EOCCO Clinics & Staff,
Welcome to the November issue of the EOCCO Monthly Newsletter. Below is a preview of the articles you will find in this month’s issue:
- Helping Clinics Leverage SDOH Data to Combat Diabetes and Cardiovascular Disease
- Winter ECHO Program Registration
- EOCCO Timely Access to Care Survey Reminder
- Upcoming Events & Trainings
- Pharmacy Benefit Manager Transition
- Prescription Drug Monitoring Program
- Bi-Mart Closures
- Updates & Reminders
Please let us know if you have any questions, concerns or recommendations. We would love to hear from you!
Please contact: Kelly Watanabe at kelly.watanabe@eocco.com
Thank you,
Your EOCCO Team
Helping Clinics Leverage SDOH Data to Combat Diabetes and Cardiovascular Disease
Social needs have been increasing during the COVID-19 pandemic, which impact health and can contribute to chronic diseases. Oregon Rural Practice-based Research Network is currently providing support on how to use social determinants of health data to inform clinical decision-making and develop population-based approaches to prevention of diabetes and cardiovascular disease. This free, low-time commitment support opportunity helps clinics support patients, work towards health equity, and meet CCO incentive measures and Primary Care First metrics. This is accomplished through pairing social determinants of health and clinical data, identifying at risk patients, and tailoring interventions for those patients based on clinic specific needs.
- An overview of this support opportunity is below:
- Clinic eligibility: Clinics in Oregon that are collecting social determinants of health and race/ethnicity data
- Clinic staff eligible: Clinic manager, community health worker, patient navigator, social worker, clinicians, nurse care manager, and other similar roles
- Program components:
- 9-month commitment
- Two learning sessions (each 2 hours)
- Two hours of technical assistance including free EHR specialist support
- Pilot test a small intervention of your choosing
Please reach out to Sara Wild (email: wilsa@ohsu.edu; cell: 971-229-9303) if you have any questions and if this program is of interest.
Winter ECHO Program Registration
Join the Oregon ECHO Network this winter for a broad slate of ECHO programs to help Oregon healthcare professionals support their patients. Winter programs include:
GENERAL PROGRAMS:
- Parkinson ECHO
- AHEC Preceptor
DENTAL PROGRAMS:
- Pain Management and Substance Use Disorders Dental ECHO
ADDICTION MEDICINE PROGRAMS:
- Chronic Pain and Opioids
- Effective Systems for Treating Addiction
- Recovery Peers in Medical Settings
- Substance Use Disorders in Hospital Care
- Substance Use Disorders Leadership
All courses will be conducted virtually and will begin the first week in January. Registration closes one week prior to classes starting. CME credits are available. To learn more about each ECHO program, or to register, visit the Oregon ECHO Network website.
EOCCO Timely Access to Care Survey Reminder
We are always working on ways to improve network adequacy and access to care. EOCCO follows the Oregon Administrative Rules and contract requirements with the Oregon Health Authority to regularly monitor our network and ensure that members can get their care in a timely manner. This survey will help us identify member wait times for both getting an appointment and wait time in the provider's office. Your accuracy is appreciated. We may contact you if we have questions about your responses.
At this time, we are only asking for Primary Care and Specialist clinics to fill out this survey. EOCCO providers are required to participate in this survey as outlined in the Provider Manual.
Please complete by November 23, 2021.
Upcoming Events & Trainings
Affordable Housing Virtual Summit
EOCCO is hosting a virtual summit to gather insight and develop a plan to increase awareness of issues surrounding affordable housing throughout Eastern Oregon.
Wednesday, December 1, 9am -1pm, PST
Registration closes November 24; click here to register
Virtual learning sessions: Pediatric COVID vaccines for clinics
Vaccinators, including FQHC staff, clinical pediatric staff, family medicine staff, pharmacists are invited to a learning session focused on pediatric COVID immunizations. As a participant, you will hear from subject matter experts and from peers on key topics such as pediatric COVID vaccine updates, how to build vaccine confidence in parents, and using equity in all planning and delivery of vaccine.
Click on the link below to register for your desired session:
Thursday, 11/18/21 from 12 pm - 1pm PST
Thursday, 12/9/21 from 12pm - 1pm PST
Thursday, 12/16/2 from 12 pm –1 pm PST
PCPCH learning collaborative: Standard 3.D -Comprehensive Health Assessment & Intervention
In this learning collaborative we will hear from PCPCHs about their strategies for routine health-related social needs (HRSN) assessment, tracking HRSN referrals, as well addressing specific patient population needs with HRSN interventions. Each session will focus on one of the three measures in PCPCH Standard 3.D – Comprehensive Health Assessment & Intervention.
Click on the link below to register for your desired session:
Friday, November 19 from 12pm -1pm PST: PCPCH Measure 3.D.1
This session will focus on the differences and similarities between HRSN and Social Determinants of Health (SDOH). We will also discuss the different HRSN assessment tools and strategies used by PCPCHs.
Friday, December 3 from 12pm - 1pm PST: PCPCH Measure 3.D.2
This session will focus on the difference between PCPCH measures 3.D.2 (HRSN referrals & coordination) and 5.E.3 (community service provider referrals & coordination). We will also discuss how PCPCHs assess and track HRSN.
Friday, December 17 12pm - 1pm PST: PCPCH Measure 3.D.3
This session will focus on strategies for how PCPCHs can analyze HRSN data and identify interventions based on patient need.
For questions or accommodations contact Bernadette.Lauer@dhsoha.state.or.us.
Pharmacy Benefit Manager Transition
We are changing our pharmacy benefits manager (PBM) to Navitus. The change will take place January 1, 2022. For EOCCO members, this means:
- New ID cards
- Changes to the prescription drug list
- Changes to the pharmacy network
- A new home delivery pharmacy option
Members who are negatively affected will be notified this month.
Network changes
The most significant change is that CVS and Target pharmacies will be out-of-network and Walgreens will be in-network starting January 1, 2022. There are over 600 pharmacies in Oregon and 52,000 pharmacies nationwide in the network .The new 2022 Pharmacy Network will be posted on the eocco.com website in November.
Prescription Drug List (PDL) changes
The underlying drug reference source is changing from First Databank to Medi-Span. Some members may be affected by changes in the PDL. We are currently evaluating the PDL changes with the intent to minimize member disruption. Any affected member will be notified in November 2021. The notification will provide alternatives if available and/or instructions to contact their provider. The new PDL will be posted on the EOCCO website in November.
New Home Delivery Pharmacy Option
Members have the option of receiving a 30-day supply of drugs via home delivery (mail-order) pharmacy if desired. Postal Prescription Services (PPS) will continue to be a home delivery (mail-order) pharmacy option for members. Starting January 1, 2022 EOCCO members can also use Costco mail order pharmacy. Members do not need a Costco membership to use the pharmacy.
If members have any questions, please share these frequently asked questions (FAQs)
Prescription Drug Monitoring Program
The Oregon Health Authority (OHA) recently amended OAR 410-141-3855 to require CCO contracted providers to check the Prescription Drug Monitoring Program (PDMP) before prescribing controlled substances. The amendment also outlines the following:
- “Providers shall maintain documentation of the prescription drug history of the individual being treated; and
- In the case that an enrolled provider is not able to conduct the PDMP check, the providers shall maintain documentation of efforts, including reasons why the provider was unable to conduct the check.
- The PDMP check does not apply to clients in exempt populations:
- Individuals receiving hospice care;
- Individuals receiving palliative care;
- Individuals receiving cancer treatment;
- Individuals with sickle cell disease; and
- residents of long-term care facilities described in 42 USC 1396a(oo)(3)(A)(ii).”
You can view the administrative order here 141-3855-100121.pdf (oregon.gov) and learn more about the PDMP on OHA's website.
Bi-Mart Closures
Bi-Mart has announced the closing of their pharmacies with the intent to move all prescriptions to Walgreens pharmacies. You can find the pharmacy the prescriptions have been transferred to by location at www.bimart.com/rxchange#updates.
In the event prescriptions cannot be transferred, EOCCO members may need prescriptions sent to the new pharmacy. The effective date of this change varies by location. At this time, EOCCO does not have information on the specific closure dates of individual Bi-Mart pharmacies.
Prescription file transfers to Walgreens is expected to be completed by January 2022. Currently, Walgreens is out-of-network for EOCCO but will move to in-network effective January 1, 2022. Depending on the region and geography, if there is not a Walgreens location nearby, the prescription will be directed to other network pharmacies (e.g., Albertsons/Safeway). We have mailed letters to members making them aware of this change and offering the following guidance:
- Ensure prescriptions are transferred to a nearby pharmacy of their choosing. The letters included a customized list of nearby in-network pharmacies.
- Reminder of the mail order pharmacy option for chronic medications, if appropriate. Preferred mail-order pharmacies are as follows:
- Postal Prescription Services (PPS): ppsrx.com or 800-552-6694
- Costco: pharmacy.costco.com or 800-607-6861
EOCCO wants to make this transition as easy as possible for our members. Our intent is to make you aware of this change in the instance that prescriptions are not automatically transferred and a new prescription needs to be sent to the new location. To locate network pharmacies, go to eocco.com, select “Find a Provider” and search for a pharmacy.
Updates & Reminders
- Monthly PCPCH Capitation Payments: Effective 11/16/2021 EOCCO has moved to Electronic Funds Transfer (EFT) payments. Physical Checks will no longer be printed.
- Umatilla County Mental Health Services Transition: Community Counseling Solutions (CCS) in Umatilla County will take over mental health services from Lifeways effective 12/1/2021
- Cross-Over Claims: Medicare & Medicaid: As a reminder, all in or out-of-network providers seeing patients with both Medicare and EOCCO – commonly referred to as Full Benefit Dual Eligible (FBDE) members, must be enrolled with both CMS and Oregon DMAP in order to bill. If your NPI is not enrolled with both Oregon DMAP and CMS, these claims cannot be processed and will be rejected by EOCCOs claims processing system when EOCCO is being billed as secondary to Medicare.
- To learn more about cross-over claims, please visit this CMS page.
- To enroll with Oregon DMAP please visit our Become a Provider page.
- Qualifying Medicare Beneficiary (QMB) Requirements: EOCCO wants to ensure that providers that are caring for members with both Medicare and Medicaid (Full Benefit Dual Eligible or FBDE) are aware of the QMB program requirements. This program helps pay the Medicare Part A and Part B premiums and any cost-sharing for individuals with low-income and enrolled in both Medicare and Medicaid. If you have an EOCCO member that you believe qualifies for Medicare and may also qualify for the QMB program, please reach out to EOCCO customer service for more information. To find out more about billing requirements for FBDE members, QMB program qualifications and resources that may be helpful for your members, please visit the CMS website.
- You may also learn more by reviewing this tool
Questions?
- Questions related to incentive measures, health equity, traditional health workers, SDoH, and HIT - Please email EOCCOMetrics@modahealth.com
- Questions related to claims and payment information - Please email EOCCOProviderInquiry@modahealth.com
- Need to verify if your provider or group NPI is active?
Please use OHA’s verification tool - Need to register your practitioner, group or facility?
You can find forms on EOCCO.com/Providers/becomeaprovider
If you would like to be added or removed from this email list, please let Kelly know at kelly.watanabe@eocco.com
