Clinical Connections News for Fall
Dear Colleagues,
As the fall season starts, Western Health is pleased to share several benefit programs being expanded to more members. These include Maven, which supports pregnant mothers and their partners; Real Appeal Weight Loss offers help with weight loss coaching and nutrition education; and Quit for Life which helps WHA members with tobacco cessation counseling and nicotine replacement therapy (NRT). Patients who are new/renewing WHA members should refer to their 2024 plan documents to see if they now have these programs available.
With GLP1s becoming all the rage, we want to remind clinical providers that WHA offers nutritional counseling visits for obesity, eating disorders, and weight loss secondary to illness. This is a covered benefit through a prior authorized referral to a contracted nutritionist. Please direct members to the WHA Nutritional Counseling webpage for more information.
With Optum Behavioral Health (OBH) services, WHA members can now access specialized case management for eating disorders, substance use, geriatric care, adolescent/teen, and specialized mental illness. All of our medical group care coordination teams have access to electronic referrals into OBH case management. Simply ask your medical case manager to generate a referral to OBH case management. Share our Behavioral Health flyer with your patients.
Khuram Arif M.D., MBA, CPE
Chief Medical Officer,
Chief Operating Officer,
Western Health Advantage
Welcome to our new Medical Director: Dr. Tasnim Khan
We are pleased to introduce WHA’s newest clinical leader, Dr. Tasnim Khan - who brings broad expertise in utilization management, quality improvement, provider relations, and out-of-area management. Dr. Khan was most recently regional medical director for Altais Health (formerly Brown and Toland) and previously served as CMO at One Community Health in Sacramento. Dr. Khan has been a leader in health tech startups abroad and helped set up Qatar’s first national health plan. She is board-certified in Family Practice and completed her master’s degree in Health Care Management at Harvard University. Dr. Khan will lead multiple clinical initiatives at Western Health.
Do you have Medicare-eligible patients?
If you have patients who are aging into Medicare this year, WHA has a Medicare Advantage plan available, allowing current WHA patients to stay with their doctors they know and trust. If your patients are asking questions about Medicare, we have online seminars at medicare.westernhealth.com as well as WHA-partnered agents onsite at several clinic locations starting in October who can answer Medicare questions. WHA created this Clinical Provider WHA Tip Sheet on our Medicare plans for information and for you to share with staff.
Pharmacy update
WHA is transitioning its Pharmacy Benefits Manager (PBM) for our Medicare Advantage members to OptumRx, starting Jan. 1, 2024. WHA anticipates a seamless transition and quality service for our MyCare members, as OptumRx has been WHA’s PBM for group and individual coverage for the past several years.
Rewarding members for being proactive
This year, WHA expanded our incentives (or rewards) to members for completing important preventive care exams and immunizations in order to close important care gaps. October is National Breast Cancer Awareness month. Remind your patients that when they complete their mammogram to go to our women’s health webpage to Enter to Win a $100 Gift Card. Your WHA patients can find more reward opportunities just for completing their vital screenings on our preventive health guidelines webpage.
Vaccinations Reminders
WHA patients can receiving their annual flu and the latest COVID-19 vaccine at the pharmacy counter or at an upcoming PCP office visit. All other vaccinations should be obtained only from their PCP.
HEDIS Articles to Note
Please note the following updated HEDIS articles:
- Article: Medication Management for People with Asthma. WHA in concert with the Integrated Healthcare Association (IHA) includes the asthma ratio and immunizations performance rates as part of the Align, Measure, and Perform (P4P) Program to give incentives to improve publicly reported rate. CAIR2 is a CA state-supported computerized immunization information system free to providers to record vaccinations. AMP/P4P rates are published annually in October and can be found on the Office of the Patient Advocate (OPA) website.
- Article: Prenatal and Postpartum Care. Article highlights include outcome data suggesting that babies born to mothers who do not receive prenatal care are three times more likely to be of low birth weight, and five times more likely to die, compared with babies born to mothers who receive prenatal care.
- Article: Childhood and Adolescent Immunization Status. HEDIS Measures: CIS and IMA Immunization Results: MY2022.
Advantage Magazine
Please read and share with your staff the fall issue of our member magazine Advantage Magazine, which features a special Aging Well insert written for our Medicare members.