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Statin Use in Type 2 Diabetic Patients

Did you know that atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality in people with diabetes and is the largest contributor to both direct and indirect costs of diabetes?1 According to the 2018 American Diabetes Association Standards of Medical Care in Diabetes, statin therapy is recommended for use in all diabetic patients 40 years of age and older and is also recommended in diabetic patients under 40 years of age who have additional ASCVD risk factors.

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Our members’ health is important to us and we want to do our part in supporting your efforts to keep them as healthy as possible. Provided below is information on statin medications covered by our US Family Health Plan and Generations Advantage health plans:

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1. American Diabetes Association. 9. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41:S86-S104.

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Four Fast Facts: Advance Care Planning

What is Advance Care Planning (ACP)?

ACP is a conversation that physicians or other qualified health professionals have with patients about their preferences for resuscitation, life-sustaining treatment and end-of-life care options.

What are some examples of ACP?

  • an advance directive,
  • actionable medical orders,
  • a living will
  • a surrogate decision maker
  • Physician Order for Life-Sustaining Treatment (POLST)

How do providers bill for ACP?

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What other provider resources are there about ACP-related topics?

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Hysterectomy Documentation and Cervical Cancer Screening

Cervical screening has proved to be a model for successful cancer prevention and is largely responsible for the 70% decrease in cervical cancer mortality in the United States over the last 50 years.

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Approximately 16% of women do not receive regular Pap tests, while 15% of the 9.5 million Pap tests performed annually are done in hysterectomized women. Since an estimated 90% of hysterectomized women should not be screened, these resources would be more effectively used if they were to cover women currently not receiving regular Pap tests.

Cervical Cancer Screening (CCS)—a HEDIS quality measure—recommendations for women:

  • Ages 21–30—have cervical cytology performed every 3 years
  • Ages 30–64—have cervical cytology performed every 3 years OR cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years

Patients can be excluded from this screening if there is clear documentation in the records that states they had any of the following in their medical history—with month and year noted: 

  • Hysterectomy with no residual cervix—a complete, total, or radical abdominal or vaginal hysterectomy
  • Cervical agenesis
  • Acquired absence of cervix

Sources: 

https://onlinelibrary.wiley.com/doi/full/10.3322/canjclin.57.2.105

HEDIS 2018, Volume 2 Technical Specifications

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Update Your Info Online with Provider DataPoint

The Centers for Medicare and Medicaid Services (CMS) now requires us to contact our network providers on a regular basis to confirm that our directory information is up to date. Watch for reminders in future editions of The Point to notify us of any changes to your provider/practice information.

Provider DataPoint is our web-based provider data management tool that helps us maintain accurate provider directories and perform timely and efficient claim processing. Using this tool is an easy way to keep all your practice/ provider(s) information up to date and accurate.

PLEASE NOTE: We no longer accept updates, changes, and credentialing applications via email or fax. Please also note that radiologists, anesthesiologists, and mid-level providers (NP, PA) who do not practice as PCPs do not require credentialing.

Please use Provider DataPoint to:

  • Change your practice information, including name, phone/fax, address, billing information, NPI, etc.
  • Add or delete a location to your already contracted practice/group
  • Change provider information, including name, specialty, panel status, add a language, etc.
  • Add a provider who requires credentialing to your practice.
  • ·Terminate a provider from your practice/ group
  • ·Check the status of a previously submitted data change request

To access Provider DataPoint, go to:
https://Providers.MartinsPoint.org/Tools/Update-Your-Info. If you have questions, see the instructions on our website or speak to your Provider Representative.

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Rx Samples to US Family Health Plan Members? Check TRICARE Formulary First!

Martin’s Point Health Care has seen an increasing number of US Family Health Plan members receiving medication samples from their provider’s office. Although we understand the desire for members to try a medication at no cost, giving samples of medications that require prior authorization can lead to frustration when they try to fill their prescription at the pharmacy. Many of these medications may also require a trial of a preferred formulary agent before the prior authorization can be approved, even if the member has already started taking the medication. This can lead to more frustration for the member since they must now start another new medication.

We kindly ask that before you give out samples to US Family Health Plan members, please check the TRICARE formulary first to make sure the medication will be covered once a prescription is written. The link to the TRICARE formulary can be found at https://tricare.martinspoint.org/prescriptions-and-pharmacies. The prior authorization criteria, including any step therapy criteria as developed by the Department of Defense, will stand even if members have started samples. Thank you for your attention to this matter.