members living with diabetes who have a gap for an A1c test, reminding them that this simple blood test is an important way for them and their Provider to know if their diabetes is in good control. An A1c should be completed at least twice a year, or every three months for unstable patients or those with medication changes.

Members are encouraged to talk to their Provider about scheduling their A1c test, either by calling your practice or during well visits.

We appreciate your support and collaboration in helping to close these important gaps in care.

Published July 2023

Each summer, MVP mails an Asthma Action Plan to school age kids in a Medicaid (NY) or Commercial (NY, VT) plan. Members are encouraged to complete the action plan, keep a copy for themselves, and share copies with their doctor and with their school. Our goal is to educate Members on the importance of completing an asthma action plan, while ensuring school staff understand how they can help our young Members in the event of an asthma attack. 

Your patients living with asthma may have questions or ask for input in completing their action plan. As always, we appreciate your support and guidance of our Members.

Published October 2022

In an effort to support the health of Members who are living with diabetes, while also helping to close gaps in care, MVP is conducting Member outreach to Medicare and Medicaid Members who have a gap in two of the following measures: retinal eye exam, A1c test, and/or kidney health evaluation. Through this outreach effort (starting late September and running into early October), MVP will assist Members with scheduling PCP appointments and educate them about the importance of diabetic screenings. Please be aware that this effort may lead to increased calls to your office as patients inquire about which preventive screenings and tests are appropriate. We appreciate your support and care of our Members in need of these services.

Published July 2023

September is Suicide Prevention Month—a time to raise awareness about this often-stigmatized topic.Suicidal thoughts, much like mental health conditions, can affect anyone regardless of age, gender, or background. Incidentally, suicide is often the result of an untreated mental health condition.

Follow-up care supports the transition of individuals who are in suicidal crisis as they continue their journey toward recovery. Research shows that 43% of suicides occur within a month of discharge from a hospital and that 47% of those individuals died before their first follow-up appointment.But follow-up care can be an impactful method of suicide prevention. To learn more visitfollowupmatters.988lifeline.org.

For more tips and best practices on follow-up care after an ED visit for your patients visit mvphealthcare.com/providers/communications-center and select Closing Gaps in Care, and then Tips for Providers (FUA, FUM).

MVP also provides telephonic case management with licensed behavioral health clinicians who can help link customers with in-network outpatient therapists, assist with access to other social service needs, provide information about other supportive resources, and much more. If you have a patient that would like access to our Case Management program, call MVP at 1-866-942-7966. Or visit mvphealthcare.com/behavioralhealth to learn more.

Published October 2022

Attention-deficit hyperactivity disorder (ADHD) is one of the most common behavioral health disorders in children. To ensure medication is prescribed and managed correctly, it is essential that children be carefully monitored by their health care provider. The HEDIS ADD measure evaluates follow-up care and medication compliance for children six to 12 years old who are prescribed medication to treat ADHD; it includes two phases, both of which must be passed to close this measure:

Phase 1 – Initiation Phase (ADD-I)

• One or more follow-up visits within 30 days from the date the prescription was filled, with a provider with prescribing authority that meet criteria.
• This visit can be in-person or via telehealth. 

Phase 2 – Continuation and Maintenance Phase (ADD-C)

• Member remained on the ADHD medication for at least 210 days.
• Two or more follow-up visits within 270 days after the end of the initiation phase (day 31 to 300 from the prescription fill date).
• Both visits can be done in-person or via telehealth.

Only one of the two visits can be on-line e-visits or virtual check-in. The other visit would have to be in-person or via telehealth.
To help support Participating Providers, MVP conducts outbound telephonic outreach and letter campaigns to the caregivers of:

1. Newly prescribed members as a reminder to set up an initial visit within the first 30 days of the prescription dispensing date.
2. Members who have passed the Initiation phase are reminded to schedule at least two more visits within nine months of the start of the medication.

Tips and Best Practices for Provider Offices to Help Improve ADD Performance

• Comply with the American Academy of Pediatrics (AAP) recommendation of both behavioral therapy and medication for children six to 12 years old.
• Understanding what the medication is going to do and how it will make them feel is an important part of establishing awareness and ensuring better compliance. Educate the patient and caregivers about:
• How and when to take the medication.
• Common side effects such as increased blood pressure, weight loss, anxiety, agitation, and insomnia.
• Potential for abuse and use of legal medication for illegal purposes.
• Set up a follow-up visit plan with the parent or guardian, and child if necessary.
• Establish this visit within 2–3 weeks of the initial medication therapy.
• Once the child attends the initial follow-up visit, schedule the additional two visits within nine months of the start of the medication.
• Ask questions to assess the child’s response to the medication, as it is often necessary to adjust to establish the correct dosage.
• Reach out to members/caregivers who cancel appointments and assist them with rescheduling as soon as possible.
• Refer the member to a behavioral health provider for consultation when clinically appropriate.
• Ensure coordination of care by sending progress notes and updates

Published April 2023

No one knows better than you that for patients who are living with persistent asthma, proper medication management includes the use of controller medications. In fact, the proper use of controller medications may reduce the need for a rescue medication, as well as ER visits, inpatient admissions, and days of school or work missed.Ensuring optimal asthma management can be challenging at times, and MVP is here as a partner to support you in providing this high-quality care.

Best Practices for Patients with Asthma

• Prescribe a controller medication for patients who do not have one. View the Formulary for a list of covered controllers by visiting mvphealthcare.com/providers and selecting Pharmacy
• Check the patient’s ratio of controller to rescue medication; ensure that for every two controller prescriptions your patient has filled at a pharmacy, they have only one rescue inhaler prescription filled
• Help your patient understand the benefit of using a controller medication regularly rather than only using a rescue medication to manage their asthma
• Instruct your patient on proper inhaler and spacer use (if appropriate)
• Encourage patients to carefully review their asthma newsletter, Breathing Easier, mailed biannually by MVP
• Work with your patient on their Asthma Action Plan so they understand their triggers and what to do during an asthma attack. Copies of the plan go to the patient, school, and with you for your records. Patients can request an Asthma Action Plan by contacting MVP Case Management at
  1-866-942-7966

Published April 2023

Coding guides are available for select Adult Behavioral Health Care, Adult Preventive Care and Medical Conditions, Child and Adolescent Care (Physical and Behavioral Health), Diabetes Management, and Women’s Preventive Care quality measures. Visit mvphealthcare.com/providers, select Reference Library, and then select 2023 Provider Coding Reference Guides for HEDIS Measures.

Published October 2022

Presented by the Cancer Services Program of the Finger Lakes Region

These virtual programs are free and available to everyone. Pass it on to your patients, family, or friends who may need their preventive cancer screenings!

Get the Facts on Breast Cancer Screenings, Risks, and Resources
Thursday October 20, 2–3 p.m. Register Now

Get the Facts on Cervical Cancer Screenings, Risks, and Resources
Thursday October 27, 2–3 p.m. Register Now

Get the Facts on Colorectal Cancer Screenings, Risks, and Resources
Thursday November 3, 2–3 p.m. Register Now

Each program will also be presented in Spanish.

To find more Living Well Programs, visit our MVP Living Well Calendar. 

Published April 2023

Mental (or behavioral) health is just as important as physical health, as it can drastically affect quality of life when imbalanced. MVP understands the increasing demands on Providers when it comes to meeting both the physical and behavioral health needs for your patients. To help ensure your patients receive the care they need, MVP offers several telehealth options for Members to access virtual behavioral health support including:

MVP also provides telephonic case management with licensed behavioral health clinicians who can help link customers with in-network outpatient therapists, assist with access to other social service needs, provide information about other supportive resources, and much more. If you have a patient that would like access to our Case Management program, Providers, the Member, or a designee can call MVP at 1-866-942-7966. Or visit mvphealthcare.com/behavioralhealth to learn more.

Published April 2023

Timely follow-up care after your patient has been discharged from the hospital or emergency department (ED) for a behavioral health (BH) event helps improve physical and mental function, increases compliance with follow-up instructions, reduces avoidable readmissions, and overall, improves health outcomes. Research also suggests that close follow-up care for people living with a behavioral health condition after a BH event:

• Reduces incidents of suicidal ideation, suicide attempts, and completed suicide
• Reduces substance abuse and improves entry into recovery
• Reduces ED use and hospital admissions
• Leads to better identification and treatment of behavioral and physical health issues

Not a behavioral health Provider? While your patient’s follow-up care requires a visit with a BH provider (psychiatrist, psychologist, clinical social worker, or other therapist), as their PCP, there are strategies your practice can implement to establish continuity of care:

• If the hospital discharge planner calls your practice to schedule a follow up visit, and the hospitalization was for a BH event, coordinate with the discharge planner to make the appointment with the Member’s BH provider
• If the Member calls your practice after discharge from a hospital or ED for a BH event, implement office procedures to assist them to schedule a follow up visit with their BH provider
• If the Member does not have a BH provider, refer them to mvphealthcare.com/FindaDoctor and use the Doctors by Specialty or Places by Type search options
• Develop a referral relationship with mental health and substance use disorder Providers close to your office

For additional information on improving your quality performance and closing gaps in care for FUH and FUA, visit mvphealthcare.com/providers, select Reference Library, and then 2023 Provider Coding Guides.

Published April 2023

NEW Measure Highlight: Developmental Screening in the First Three Years of Life

In 2022, NYS introduced a new QARR measure: Developmental Screening in the First Three Years of Life (DEV-N) which was adapted by NYSDOH, with permission, from the “Developmental Screening in the First Three Years of Life” measure stewarded by Orgon Health and Sciences University.

DEV-N looks at the percentage of children screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the 12 months preceding or on their first, second, or third birthday.

Important things to note:

• Developmental screening as described here requires a global (multi-domain) screen and not a single-domain screen, like autism
• Screening tools must include the developmental domains for motor, language, cognitive, and social-emotional development
• Tools must have established reliability scores of approximately 0.70 or above
• Claims data requires the use of CPT code 96110 orICD-10-CM code Z13.42
• Do not include modifiers added to claims indicating standardized screening for a specific domain of development—DEV-N is anchored to recommendations focused on global development screening using tools that focus on identifying risk for developmental, behavioral, and social delays

Documentation standards in the medical record:

• A note indicating the date on which the test was performed
• The name of the standardized tool used
• Evidence of a screening result or screening score

For a list of standardized tools that meet criteria cited by Bright Futures and the American Academy of Pediatrics statement on developmental screening, visit aap.org/brightfutures and select Practice Management, then Materials and Tools, and then Bright Futures Tool and Resource Kit, second edition.

Published April 2023

The HEDIS quality measure for Osteoporosis Management in Women Who Had a Fracture (OMW) looks at the percentage of women 67-85 years of age who suffered a fracture and who had either a BMD test or prescription for a drug to treat osteoporosis in the six months after the fracture. The current measurement year for OMW (July 1, 2022-June 30, 2023) will soon end. The time for closing these gaps in care is now.

View the OMW Coding Guide at mvphealthcare.com/providers. Select Reference Library then 2023 Provider Coding Guides for HEDIS Measures.

Expanding Osteoporosis Testing

You may consider expanding evaluation to individuals who have health and physical risk factors that could pre-dispose them to developing osteoporosis, including:

• An autoimmune disorder (rheumatoid arthritis, lupus, multiple sclerosis)
• An endocrine or hormonal disorder (hyperparathyroidism, Cushing’s syndrome, hyperthyroidism, low testosterone)
• A digestive disorder (inflammatory bowel disease, poor absorption)
• HIV/AIDS
• COPD
• History of transplant
• Family history of osteoporosis
• Risk factors such as poor diet, loss of weight, smoking, increased alcohol consumption, etc.

Published April 2023

As Spring arrives, MVP’s HEDIS Operations team will close out the annual HEDIS Review to make way for the 2023 Gaps In Care (GIC) Program.

Provider practices can resume sending GIC documentation to mvpgapclosures@mvphealthcare.comafter May 1, 2023.

Please be sure to use the publication of the March 2023 GIC report to allow for Q1 claims to process. For information on how to access your practice’s monthly GIC report, visit mvphealthcare.com/providers, select Reference Library, then HEDIS Measures and Gaps in Care Resources.

Please follow the guidelines below to help streamline our GIC program and process submissions most efficiently:

• Use one dedicated cover sheet for each date of submission, completed in its entirety. The cover sheet can be found in a separate tab accompanying the GIC reports. It’s important for the review team to have an office contact for follow-up so our team can communicate with you if further documentation is needed
• Attach individual patient records to your transmission as opposed to sending batch files that are not separated per Member. This improves processing time for your submissions
• Make sure the patient name on all documents matches the name shown on the GIC report. If the name on a report differs, submit the Member’s demographic sheet showing the former name (i.e., change in marital status). HIXNY demographic information also shows all aliases for Members who are enrolled. Please submit that document if necessary
• Follow all measure specifications shown in the GIC Cover sheet tab as a guide to required documentation and specific timeframes for each measure
• Maintain a tracking mechanism to avoid duplicate submissions. Allow 60 days for a patient’s “required” service to show a “pass” for that measure on the report. Do not re-submit the same documentation before two more GIC reports have been published
• Do not submit documentation for members who don’t appear on the GIC report. We will not be able to process it
• Be sure to use the most recent GIC report for all submissions to ensure the gap has not already been closed with a claim

MVP HEDIS Operations Team thanks you in advance for your attention to these guidelines. Submit questions about our GIC process to mvpgapclosures@mvphealthcare.com.

Published January 2023

A New HEDIS Hybrid Measure

Eligibility Criteria:

• Members who are enrolled in MVP DualAccess (HMO-DSNP), a new plan offering in 2022 for dual-eligible individuals (Medicare/Medicaid)
• Members must be 66 years of age or older in 2022 and had each of the following services completed during the measurement year:

1. Medication Review documented by a clinical pharmacist or prescribing provider in 2022. The review must occur in an outpatient setting or non-acute facility and may include telephone encounters or telehealth visits. The Member does not need to be present for a medication review. A current medication list must be filed in the medical record.NOTE: Members who received Transitional Care Management Services in 2022 are also compliant for this sub-measure.
2. Functional Status Assessment performed in an outpatient setting or non-acute facility and may include telephone encounters or telehealth visits. All components must be documented in 2022 but may take place during separate visits. Functional Status Assessment components include:
   
   • Documentation of a complete functional status assessment that includes the ability to perform activities of daily living (ADLs) and instrumental ADLs (IADLs); or
   • Completion of a Functional Status Assessment Tool filed in the medical record.
3. Pain Assessment performed in an outpatient setting or non-acute facility and may include telephone encounters or telehealth visits. At a minimum, documentation must show that:
   
   • The patient was assessed for pain; or
   • A standardized pain assessment tool was completed.

MVP publishes various tools and resources to help support Participating Providers close gaps in care for COA and other HEDIS measures. Visit mvphealthcare.com/Providers, select Reference Library, and then select HEDIS Measures and Gaps in Care Resources.

Published October 2022

Providers can submit supplemental data for 2022 dates of service gap closure at any point during the year. Access your MVP Gaps in Care Report for submission instructions.

MVP Health Care® (MVP) is pleased to announce the launch of a 2022 Primary Care Provider Medicaid Incentive Program.

Program Overview

Eligible primary care provider groups have an opportunity to earn incentives for closing gaps in care for Members in need of preventive or health monitoring services. This Incentive Program includes 19 quality measures. Participating Providers will earn $20 for each claim-basedmember gap in carethat is closed from August 1, 2022-December 31, 2022.

 Eligibility Criteria

To be eligible for this TIN level Provider Incentive Program, primary care provider groups must have at least 30 or more attributed MVP Medicaid Members by December 31, 2022. Additionally, eligible provider groups cannot be in a current quality pay-for-performance arrangement with MVP.

Eligible groups should have received a letter from MVP that outlined the Incentive Program, along with information on the quality measures, resources, and potential earnings available.

If you have questions about the program or your eligibility, please call the MVP Quality Incentive Hotline at 1-866-954-1869 or email MVPQualityIncentive@mvphealthcare.com.

Published January 2023

The annual HEDIS medical record collection project will begin the first quarter of 2023. MVP is contracting again with Inovalon to conduct record collection on behalf of MVP. Reminder letters will be sent out to Participating Providers. 

We understand this is a highly intensive process that requires a lot of your staff’s time. To help reduce the burden, consider granting MVP access to your electronic health record (EHR). This will allow MVP to collect the information needed instead of utilization of your valuable staffing resources. For further information or if you would like to grant MVP EHR access, please contact Melissa Alter at melkelly@mvphealthcare.com. As always, we appreciate your partnership.

Follow-Up After Emergency Department Visit for Alcohol and Other Substance Use or Dependence (FUA) measures the rate of your patients ages 13 and older with a diagnosis of alcohol or other substance use or dependence, who have had an emergency department (ED) visit and need a follow-up visit within seven or 30 days of the ED visit.

Follow-Up After Emergency Department Visit for Mental Illness (FUM) measures the rate of your patients ages six and older with a diagnosis of mental illness or intentional self-harm, who have had an ED visit and need a follow-up visit for mental illness within seven or 30 days of the ED visit. 

Why follow-up care after an ED visit matters 

Timely follow-up care after your patient has been discharged from the ED, whether it be for a physical or behavioral health event, may reduce repeat ED visits, increase compliance with follow-up treatment plans, and help to improve overall health outcomes. Closing these gaps for your patients will also help to improve your HEDIS quality performance scores. Follow-up visits can be with any provider if the primary diagnosis for the ED visit is due to alcohol or other substance use/dependence, mental illness, or intentional self-harm. 

Primary care providers are encouraged to establish continuity of care by connecting patients with appropriate behavioral health providers in their area. You can further facilitate integrated health care by encouraging your patients to sign a release of information.

For additional information and best practices to help improve quality performance, download the MVP HEDIS Reference Guides for Primary Care:

• Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA).
• Follow-Up After Emergency Department Visit for Mental Illness (FUM)

Published January 2023

As a Medicare Advantage Plan and an ACA Qualified Health Plan, MVP must meet standards for data submission and coding accuracy. The MVP Risk Adjustment team conducts annual reviews of Member records to meet these standards, and throughout the year we will randomly request to collect EHR or paper charts, depending on your system’s capabilities. The purpose is to verify that serious or chronic medical conditions are being reported with the right diagnosis as well as being coded to the highest level of specificity for those diagnoses.

Starting at the end of December 2022 through April 2023, MVP will collect records for services performed in 2022 for the Commercial Chart Review Project. We will follow that with the Medicaid Chart Review beginning February 2023 through July 2023. Lastly, the Medicare Chart Review will run April 2023 through December 2023. For any questions, please contact Anselmo Nieves at anieves@mvphealthcare.com.

Every MVP Member deserves quality health care. MVP’s Strategic Provider Engagement Team helps drive clinical innovation and collaboration with our provider partners to help achieve the best outcomes for our Members. Utilizing a regional approach to engage with high volume hospitals, health systems, and provider groups, together we can:

• Improve member/patient care, efficiency, and coordination.
• Be more efficient with decision-making and transparency to help reduce multiple member/patient touches while still providing focused care.
• Increase quality performance.

Clinical alignment with our providers will lead to enhanced support and improved outcomes, and more importantly, a more personal and positive health care experience for our Members, your patients. 

To learn more contact:

Tracy Tadarro-Ott 
Director, Member and Client Advocacy

Lauren Dyroff 
Leader, Strategic Provider Engagement 

Published January 2023

Adherence to statin medications can aid in risk reduction of clinical atherosclerotic cardiovascular disease (ASCVD) for patients living with cardiovascular disease (CVD) and/or diabetes. As such, the National Committee for Quality Assurance (NCQA) has two unique statin therapy measures.

Statin Therapy for Patients with Cardiovascular Disease (SPC) assesses males 21-75 years of age and females 40-75 years of age during the measurement year, who are identified as having ASCVD and meet the following criteria:

• Received at least one high or moderate intensity statin medication during the measurement year.
• Had adherence to the statin medication regimen for at least 80% of the treatment period.

Statin Therapy for Patients with Diabetes (SPD) assesses individuals 40-75 years of age with a diagnosis of diabetes and no diagnosis of ASCVD, and who meet the following criteria:

• Members who have received at least one statin medication of any intensity during the measurement year and
• Had adherence to the statin medication regimen for at least 80% of the treatment period.

As a point of reference, the American Diabetes Association recommends that individuals living with diabetes and a history of CVD, as well as those older than 40 years of age without CVD but with CVD risk factors, should be treated with a statin regardless of their baseline LDL cholesterol concentration.

When prescribing statins to Patients living with cardiovascular disease or diabetes, please ensure the medication is included in the MVP Formulary. To review the following a table for High, Moderate, and Low-intensity statin medications that will best suit your Patient, see the table below.

Published July 2022

Each year before the back-to-school season begins, MVP mails Asthma Action Plans to New York State and Vermont Members aged 6–17 who have an asthma diagnosis. MVP wants to make sure that families are prepared and thinking about the care of their child’s asthma while at school. The 2022 Asthma Action Plans will mail this summer, along with a letter encouraging parents to take the Asthma Action Plan to their child’s doctor to complete. The purpose of this Plan is to help families become proactive and anticipatory with respect to asthma exacerbations and their control. The Asthma Action Plan should be used as an education and communication tool between the provider, the Member living with asthma, and his or her family. 

Questions that you can discuss with the Member and his/her parents include:

• What would you like to see happen when managing your child’s asthma at school?
• What is the most important thing about managing your child’s asthma in school?
• What do you need to do to have this happen?

The Member/family should be able to demonstrate an understanding of the plan and the appropriate use of medicines. In addition, this form has been designed for the PCP to use with families who need a simple asthma management regimen. Once a family has become more informed about asthma, a plan can be developed with additional flexibility in treatment. Families should be given additional educational materials about asthma, peak flow monitoring, and environmental control. A spacer should be prescribed for all patients using an MDI.

A copy of the Asthma Action Plan should stay with the family, another copy should be provided to the school or daycare, and a copy should be on file with the Provider. For additional tools and resources on Asthma management, visit mvphealthcare.com/PQIR, then select Respiratory.

Published January 2023

Off-cycle HEDIS measures do not follow the January-December measurement year (MY) like other HEDIS measures. Here is what you need to know to help close gaps in care for off-cycle measures:

Published July 2022

MVP would like to stress the importance of scheduling Members for preventive health maintenance screenings and diagnosis related services that need to be performed by 12/31/2022. The monthly Gaps in Care (GIC) report helps provider practices find those Members and is a valuable tool to help improve HEDIS/quality rates.

Here Are Helpful Reminders About Medical Record Submissions

• Make sure Membername and date of birth (DOB) are shown on each document. If a report does not include DOB, add a demographic sheet (or similar) to avoid a call for date of birth validation.
• If a Member has had a name change and documentation needed shows a former name, include a demographic sheet showing both names and DOB to avoid a call for name validation. If the patient is registered with your local RHIO, a list of all names that have been used can be found in their demographic documents.
• Send all pages of office notes to include provider signature. This will help avoid calls for the complete note.
• Please do not send documentation not specifically outlined in the GIC cover page detail.
• Contact us: mvpgapclosures@mvphealthcare.com for more guidance with your submissions.

MVP offers additional tools and resources to help your practice close gaps in care. Visit mvphealthcare.com/providers, select Reference Library and then select the HEDIS Measures and Gaps in Care Resources accordion.

Improving Rates of Preventive Dental Care for MMC Adult Members Ages 21-64 Years

Published July 2022

Low-income adults suffer a disproportionate share of dental disease and are nearly 40% less likely to have a dental visit in the past 12 months, compared to those with higher incomes. Poor oral health can increase risks for chronic conditions such as diabetes, heart disease, and tooth decay—currently the most common chronic disease in the US. The NYS Department of Health (NYSDOH) recognizes the importance of annual dental visits and good oral health for the Medicaid Managed Care (MMC) population and is the foundation for the NYS PIP Improving Rates of Preventive Dental Care for MMC Adult Members Ages 21-64 Years. To help improve preventive dental care rates among this population, MVP will focus on three areas:

• Annual dental visits
• Emergency department for non-traumatic dental conditions
• Social determinants of health

Visit mvphealthcare.com/providers/communications-center and select Closing Gaps in Care, then select Improving Rates of Preventive Dental Care to review the NYS PIP and how primary care teams can help Members understand the importance of oral health in the context of their overall health and reinforce the importance of annual dental visits and preventive care.

Published July 2022

The fear of falling becomes more common as people age. Studies show that a fear of falling can keep older adults from going about their normal activities and, as a result, they may become frailer, which actually increases their risk of falling. Talk to your older patients about their risk for falling and create a personal prevention plan that best fits their lifestyle. To help get the conversation started, download the MVP brochure. To request printed brochures, contact your MVP Professional Relations Representative.

Published July 2022

MVP would like to extend a sincere thank you for your participation in the annual HEDIS chart collection and making it a successful season! We know this is a busy time for you and your staff. MVP appreciates your ongoing support and collaboration to ensure our Members continue to receive excellent care. If you have any questions on submission of data to support gap closures year-round, please email mvpgapclosures@mvphealthcare.com to connect with the appropriate Quality staff.

Published July 2022

Last quarter, MVP announced our collaboration with BioReference Laboratories to provide MVP Members an easy way to complete their medically necessary lab testing. Since then, we have launched a pilot program for what we hope will be a simple and easy way for Members—and their Providers—to close certain gaps in care.

The pilot program uses a standing order protocol to trigger home-based lab test collection orders for MVP Medicaid Members who are overdue for diabetes-related testing.

Currently, the pilot includes MVP Medicaid Members who:

1. Have a diagnosis of type 2 diabetes; and
2. Have no record of recent HbA1c test, urine Albumin-Creatinine Ratio, or fasting lipid panel.
   
   

Identified Members are offered the option to schedule home-based lab collection with Scarlet Health®. Scarlet lab technicians will send lab specimens to be processed at a BioReference Laboratories facility. Results are available to the patient through the BioReference secure patient portal and will also be sent to the listed Primary Care Provider via fax.

MVP is working with our virtual care partner to conduct immediate clinical outreach for all patients with an abnormal result. The virtual care Provider will assess the patient and facilitate next steps, including follow up directly with the patient’s Provider. The patient’s Provider will be sent a copy of that visit note for your records.

The gap closure will be credited to the Member’s attributed Provider. We expect this to have positive results for both Providers and MVP’s quality scores. We appreciate your support of this initiative. For more information, or if you would like to partner with MVP in bringing this solution to your patients, please contact your Professional Relations Representative.

Did you know?

• 51.9% of men aged 20 and over have hypertension
• 24.1% of men aged 20 and over have heart disease
• 13.2% of men aged 18 and over are in fair or poor health
  
  

June is men’s health awareness month, and studies conducted throughout the last two decades have shown that men are less likely (than women) to get routine physical exams and screenings. In fact, most will not go to the doctor unless they feel sick and even then, they often choose a walk-in urgent care facility over a visit to a primary care provider. A study published in June 2021 by the insurance company Aflac found that in the United States, out of 1,000 men (ages 18 years and older) surveyed, 45% had not had an annual wellness visit or checkup in the past 12 months and 60% missed visits for preventive care services such as screenings and vaccines. As primary care providers, you and your staff can directly affect the health and wellness of your male patients, but the first step is getting those Members into the exam room. Some potential strategies to help overcome that first hurdle include:

• Focus on member priority rather than clinical importance.
• Describe to the member what this visit includes and try to identify what appeals most to him (i.e., risks due to family history, previous injuries, sexual health, physical activities, etc.)
• Provide a health risk appraisal for the member to complete ahead of the visit so that he has a sense of what to expect.
• Identify barriers such as transportation, time off from work, or lack of childcare and discuss potential solutions to overcome these barriers.

Maintaining annual wellness exams, completing preventive care services, and managing chronic conditions with blood pressure checks, cholesterol screenings, and medication adherence will also help to improve your practice’s quality performance. During well-person exams, it is extremely important to talk about what preventive services are recommended/due based on age and any risk factors that may be due to ethnicity and lifestyle. 

Counsel and screen for the following at every wellness exam:

• Diet and exercise
• High blood pressure
• Smoking cessation
• Mental health disorders
• Substance use disorders
• HIV and other STI’s
• Dental health
• Other lifestyle or age-related concerns

Review history and order screenings, as needed, for:

• Colorectal cancer screenings (men aged 45 and over and at average risk may be eligible for Cologuard®).
• Diabetes screening services for members who are overweight or obese
• Cholesterol screenings for members at certain ages or have a higher risk for developing high cholesterol

Review immunization history and schedule for upcoming or catch-up vaccines, recommended by age, including but not limited to: 

• COVID-19
• Annual flu shot
• HPV (catch up to age 45)
• Tdap/DTaP
• Pneumococcal
• Shingles 

Program Overview

Low-income adults suffer a disproportionate share of dental disease and are nearly 40% less likely to have a dental visit in the past 12 months, compared to those with higher incomes. Poor oral health can increase risks for chronic conditions such as diabetes, heart disease, and tooth decay—currently the most common chronic disease in the US. The NYS Department of Health (NYSDOH) recognizes the importance of annual dental visits and good oral health for the Medicaid Managed Care (MMC) population and is the foundation for the NYS PIP Improving Rates of Preventive Dental Care for MMC Adult Members Ages 21-64 Years. To help improve preventive dental care rates among this population, the PIP will focus on three areas:

1. Annual dental visits (ADV)
2. Emergency department for non-traumatic dental conditions (NTDC-ED)
3. Social determinants of health (SDOH)

MVP identified that in 2019, only 25% of MMC adult members completed an ADV and there were more than 1,700 member visits for NTDC-ED. Between 2019 and 2021, MVP MMC adult membership increased over 60%. However, partial 2021 data indicate similar trends for NTDC-ED and a downward trend for ADV. 

According to the CDC, in the US, nearly twice as many Black and Mexican American adults have untreated cavities compared to White adults. The CDC also reports that about 40% of adults with low-income or no private health insurance have untreated cavities.

Dental Care is Primary Care

Primary care teams can help members understand the importance of oral health in the context of their overall health and reinforce the importance of annual dental visits and preventive care. Additionally, primary care providers and their teams can leverage their skills, resources, and tools to intervene in the oral disease process:

• Ask about the member’s oral health, risk factors, and symptoms of oral disease.
• Look for signs that indicate oral health risk or active oral disease.
• Identify SDOH or local/regional barriers to dental care.
• Decide on the most appropriate response.
• Offer preventive interventions, referral for treatment, and/or self-care practices.
• To align with goals for the NYS PIP, MVP has partnered with Healthplex, facilities, providers, and community partners to reduce NTDC-ED, increase ADVs, and improve member experience, access to appropriate care, and overall member health.

Published April 2022

Medication adherence is a critical aspect for managing chronic conditions such as diabetes and hypertension. Despite its importance, medication nonadherence continues to be a serious problem and a leading driver of poor health outcomes.

Strategies for Improving Medication Adherence:

• Ensure open and ongoing communication between you and your patient, with the goal of achieving optimal health outcomes. For example, when ordering the initial prescription, educate the Member on the benefits and potential side effects.
• Leverage all visits, including annual wellness and sick visits to conduct medication reconciliation. Patients fail to take their medications about 50% of the time. Medication reconciliation creates an opportunity to discuss adherence, stress the risk factors associated with non-adherence, and help improve compliance with instructions.
• Assess if the Member is eligible for a longer-term supply of their medication. Not only does it mean fewer trips to the pharmacy and possible cost-savings for the Member, but studies have also shown that adherence is 20% higher when the individual has a 90-day supply versus a 30-day.

There are countless reasons for medication nonadherence, and no easy solutions. The best approach for improving adherence is by working collaboratively with the Member and their pharmacists, specialists, and entire health care team.

Published April 2022

CVS® Caremark Mail Service Pharmacy

MVP Members who have prescription drug coverage may be able order up to a 90-day supply of their maintenance medications through this program. To find out if a medication is available from CVS Caremark Mail Service Pharmacy, view MVP Formularies, and the select the appropriate formulary; if a drug or drug class has an asterisk (*) next to it, that drug or all drugs in that class are available through mail service program.

SimpleDose™ from CVS Pharmacy®

SimpleDose is a convenient and simple medication management solution for your patients taking multiple medications. Eligible medications are presorted into easy-to-open packets based on dose, date, and time. There is no additional cost to enroll. Free nationwide delivery to the Member’s home or any CVS Pharmacy location is included. SimpleDose™ can only be filled for 30-day supplies. If you have a Member who would like to learn move, visit CVS.com/SimpleDose or call 1-800-753-0596.

Published April 2022

Eligible MVP Medicare Advantage Members can speak with an MVP pharmacist privately over the phone to review their medications for safety and check if lower-cost alternatives are available. The Medication Therapy Management Program (MTMP) also helps to ensure that Members understand why they have been prescribed a medication and the importance of taking it exactly as prescribed. To find out if a Member is eligible for MTMP, call MVP at 1-866-942-7754, Monday–Friday, 8:30 am–5 pm Eastern Time.

Published April 2022

Whether it’s keeping up with routine screenings or needing specialized diagnosis and treatment, women face complex health decisions at every stage in life.

Adolescence

Establishing a strong foundation during early childhood and adolescence will make it easier to help them manage changes, both physical and behavioral, as they grow into adulthood.

• Starting at birth, girls should see their pediatrician or PCP for routine well-child visits
• It’s important that girls select a gynecologist and start annual well-woman exams once in their teens.
• HPV is the leading cause of cervical cancer. Adolescent girls should get the HPV vaccine series completed between nine and 13 years old

Teens andYoung Adult

• Working with younger female patients to develop and maintain healthy habits may help them stay physically and mentally fit as they get older. Implement office procedures to ensure your female patients keep regular checkups, health screenings, and immunizations.
• One in four young female adults will be diagnosed with an STD. Women who are 16–24 years old and sexually active should have at least one test for chlamydia each year.
• Cervical cancer can be found with regular pap tests. Women should be screened for cervical cancer every three years starting at age 21
• Women in reproductive years are recommended to seek contraception and family planning counseling.

Mature Adult

Promoting self-care becomes especially important during this phase of a woman’s life. Along with the demands of everyday responsibilities, women are going through changes that can raise their risk of high blood pressure, heart disease, and diabetes.

• Use annual well-care or well-woman visits to discuss stress, depression, anxiety, or other mental health issues.
• Begin scheduling breast and colorectal cancer screenings at age 40 and 45, respectively, unless risk factors indicate for earlier screenings.
• One in four women die from heart disease—talk about health screenings that are age or lifestyle appropriate such as blood pressure readings and hemoglobin A1C testing to help prevent or manage chronic care conditions.

Older Adult

In addition to chronic conditions like heart disease and diabetes, this is the time to speak with your female patients about good bone health.

• One in two women will have an osteoporosis-related bone break; 33% of women will be diagnosed with osteoporosis by age 75.
• 46% of older women take five or more prescription drugs. Make sure you know all their medications, and if they’re causing side effects.
• Work with your older patients on a fall prevention plan including appropriate exercises for balance and strength and hearing and vision checks
• Starting at age 65, women should complete an osteoporosis screening every two years.

From early childhood to older adulthood, the provider-patient relationship that fosters open-communication and coordination of care increases the likelihood that women will be more involved in their health care, improving overall health outcomes.

Published April 2022

The world may have changed due to the pandemic, but the importance of annual wellness visits has not. Even prior to COVID-19 people may have justified not seeing their PCP annually with reasons like “I never get sick” or “I don’t have any risk factors”. However, in today’s times, it’s vital that Members recognize that preventive care, including annual wellness visits, is an investment in their health.

Routine annual visits, regardless of the Member’s state of health, allow the PCP to build a comprehensive picture of the Member’s health risks, goals, and barriers. Implementing an integrated approach with your patients that includes physical, behavioral, and social factors encourages Members to be active players in their health care and empowers them to make well-informed decisions appropriate for their own health journey.

Annual visits also provide a good opportunity to remind your patients of any other services they may need, such as:

• Are they due for a colorectal cancer screening (COL) and would they be a candidate for home screening such as Cologuard®?
• Are they due for breast cancer screening (BCS) or a bone mineral density test and can you get that appointment set up before the visit is over to ensure better compliance?
• Remind them if they need a HbA1c lab testing, kidney health evaluation, or retinal screening.
• Review immunizations they may be due for; identify any that can be given during the wellness visit to ensure better compliance.
• Would they benefit from support services or referrals for healthy living such as weight management, behavioral health treatment, or tobacco cessation?

Continue to utilize telehealth services when appropriate and make sure that Members keep upcoming appointments with outreach calls or letter reminders. Specify what they need to do or have available at the time of the visit, such as medications, list of other health care providers, blood pressure readings, etc.

While the last two years have been challenging for everyone it is still crucial that plans and Providers work together now to educate, facilitate, and remind Members why annual wellness visits and preventive care are necessary.