PROVIDER NEWSDECEMBER 2013 | VOLUME 13 NUMBER 3

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DIVERSE PATIENT POPULATION REQUIRES UNIQUE COMMUNICATIONS EFFORTWorking effectively with patients/members from diverse socioeconomic and cultural backgrounds requires a special focus on communication. The goal of ensuring that your patients understand what is being discussed – and being required of them – could have a major impact on their health.

Through the Cultural Competency link on the Providers page at BMCHP.org, you’ll find valuable information to help you assess how culturally competent your practice is and what you can do to improve your levels of cultural competency. You can also link to the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, an implementation guide from the federal Office of Minority Health.

RESOURCES AVAILABLE AT BMCHP.ORG

Ì Encourage them to use the Ask Me 3™ technique. This involves three questions they should ask and have answered at each visit: What is my main problem? What do I need to do? Why is it important for me to do this?

Ì A family member is no substitute for a professional interpreter who is skilled in medical jargon. Make sure your practice has access to a certified interpreter service.

Ì Unfortunately, not everyone can read or completely comprehend what they read. Be aware of this when you give a patient printed information.

Ì Use photos or illustrations to support what you’re discussing.

Ì Many people born outside the U.S. only know metric units of measure, not imperial units. Make sure your patients understand the difference between kilograms and pounds.

Here are some suggestions to consider when communicating with a diverse patient population:

Avoiding psychiatric hospitalization whenever possible is the goal of Emergency Service Programs (ESPs). They provide psychiatric crisis stabilization in the community, allowing individuals to avoid the need to call 911 or to have police contact. ESP teams are mobile and will respond to crisis situations 24/7. Each program also has a public location where ESP clinicians can assess the individual, provide stabilizing services or arrange for a psychiatric hospitalization.

To locate the closest ESP: call 877-382-1609 and enter your zip code.

OR

you can access the website for the National Alliance on Mental Illness, namimass.org, and click on the “Crisis” link.

CAN ELIMINATE THE NEED FOR CALLING 911 IN A MENTAL HEALTH CRISIS

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WIC BOOK PROGRAM SUPPORTS MAINTAINING CHILDHOOD IMMUNIZATION RECORDSProviders may receive fax requests from Women, Infants, and Children (WIC) offices for children’s immunization records. BMC HealthNet Plan and the Massachusetts Department of Health and Human Services encourage providers to do their best to comply with these requests. Local WIC offices will donate a children’s book to the family of a child when the updated immunization record is faxed back to WIC.

In addition, WIC is required to document certain health measures, such as monitoring lead levels and maintaining immunization records, in order to meet federal requirements.

Remind patients to keep records safe It is also important to remind parents and guardians to store immunization records in a safe place since they’re necessary when children register for school, child care, athletic teams, summer camp, to travel or for the local WIC program.

Sunny Start is a comprehensive maternity care management program to help moms and babies get the care they need during and after pregnancy. Members who enroll in Sunny Start receive help from our care managers, including customized care planning by care coordinators (for low-risk pregnancies) or by our registered nurses (for moderate or high risk pregnancies.)

Sunny Start moms also get:• Access to an RN who is skilled in obstetrics

and newborn care for needs relating to safe and healthy pregnancies

• The What To Do When You’re Having a Baby book

• Childbirth education and parenting classes

• Help with transportation to appointments

• Help with determining eligibility and applying for Women, Infants, and Children (WIC)

• Education on preventing preterm labor and delivery

• Assistance and reminder calls related to postpartum care

• Postpartum and newborn care information

• Help finding community resources like housing, legal assistance, shelter and clothing

To ensure that members get the full benefits of participating in Sunny Start, providers must notify our Prior Authorization department of every confirmed member pregnancy. You can report the pregnancy by calling our provider line at 1-888-566-0008 or faxing the information to 617-951-3464.

GIVE YOUR PRE- AND POSTPARTUM PATIENTS A SUNNY START

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UPDATED PERINATAL CARE GUIDELINES ENDORSED

With an increase in pertussis disease in the U.S., the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends that providers administer a dose of Tdap during pregnancy, regardless of a prior history of receiving Tdap. The optimal time to administer Tdap is between 27 and 36 weeks of gestation, although it may be given any time during pregnancy. There is no evidence of adverse fetal effects from vaccinating pregnant women with an inactivated virus or bacterial vaccines or toxoids. ACIP recommends that if a pertussis vaccination is indicated, it should not be delayed, and Tdap should be administered regardless of interval since the last tetanus or diphtheria toxoid-containing vaccine.

If the mother never had a Tdap vaccine or did not receive one during pregnancy, it should be administered to her immediately postpartum to reduce the risk of transmission to the newborn.

There is growing concern among public health professionals, doctors and patients about the overuse of antibiotics. Research as far back as 19971 found that more than half of the antibiotics prescribed for acute respiratory infections – such as acute bronchitis – are unnecessary because the infection is viral.

In Massachusetts, we still over-prescribe antibiotics for acute bronchitis. According to the most recent statewide information published by the Massachusetts Health Quality Partners (MHQP), we use antibiotics appropriately in only 24% of cases of acute bronchitis2, which means that in almost 8 out of 10 cases we are still prescribing antibiotics. PERTUSSIS ON

THE RISEIMMUNIZATION RECOMMENDED IN PREGNANCY

BMC HealthNet Plan has endorsed the newly released Massachusetts Health Quality Partners (MHQP) 2013 Perinatal Care Guidelines. The Guidelines, a synthesis of several evidence-based guidelines, were developed to support clinicians in providing high-quality, evidence-based care. You can request a copy from your Provider Relations Consultant or download them from the Providers page at bmchp.org.

1 Gonzales, Ralph MD MSPH, Steiner, John MD MPH, Sande, Merle MD. “Antibiotic Prescribing for Adults with Colds, Upper Respiratory Tract Infections, and Bronchitis by Ambulatory Care Physicians.” The Journal of the American Medical Association. September 17, 1997. Volume 278. Number 11.

2 “Medication Management: Correct Use of Antibiotics for Acute Bronchitis.” Massachusetts Health Quality Partners. Web. Quality Reports. http://mhqp.org/quality/clinical/cqMASumm.asp?nav=032400

RESPIRATORY TRACT INFECTIONS:

ANTIBIOTICS AREN’T ALWAYS THE ANSWER

So what do you do when patients with acute viral bronchitis ask for antibiotics?

You may need to tell them that:

To help you educate your patients about proper antibiotic use, the Centers for Disease Control and Prevention offers free tools including a viral prescription pad. You’ll find a link to the tools at bmchp.org on the Providers page under Clinical Resources.

When acute bronchitis is from a virus, antibiotics will not help.

Antibiotics can cause harm if used when not needed because bacteria can become resistant.

Antibiotics can cause side effects such as headaches and rashes.

ESP CAN ELIMINATE CALLING 911 4 Page 1

WIC BOOK PROGRAM MAINTAINSIMMUNIZATION RECORDS4 Page 2

UPDATED PERINATAL CARE GUIDELINES4 Page 3

WHAT’S INSIDE:

Boston Area Main Office:Two Copley PlaceSuite 600Boston, MA 02116

Western Massachusetts Regional Office:1350 Main Street, 13th FloorSpringfield, MA 01103

Southeastern MassachusettsRegional Office:Bourne Counting HouseOne Merrills WharfNew Bedford, MA 02740

Provider Line 1-888-566-0008www.bmchp.org

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Two Copley PlaceSuite 600Boston, MA 02116

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CONDUCT BUSINESS WITH US AT YOUR CONVENIENCE THROUGH BMCHP.ORGThrough the provider portal at bmchp.org, you can manage a variety of important business functions 24 hours a day, seven days a week. With your login you can:

u Check member eligibility

u Inquire about the status of claims in real time

u Request reports, for example, a list of your BMC HealthNet Plan patients who are hospitalized

u Request a remittance history

If you need a login, there’s a link on the Providers page that will allow you to request one.

BMCHP.ORG - A WEALTH OF INFORMATION Our online Provider Manual contains the most current information you need to administer BMC HealthNet Plan in your practice. At bmchp.org you can also review Network Notifications and copies of recent provider mailings, as well as find copies of our clinical and reimbursement policies, and a variety of important clinical resources.

Always check bmchp.org to help make your work load a little lighter.