| | | | | | | | Summer 2022 Provider Newsletter | | Saluting Jim Moran on his Retirement | | | | Jim Moran, Founder and CEO of Care Design NY, will be retiring on August 28, 2022. Kerry Delaney will assume the Care Design NY CEO responsibilities. In 2018, Jim demonstrated tremendous leadership and vision in launching Care Design NY, a Care Coordination Organization/Health Home that supports 28,000+ individuals with Intellectual and Developmental Disabilities (IDD) in 30 New York State counties.
His commitment to building a mission driven organization that helps individuals access supports and services so they may live their best lives has been remarkable. Jim’s passion and advocacy for all New Yorkers with disabilities has transformed lives. His legacy and impact will live on every day through the compassionate care coordination that Care Design NY provides members and families.
Please join us in wishing Jim the very best in retirement! | | | |
Meet the Network Development and Provider Relations Team!
Care Design NY’s NDPR department is committed to building a network of providers that effectively meets the needs of individuals with intellectual and/or developmental disabilities. Our team is happy to assist providers with any concerns, questions, or feedback to foster a positive and collaborative working relationship between CDNY and our provider partners. We want to ensure we’re communicating with our network on the latest CDNY developments, and this quarterly newsletter is one of the many ways we hope to keep providers updated.
Meet the NDPR Team!
Stephen Schneider is the Senior Director of Network Development and Provider Relations (NDPR). Steve joined Partners Health Plan (PHP) in September 2019 responsible for directing the provider relations, network contract and planning of the health plan’s participating provider network. Recently Steve began to direct the provider relations activities of the CDNY CCO/Health Home.
Previously Steve worked with both large national payers (HealthNet and WellCare) and local programs (Elderplan and Beth Abraham’s PACE program). In addition, he has had executive experience working for hospital and physician groups. Steve can be reached at sschneider@caredesignny.org.
Kim Carroccia is the Director of NDPR, overseeing a team of Account Managers and a Vendor Coordinator for both CDNY and PHP . Kim joined PHP in September 2015 and supported the launch of the health plan in 2016. Prior to transitioning to the NDPR team, Kim held several roles in the Operations department, with the most recent being the Manager of Vendor Oversight and Special Projects. Before PHP she worked for a Third-Party Administrator (TPA) providing various services to health plans in New York, South Carolina, and Florida. Kim was a graduate of Siena College, so she also has familiarity with the Capital Region. Kim can be reached at kcarroccia@caredesignny.org.
Bridget Virkler is the NDPR Account Manager. Bridget joins us from CDNY where for the past several years she has served as a Care Manager Supervisor in the Capital Region. With that experience, she provides great insight as she works with CDNY team members and providers. Bridget can be reached at bvirkler@caredesignny.org. | | | | NDPR Initiatives
Ticketing System If you are a current Care Design NY Network Provider seeking assistance or information, or a provider interested in becoming a Care Design NY Network Provider, please complete the Provider Ticket Submission Form. Submitting a ticket is the most efficient way to reach the NDPR team. We look forward to hearing from you!
Provider Spotlight The Provider Spotlight series is an opportunity for providers to showcase their services to CDNY Care Managers. We are seeking DD, healthcare or behavioral health providers, community organizations and more to present to our team. This series will allow CDNY Care Managers to learn the latest and greatest information that your organization has to offer and make referrals to your organization. If you are interested in presenting, please open a ticket and a member of our team will be in touch.
Provider Recognition Our Care Managers and the individuals we support are lucky to have fantastic experiences working with providers that go above and beyond. We’d like to show our gratitude and share some amazing stories about CDNY’s collaboration with various providers. Care Managers and members can make a “Share Your Story” submission on our website. We plan to share these incredible stories to show appreciation for these especially fantastic provider agencies.
Program Vacancy Communication We want to ensure our Care Managers are aware of program openings and expansions. If your agency has a program vacancy, please open a ticket to let the NDPR team know. NDPR will communicate this out to the appropriate Care Management region to expedite the referral process and get people the services they need! | | | | Care Management Update What’s New in Care Management? Care Management is working to pivot back to in-person work, while also respecting the wishes and preferences of those we support. During this time, the flexibility of the Federal PHE remains in effect, so that does allow us to continue to offer a flexible approach. When the PHE ends, the regulatory requirements from the 1/1/21 OPWDD Memo titled “Care Coordination Organization/Health Home (CCO/HH) Provider Policy Guidance and Manual Updates” will go into effect. More details on the in-person requirements can be found HERE.
Care Management has also launched training and new expectations for Care Managers around medication adherence. A significant role of the CCO Care Manager is to promote health, wellness and preventative care, as well as supporting members to understand and successfully manage chronic conditions. Care Managers will be assessing members as a part of existing tools on any needs related to medication adherence, and will work to remove any barriers to following their prescribed treatment regimen.
Are you looking to contact a Care Manager or Regional Leadership? We have added the supervisor’s name and contact to all email signatures. In the event that there are vacations, leaves or changes – the name and contact information of the supervisor will be in the signature line for you to reach out to. Additionally, all of our Regional Leadership contacts can be found in an interactive regional map on our website HERE . | | | |
A Message from Chief Medical Officer, Dr. Stephan DeutschMedication review and reconciliation programs to address polypharmacy in individuals with intellectual and development disabilities (I/DD) are extremely important. Polypharmacy is defined as the use of multiple medications by an individual. The minimum number of medications used for the definition of polypharmacy varies, but generally ranges from 5-10. Problematic polypharmacy is defined as the use of multiple medications in a way that is not deemed appropriate by clinical guidelines or an individual’s physician (e.g., treatment is not evidence-based or the risk of harm from treatments outweighs the benefits). Often an adverse drug event (ADE) such as a drug-drug or drug-disease interaction is misinterpreted as a new symptom or medical condition and additional drug therapy is then prescribed. This is known as a prescribing cascade and makes polypharmacy even more problematic.
Polypharmacy can lead to negative health effects and independent studies have shown that the increasing the number of medications a person takes is associated with an increased risk for an ADE and or a hospital admission. Individuals with IDD are diagnosed with multiple chronic conditions at high rates and typically prescribed more medications leading to a greater risk of polypharmacy than the general population. Other factors that increase an individual’s risk of polypharmacy include having chronic mental health conditions, living in a long-term care facility, and seeing multiple physicians.
Strategies to reduce the risk from polypharmacy include thoughtful assessment and communication among healthcare providers who are managing the patient. Formal targeted review and outreach programs can be effective in assessing and reducing the risk of polypharmacy, particularly for populations at higher risk, such as those with I/DD. For example, one study found that dually eligible individuals taking more than 15 medications who participated in a care coordinator-driven medication review program had a 34 percent reduction in hospitalizations and a 25 percent reduction in emergency room visits. Individualized person-centered care is especially important when addressing polypharmacy for persons with I/DD, since this population experiences a great deal of variability in disability type, associated impact on functioning, and variability in prescribed necessary medications. Individuals with I/DD may also have difficulty understanding medication side effects or the impact of the prescribed additional medication. | | | |
Quality Corner by Premila Kumar, Chief of Quality InitiativesThe Importance of Preventive Care As we move through 2022 the spotlight on Preventive Care measures has come to the forefront as a result of the COVID-19 pandemic during which many cancer screenings were suspended or delayed, and for some individuals there is ongoing fear of exposure or fear of the screening and potential outcomes. Screening rates dropped as much as 80% in the early stages of the pandemic and according to American Cancer Society remained 29%-36% below pre-pandemic levels in 2020. The results of delayed screenings and late diagnoses will not be fully understood for several years.
The importance of ensuring our members have access to and complete all due and delayed preventive care screenings has never been more critical. This includes the need for good documentation in the medical record along with the submittal of claims which allow us to capture the completion of the screenings in a timely and less cumbersome manner. Looking specifically to Colorectal cancer and breast cancer screenings, PHP wants to support our members to ensure they have access to and avail themselves of delayed or missed screenings.
According to the CDC, Breast Cancer in females is the leading cause of new cancer diagnosis in the USA with a prevalence of 126.8/100,000 and a mortality rate of 19.9/100,000. The current recommendation is for all females aged 50-74 to have a mammogram at least every 2 years. Screenings may be appropriate in a younger population based on their personal risk factors such as genetic mutations (BRCA1 & BRCA2), personal history and family history.
Recent national data from the CDC shows Colorectal cancer is the 4th leading cause of newly diagnosed cancer at a prevalence rate of 36.5/100,000, as well as the fourth leading cause of death among all cancers. Colorectal cancer screening is extremely effective in early detection of pre-cancerous and cancerous lesions which leads to early intervention and improved outcomes. Both the CDC and ACS now recommend colorectal cancer screenings for adults aged 45 and above as well as lower age screenings for those with a family history of colon cancer and inflammatory bowel disease. Screening options can vary based on the individual’s ability to tolerate different procedures, they include a colonoscopy, flexible sigmoidoscopy, CT colonography, FIT-DNA test, or a Fecal occult Blood test.
Meet Premila Kumar, Chief of Quality Initiatives: CLICK HERE! | | | | Other News
Administrative Support Initiative
Care Design’s administrative staff may be reaching out to DD agencies to request outstanding staff action plans on behalf of CDNY Care Managers. This is being done to provide some added support for our Care Management team. We would like agencies to be aware of this new support, as you may be receiving requests from CDNY staff that are not within a member’s typical circle of support. Administrative staff will reach out with these requests via their CDNY email address. We appreciate your support with this new request process!
Provider Satisfaction Survey CDNY’s Provider Satisfaction Survey will be sent to providers in the Fall of 2022. This will provide valuable insights on the provider’s experiences when working with CDNY. We encourage providers to complete these surveys so CDNY can continue to improve the quality of support and services we provide. | |
Please contact the Network Development and Provider Relations team at providerrelations@caredesignny.org with any questions or concerns.
Thank you, Care Design NY Network Development and Provider Relations
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