CountyCare Provider is our quarterly newsletter for CountyCare providers and their teams. Each issue will give you updates and important information from CountyCare. Check out the latest issue below.
Spotlight on Behavioral Health Services
Before getting help from LRCC, Jaylen’s mom, Sharon was overwhelmed. She is a single mom with four children. Her 11-year-old son, Jaelyn, was diagnosed with ADHD and Interventive Explosive Disorder. Children with special health care needs are increasingly common in pediatric practices. To offer holistic services for these patients, CountyCare partners with La Rabida Care Coordination (LRCC) to make sure high-needs children can carry out their treatment plans and find the people, services and equipment they need.
The LRCC team has an integrated behavioral and physical health model, and has deep experience in the complicated issues of high-needs children. Their team members have varied backgrounds from social work to medical nursing. When patients are assigned to a case manager, LRCC takes each team member’s experience / background into account and makes the best match for each case.
For instance, for one patient, Jaylen and his family*, LRCC combined social work and medical nursing experience to provide:
- Coordination of medication management with school nurse
- Access to legal advice
- Follow up on quarterly reports from C4, a Behavioral Health Consortium agency.
- Follow up with physicians on medications
- Referrals to free behavioral health seminars
- Public transit passes for appointment
Before getting help from LRCC, Jaylen’s mom, Sharon was overwhelmed. She is a single mom with four children. Her 11-year-old son, Jaylen, was diagnosed with ADHD and Interventive Explosive Disorder.
“Being a mother of a child who has a disability is a struggle,” says Sharon. “There were a lot of times I wanted to throw in the towel. But I need to stand up for Jaylen. I try my best to do what I can to help him even when it becomes overwhelming.
Sharon found out about Jaylen's diagnoses in preschool. “No mother wants to hear this. I was in denial for a good while until he was in kindergarten and he was suspended for getting in a fight.”
To make matters worse, Jaylen was not getting school-based services tailored to his needs, and the family’s insurance at the time was also difficult to work with when Jaylen needed to be hospitalized.
But then Sharon switched to CountyCare. “I found out about CountyCare when the State of Illinois changed medical plans and we needed our own personal health insurance provider.” Sharon’s mother encouraged her to sign up for CountyCare, which she felt could provide the services Jaylen needed.
Soon after she became a CountyCare member, Sharon received a letter from LRCC. After contacting them directly, Sharon and Jaylen were assigned to care manager Jewell Holmes, who immediately got to work helping the family. “He needed medication management and counseling. Mom was struggling,” says Jewell. She accompanied Sharon to a meeting at Jaylen’s school and advocated for him to be put on an emergency Individual Education Plan (IEP). She helped Sharon know how to better manage Jaylen’s outbursts, and assisted her with medication management. “I discovered the school had a clinic for medication administration but the school hadn’t offered it as a resource for Jaylen,” says Jewell. So, she went straight to the clinic to request that Jaylen’s medication be administered by them.
Jewell referred Sharon to the Behavioral Health Consortium, provided through CountyCare, to help Jaylen get the counseling services he needed. Jewell also made sure Sharon had access to bus passes to get to and from the counseling sessions.
“As care coordinators we make sure this family gets all support that is needed to make sure this child gets all the care he needs. That’s our job,” says Jewell.
“Jewell helps me a lot,” says Sharon. “She’s not only a counselor or social worker, but she listens to me. She talks to me from a professional point of view and a mother’s point of view. She doesn’t tell me what to do, but makes helpful suggestions on how to look at things in a different perspective. She’s a great listener.”
These days, Jaylen is doing much better. He plays basketball, loves toy army men, video games, puzzles and the Disney Channel. He’s at a new school that he loves and has new friends. “Thanks to LRCC, things are falling into place and he’s happy,” says Sharon. “Working with them is like a blessing from heaven. I’ve been asking and praying for help, and I am so grateful.”
* Member names have been changed to protect identity.
The La Rabida Care Coordination (LRCC) program helps high-needs pediatric patients and their families. But it’s also a valuable resource for providers.
“LRCC is a service that can benefit the patient and the Provider,” says Denise R. Cunill, M.D., a CountyCare Provider. “LRCC is an example of a model of medicine which basically becomes an extension of the medical home into the community where the provider does not have, or has limited, capability.”
CountyCare talked with Dr. Cunill to hear more about this unique program from a Provider’s perspective:
Q: What is your role/relationship to CountyCare and to the La Rabida Care Coordination (LRCC) program?
A: I am a pediatrician and I am also the Cook County Health and Hospitals System’s (CCHHS) Associate Medical Director of Ambulatory Pediatrics and Medical Director of the CCHHS Logan Square Health Center, a CountyCare medical home/clinic. In my relationship with CountyCare and La Rabida, I wear all of these hats.
Q: What has been your experience as a provider working with LRCC?
A: LRCC has really filled gaps in areas where the medical home has limited or no resources. Having that extra piece has really made a difference with my high-needs patients.
When LRCC was introduced to CountyCare, I was so excited. The care coordinators interact with patients in their homes, and give us a different perspective because they see the patient’s family as a unit within their own living space and communities. This perspective is especially valuable since many of my patients travel to clinics for medical care—and their home surroundings do not offer the same resources. Therefore, the in-home component is a major plus. The hands-on interaction of care coordinators, who attend specialty clinics with patients, is also very valuable. They provide a second set of ears for the patients, and help them retain information.
Q: What resources does the CountyCare and LRCC partnership offer providers who have high-needs patients?
A: In general, they help coordinate visits. They also look at the resources within a patient’s community. If the patient has food insecurity, the care coordinator will help connect them with LINK and WIC, or any other government programs they are eligible for. LRCC care coordinators also ensure other needs are being met, such as medical, mental health, home nursing, IV therapy, providing durable medical equipment, and even accompanying parents to school meetings. LRCC is really an extension of the medical home and has been very open to suggestions and critiques from Providers. LRCC has been a great liaison with the Behavioral Health Consortium, too, another resource for CountyCare patients.
Q: How can providers screen their patients appropriately to determine if they qualify for referral to La Rabida’s Care Coordination program?
A: If I have a patient with more than one specialist, I refer them to LRCC through the referral form. I also refer patients who are on multiple medications, those who have complex mental health needs, or are in a complex psycho-social environment. I evaluate the patient’s environment to determine if it has a lot of stressors or adverse childhood-experience factors.
Q: How does the communication process work between providers and LRCC?
A: The family gives permission for an LRCC care coordinator to attend the doctor visit. Also, I try to meet with the care coordinators on a quarterly basis to get an update on all patients. And I communicate with them about patients by fax, email or phone on a regular basis.
Q: What makes the partnership between CountyCare and LRCC unique?
A: Integration of LRCC into the medical home has been a success. They are very engaged and help take care of the family as a unit. Although they are only able to provide services to the CountyCare-insured patient, the services provide indirect benefits to the other family members as well, even if they are not CountyCare members.
If you see patients who may benefit from LRCC, you can refer them directly, through the referral form found on the CountyCare website. Patients and their families can also contact LRCC directly for self-referral. When patients enroll in CountyCare, they receive a letter with information about LRCC’s services.
For members under age 21 experiencing a crisis event, CountyCare provides a crisis line, mobile crisis response services, crisis screening, and follow-up psychiatric consultation and medication management services. CountyCare providers should encourage patients’ families to take advantage of existing tools that connect children and adolescents with the behavioral health services they need as quickly as possible.
The CARES crisis line (Crisis And Referral Entry Services) is a statewide hotline that triages children and adolescents in mental health crisis. Emergency Departments (EDs) and hospitals are required to call CARES for all children and adolescents that they treat for mental health crises. When the crisis line is called, a mental health specialist from an assigned community mental health Screening, Assessment and Support Services (SASS) agency arrives within an hour to assess the child/adolescent and recommend treatment. Each morning, CountyCare receives a log of all CARES calls and sends the log to CountyCare’s Care Coordination teams who reach out to families, SASS agencies, and both primary care and behavioral health providers to assist in arranging services needed to support the child and prevent future crisis.
This process has made a positive difference for many members, including an example involving the La Rabida Care Coordination team. The team had been attempting a variety of outreach methods over several months in an effort to engage a family of a child with special health needs. One morning they found this child’s name on the CARES log, with new contact information as well as the SASS agency that responded to the crisis. The Care Coordinator reached out to these new contacts and was able to speak with his mother who said, “I feel so lucky you called me – I really need some help and wasn’t sure what to do next.” Unfortunately this family experienced a crisis but a well-coordinated response allowed them to begin a new phase in addressing his needs.
The CARES Hotline is 1-800-345-9049 and is available 24 hours per day, 365 days per year. CountyCare’s main call tree also offers an option to link to CARES, and in June 2016 CountyCare added a phone tree option that links members directly to an appointment line for CountyCare’s preferred behavioral health providers (see BH Consortium article).
All SASS providers are in the CountyCare network. To learn more about the SASS program, please visit the HFS website. The following SASS agencies are also in the Behavioral Health Consortium: C4, Metropolitan Family Services, Pillars and Lutheran Social Services of Illlinois.
In 2016, CCHHS rolled out the Behavioral Health Consortium, a new initiative that leverages the infrastructure established by CountyCare to connect members with coordinated behavioral health services based on their individual needs. Composed of 12 organizations providing community-based mental health and substance use disorder treatment, the Consortium serves as a single resource for comprehensive services across Cook County. Visit the CountyCare website for a complete listing of Consortium agencies.
With just one phone call, providers or care coordinators in the CountyCare network who have a patient in need of services can request a referral. Intake for appropriate and available treatment is within seven days or 48 hours if the need is urgent. A live representative is available from 8am to 8pm Monday through Friday to schedule services at any of the 12 Consortium agencies. Intake staff are bilingual (Spanish) and many of the Consortium’s services are available in Spanish as well. Call CountyCare at 312-864-8200, select 4 for member options, then select 1 for behavioral health to refer a patient.
In describing this innovative new strategy for delivering behavioral health services, Chris Carroll, President and CEO of C4, noted its “potential to transform” the way providers nationwide respond to the country’s growing need for mental health and substance use services.
Felix Rodriguez, LCSW, ACSW, Manager of Behavioral Health Services for CountyCare, agrees. “There’s great power in such a collaborative approach. It isn’t simply more efficient or effective. It fundamentally changes our ability to affect more positive and sustainable outcomes.”
CountyCare encourages all providers and care coordinators to take advantage of this groundbreaking program as a way of significantly expanding the depth and quality of behavioral health services they provide to members.
CountyCare is proud to highlight three in-network resources for pregnant and post-partum women who need behavior health care, whether it’s for chemical dependency, post-partum depression, or stress and anxiety. If you see the signs of behavioral health issues in your patients, consider referring them to one of the following programs.
PCC Community Wellness Center
PCC Community Wellness Center (PCC) is the first organization in Chicago to offer integrated substance abuse and obstetrics care to prenatal women with an opioid use disorder. As part of PCC’s high-risk obstetrics fellowship, prenatal PCC patients have access to Drug Addiction Treatment Act (DATA), Waivered Prescribers who can prescribe Suboxone for opioid use disorders, and with expertise in obstetrics care. They also have the benefit of an integrated care team including behavioral health and care coordination services.
The PCC program was created in response to the growing epidemic of opiate use on the West Side of Chicago, and uses a team-based approach to treatment, including medical, behavioral health, and care-management support. The program offers services for other types of substance abuse as well.
“We are excited to share with the CountyCare community our innovative approach to substance abuse treatment.” says Amanda Brooks, LCSW, CADC, Director of Behavioral Health at PCC Community Wellness Center. “Our innovative approach, positioned within a family practice model, helps not just the patient, but offers a multigenerational approach to substance abuse prevention and treatment.”
To refer your patients to the PCC program contact Takara Wallace, RN Care Manager at 708-406-3929 ext. 5220.
Healthcare Alternative Systems, Inc.
The Postpartum Depression (PPD) Program at Healthcare Alternative Systems, Inc. (HAS) provides psychotherapy, case management, and psychiatric services to new and/or expectant mothers suffering from or at risk for developing postpartum depression.
The program offers clinical evaluations and assessments, individual psychotherapy, psychiatric evaluations and follow-up care (including medication management), support groups, case management services, CTA transit cards for women experiencing transportation difficulties, trainings on postpartum depression for case managers/case workers, counselors, nurses, midwives and all other health and mental health professionals who work with pregnant and/or postpartum women, and informational workshops on PPD for new and/or expectant mothers.Moms are eligible for the program if they are at least two weeks but not more than 12 months postpartum and are experiencing symptoms associated with postpartum depression. Women who are pregnant and have either a history of PPD or are currently suffering from depression and/or anxiety are also eligible to receive services, as are women who have lost babies or terminated a pregnancy and are experiencing mood instability.
Referrals for the program are accepted via fax and should be made using HAS’ referral form which can be obtained by contacting HAS’ intake coordinator, Shirley Bonet at: 773-745-7107 ext. 858 or email@example.com.
Moms Hotline from the Northshore University HealthSystem
The Northshore University HealthSystem Hotline for new moms can be a convenient resource for moms who need to talk to someone immediately. Share the hotline with your patients so they always have this information on-hand. The hotline offers support 24 hours a day, 365 days a year, and interpreters are available in any language. The hotline is confidential, and is answered by professional counselors who can listen, answer questions, offer support, and find referrals when needed. There is no cost to members for this program.
Patients can call 1-866-364-MOMS (6667) any time day or night to get help.
We are happy to share the newly launched Provider Billing Resources page on the CountyCare website. On this page you will find valuable information to assist with billing questions and claims submissions, as well as several resources for current issues you may be experiencing. Included within the new page are:
- Monthly updates for ongoing and recent claims projects.
- CountyCare’s Billing Manual.
- Billing guidelines specific to provide types, claim submission types claim remark code references, and more.
- Useful links to the most current HFS notices and releases and fee schedules.
At CountyCare, we believe helping members actively engage in their own care is crucial for improving health outcomes and controlling costs. For members to learn how to self-manage and appreciate what is required of them, effective communication is key.
For this reason, CountyCare has adopted several dimensions of Doctors’ Communication and Service in our 2017 Priority Measures.
For example, to help gauge and improve the quality of provider-member interactions, CountyCare relies on several key patient experience questions from the Consumer Assessment of Healthcare Providers and Systems® (CAHPS®) health plan survey. Response data from the survey are also used to compile the Illinois Medicaid Plan Report Card distributed by the Illinois Department of Healthcare and Family Services, which provides comparative ratings for Medicaid managed care plans statewide.
The most relevant parts of the CAHPS survey focus on four critical elements of effective communication as they relate to the delivery of higher value healthcare. Your patients are being asked to rate their experience related to:
- Appropriate Language: How well providers explain things to patients in a way that’s easy for them to understand.
- Active Listening: How carefully and respectfully providers listen to patients and consider their input.
- Shared Decision-making: How intentionally providers involve patients in making choices about their care.
- Sufficient Time: How satisfied patients are that providers spend enough time with them to meet their needs.
CountyCare appreciates every providers’ recognition of the importance of effective communication in the delivery of quality care and improved performance on these priority measures. Below are some reminders specific to survey questions for which your patients are asked to respond.
- Consider cultural and language barriers - Remember that all provider groups have translation lines most of us don’t use often. Ask an administrator to send a reminder to all staff and add it to speed dial in exam rooms or make a contact on your cell phone.
- Ask the right kind of questions — One effective technique involves using open-ended questions that can't be answered with a simple "yes" or "no." This kind of inquiry invites members to really think about their symptoms or problems. It can help uncover underlying problems or anxieties and provide important clues to the best way to talk to and treat them.
- Try the “teach back” method — Asking patients to repeat in their own words what they have just been told is another effective tactic. That way, if there is a misunderstanding, the provider or staff member has an opportunity to quickly straighten it out.
- Encourage patients to take notes — Having information and instructions in writing — in their own language — helps patients remember what transpired during their visit and makes it easier for them to tell other family members or caregivers what they need to know. What works even better is encouraging patients to bring someone along to their appointments to ask the questions they might be hesitant to bring up, help them process the information, and record instructions.
® "CAHPS" is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
The CAHPS surveys cover those important aspects of the patient experience that consumers are in the best position to assess. As part of its priority evaluation of in-network providers’ performance, CountyCare uses the following questions from the CAHPS health plan survey that tie patient satisfaction to provider communication skills and level of service.
- In the last 6 months, how often did your personal doctor explain things in a way that was easy to understand?
- In the last 6 months, how often did your personal doctor listen carefully to you?
- In the last 6 months, how often did your personal doctor show respect for what you had to say?
- In the last 6 months, how often did your personal doctor spend enough time with you?
- Did you and a doctor or other health provider talk about the reasons you might want to take a medicine?
- Did you and a doctor or other health provider talk about the reasons you might not want to take a medicine?
- When you talked about starting or stopping a prescription medicine, did a doctor or other health provider ask you what you thought was best for you?
- In the last 6 months, did you get information or help from your health plan’s customer service?
- Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor?
- How many specialists have you seen in the last 6 months?
- We want to know your rating of the specialist you saw most often in the last 6 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate that specialist?
These questions are common to all health plans. We hope you find it helpul to know what questions are being asked to your patients each spring.
Striving for successful financial communication is also important to efficiency and achieving an excellent patient experience. It’s important to give employees access to the information they need to answer patients’ questions and solve problems quickly. For example, CountyCare members likely have questions about billing. Here is a clear and concise explanation of CountyCare policy you and your staff can use:
If you are an eligible Medicaid member, you cannot be charged for services that are covered under the Medicaid program. You (or your family) also cannot be billed for co-pays or deductibles or for the cost difference between what providers usually charge for a service and what the state pays them. If your provider recommends a service that is not covered by Medicaid or recommends treatment by a provider who does not accept Medicaid, you must be told about any costs you’ll be responsible for before receiving the service.
We thank our medical homes for supporting CountyCare’s key metrics, which include standards related to provider access and availability.
CountyCare helps assure and improve the quality of care by analyzing and acting on data, such as the findings of the 2016 Network Survey for Access and Availability. This survey’s results were sent to providers in early January. Below are some of the highlights of the survey’s key findings.
PCPs/ Medical Homes
|Results||Of 143 TOTAL:
||Of 33 TOTAL:
||Of 90 TOTAL:
Outstanding Performance: 24-Hour Access
The hard work that providers have put into focusing on these measures has translated into results: Medical homes performed extremely well on the survey regarding providing 24-hour access and availability.
PCPs/ Medical Homes
|Results||Of 264 TOTAL:
||Of 1239 sampling:
Opportunities for Improvement
There is always room for improvement in terms of promoting access and appointments. Below are areas that deserve special attention:
- After-hour Access: Steering Away From Voice Mail
Going into voicemail does not meet access and availability standards. CountyCare encourages members to always contact their Primary Care Provider first to seek advice. This allows PCPs to manage and coordinate care. Providers should ensure they have 24-hour availability for members to reach a provider after hours may help you see improvements in this area.
- Behavioral Health: Follow-up and Initiation
There are many opportunities to improve timely access to behavioral health care. This is why the Behavioral Health Consortium of IL, LLC was founded. All BH providers should pay particular attention to requests for follow-up after hospitalization for mental illness and initiation and engagement of alcohol and other drug dependence treatment.
- Keeping Provider Information Current
During the survey, it was found that some providers are no longer with the practice. To avoid this, providers must send regular updates regarding provider additions and terminations per their contracts. If there are any changes regarding practice locations or contact information, please contact Daujuana “D.J.” Paramore, Provider Relations Business Manager, at 312-864-0921, fax 312-864-9240 or email firstname.lastname@example.org.
We appreciate your ongoing support as we regularly analyze data and work together to make improvements in delivery of care. These efforts are key components in creating a healthier community.
For member convenience, the CountyCare Find a Provider tool is available on our website at www.countycare.com/find-a-provider, as well as downloadable pdfs of the full network of Primary Care Sites, Behavioral Health Providers, Home Health Providers and Breast Imaging Centers.
ATTENTION: Medical Homes and PCPs
CountyCare is very excited to announce the rollout of our quality portal- Vision! Vision is a one stop-shop to monitor HEDIS performance measures on a monthly basis. It also allows you to identify care gaps and streamline delivery of needed services for your members
- Ability to view provider and practice level performance rate against CountyCare quality benchmarks and overall network performance
- Streamlined view of your patient gaps- easily identify needed services with member and service level details
- Print reports and face-sheets to quickly identify and focus on “what’s needed” for your practice and/or individual members
- Vision complements existing EMRs/EHRs- does NOT replace them
CountyCare Provider Relations Representatives have reached out to perform on-site sessions for key staff at all Medical Homes (FQHCs) and PCP offices (if not part of Medical Home). Contact your provider representative directly if have any questions about these sessions or to request another one.
The Illinois Chapter of the American Academy of Pediatrics (ICAAP) offers a wide range of events including free office- and hospital-based educational programs, educational webinars, seminars and conferences.
Event and registration details can be found at www.icaap.memberlodge.org/events.