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A Publication of Medicaid Managed Care Services (MMCS) and the Arkansas Department of Human Services

VOLUME 11 | ISSUE 1 WINTER 2012

Breast cancer screening rate

dropping sharply among

Arkansas Medicaid beneficiaries

See WOMEN, page 2

ewer than three out of 10 female Medicaid beneficiaries in Arkansas ages 40 through 69 had undergone a screening mammography in the pre-vious two years, according to data from the

Healthcare Effec-tiveness Data and Information Set (HEDIS®, a reg-istered trademark of the National Committe for Quality Assurance) covering state fiscal year 2009. The rate dropped more than four percentage points from SFY 2008, continuing a

decline that began in SFY 2004. Other HEDIS women’s health measures for SFY 2009 — the most recent data available — show room for improvement as well.

nBREAST CANCER: The mammogram

screening rate for Arkansas Medicaid ben-eficiaries declined sharply for the second straight year. HEDIS measures the percentage of beneficiaries ages 40 to 69 who had a mam-mogram during the previous two years. In SFY 2009, the rate was 29.8 percent, down from 34.1 percent in SFY 2008 and 37 percent in SFY 2007. In contrast, the national Medicaid rate increased slightly from 50.1 percent in SFY 2008 to 50.5 percent in SFY 2009 — although that is still below the 54.7 percent mark from SFY 2005.

INSIDE

n

FYI:

“Get it Right from the Start!”

New DHS website offers

information for parents of

young children

Page 3

n

POLICY UPDATE:

Medicaid strengthens

antipsychotic prescriptions

policy for children

Page 4-5

n

REMINDERS:

Pregnant women’s flu

vaccination rates lag

Page 6

n

QI UPDATE:

Room to improve after-hours

access to primary care,

survey shows

Page 7

(2)

PAGE 2 MMCS Update   •   WINTER 2012

WOMEN,

continued from front

For more information about any of the projects or stories mentioned in this publication, please call

Tereasa Holmes at 1-501-375-1200, ext. 8676, or visit www.afmc.org/mmcs.

THIS MATERIAL WAS PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) UNDER CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT. MP2-MMCS.NEWS,4-12/11

Women patients may be confused by conflicting recommendations on the age at which they should start having regular screening mammograms. The U.S. Preventive Services Task Force revised their recommendation in 2009

to state that routine screening should begin at age 50 unless individual women in consultation with their physicians choose to begin screening earlier. Several other national groups, however, including the American Cancer Society and the American College of Obstetricians and Gynecologists, still recommend beginning at age 40. Medicaid covers screening mammograms beginning at age 40. Physicians can help improve the screening rate by making sure to talk to female patients in the appropriate age range about the importance of regular screening mammograms, and taking advantage of automated reminder systems to flag patients who are due or overdue for mammograms.

nCHLAMYDIA: HEDIS measures the

percentage of women ages 16 through 24, identified as sexually active, who

had at least one test for chlamydia during the measurement year. Arkansas’s chlamydia screening rate actually increased substantially, rising from 48.1 percent in SFY 2008 to 57.3 percent in SFY 2009. The SFY 2009 rate surpassed the national Medicaid rate of 54.8 percent for the same time period. Routine chlamydia screening is essential to treating the disease successfully because about 75 percent of infected women have no symptoms. Approximately 2.3 million people in the

United States between the ages of 14 and 39 are infected each year.

nCERVICAL CANCER: Although

screening rates for cervical cancer rose from 41.1 percent in SFY 2008 to 43.5 percent in SFY 2009, Arkansas’s rate still lags dramatically behind the national rate of 67.6 percent. This measure is defined as the percentage of women ages 21 through 64 who had at least one Pap test to screen for

cervical cancer during the previous two years.

The Arkansas Foundation for Medical Care (AFMC), under contract with the state Division of Medical Services, has developed women’s health intervention tools for both providers and beneficiaries available at no charge through AFMC’s

website at www.afmc.org/tools. These

include chart reminder stickers and

mammography referral slips. s

Breast cancer screening rates,

Arkansas vs. national

0.0% 50.0% 100.0%

National

Arkansas

SFY 2009 SFY 2008 SFY 2007 SFY 2006 SFY 2005

38.8%

54.7%

37.9%

53.9%

37.0%

49.2%

34.1%

50.1%

29.8%*

50.5%

change from the previous year’s rate.*Indicates a statistically significant

(3)

MMCS Update   •   WINTER 2012 PAGE 3

FOR YOUR INFORMATION

T

he Arkansas Department of Human

Ser-vices has introduced Healthy Families, a new resource for families in Arkansas and western Tennessee that provides informa-tion about the health, safety and well-being of children from before birth through age 5.

Healthy Families began almost 20 years ago as the “Campaign for Healthier Babies” and was later branded “Healthy Baby.” The campaign used the Happy Birthday Baby Book to encourage pregnant women to seek early and continuous prenatal care in hopes of improving birth outcomes and quality of life for both mother and child.

Today Healthy Families strives for this goal and more. Its strategies have expanded, too. They include the production of:

n An updated Happy Birthday Baby Book:

Book One (prenatal through age 1) to be released in 2012

“Get it Right from the Start”

n

New DHS website offers information for parents of young children

n A new Happy Birthday Baby Book: Book

Two (newborn through age 5) to be released in 2012

n An online platform, www.

HealthyFamiliesNow.net, with A-Z resources, online order forms, hot topics, e-newsletter sign-up and more Healthy Families is constantly evolving and adding new resources and materials to help Arkansans and West Tennesseans care for their families. Our goal is the same as yours — to keep families healthy and happy.

Visit www.HealthyFamiliesNow.

net to learn more and become

connected to Healthy Families. s

Call 1-501-375-1200 or toll-free 1-888-987-1200

and contact your provider representative below:

Tereasa Holmes,

Manager

ext. 8676

Becky Andrews

ext. 8684

Gloria Boone

ext. 8675

Amelia Elam

ext. 8674

Sheryl Hurt

ext. 8688

Tabitha Kinggard

ext. 8681

Teresa McFarland

ext. 8680

Kellie Cornelius

ext. 8677

Connie Riley

ext. 8682

Shawna Branscum,

Program Coordinator

ext. 8686

Questions? Need to schedule an MMCS Provider Relations visit?

(4)

PAGE 4 MMCS Update   •   WINTER 2012 MMCS Update   •   WINTER 2012 PAGE 5 rkansas Medicaid has added

new requirements to its policy on prescribing

antipsychotic medications for children and

adolescents under age 18. The new requirements address concerns about over-prescribing and the possibility of serious biological side effects.

Medicaid now requires prior authoriza-tion for all new prescripauthoriza-tions of typical and atypical antipsychotic medications for children and adolescents under age 18, and will require prior authorization for all estab-lished patient renewals in that age group beginning June 12, 2012.

Prior authorization requests must include a signed informed consent and baseline fasting blood glucose and lipid profile.” In addition, providers must submit a brief justification for approval for pre-scriptions for children under age 6. This justification will be manually reviewed by a pediatric psychiatrist.

The policy applies to the medications listed in Table 1.

“New” patients are those who have not had a Medicaid claim filled for a prescription for any of the listed drugs in the past six months. As of Nov. 8, 2011, an informed consent must be submitted

for all new patients. Prescribing

provid-ers are also required to submit copies of the completed lab testing when the new drug is prescribed. As of June 12, 2012, an informed consent will also be required for patients using a newly prescribed drug, even if they were previously using another drug on the list.

“Established” patients are those who are already being prescribed an antipsychotic and have a Medicaid claim for a drug in the above chart in the past six months. Beginning June 12, 2012, the Medicaid pharmacy program’s point of sale system will verify if the required lab work has been completed and billed. If the lab work has been billed in the past nine months and the medication has not changed, the pre-scription will pay at the pharmacy. If not,

the physician may contact the EBRx call center and ask for a one-month approval. The required testing must be completed within the approved month.

The number of children prescribed antipsychotic medications has been rising continually for 20 years. In Arkansas, one study found that the number of children prescribed second-generation antipsychotics more than doubled from 2001 to 2003. Moreover, a large proportion — 41.3 percent of new users — had not been diagnosed with a disorder for which any evidence existed for the use of atypical antipsychotics.

In contrast, other interventions such as family therapy, behavior therapy and parent management training are underused. Psychosocial interventions should be tried before medication, according to the Ameri-can Academy of Child and Adolescent Psychiatry’s practice parameters for the use of atypical antipsychotic medications.

Children who use these medications can also suffer serious side effects, includ-ing weight gain, hyperglycemia, new onset diabetes, alterations in the lipid profile, cardiovascular abnormalities, movement disorders and hyperprolactinemia, that increase the risk of morbidity and mortality. It’s also unknown how these medications affect children’s still-developing brains.

Medicaid strengthens antipsychotic prescriptions policy for children

Safety is goal of requiring informed consent

and monitoring of side effects

Arkansas Medicaid began monitoring trends in the prescription of atypical antipsychotics in children several years ago, and in July 2009 began requiring prior authorization for antipsychotic prescriptions for children younger than 5 years old. The new policy also placed limits on the dosage of prescriptions of these medications for children younger than 18.

In forming the latest policy changes, the Arkansas Depart-ment of Human Services worked with child psychiatrists, psy-chiatrists, pediatricians and pharmacists. This collabora-tion settled on an informed consent as the best way to ensure family participation in treatment, and created a form with specific instructions for monitoring biological side effects (weight, lipid profile, fasting blood glucose).

More details about the new policy as well as downloadable sample informed consent forms and flowsheets for monitoring side effects can be found at

www.afmc.org/mmcs and www.medicaid.state.ar.us. s

TABLE 1.

TYPICALS ATYPICALS Chlorpromazine Aripiprazole Fluphenazine Clozapine Haloperidol Olanzapine Loxapine Olanzapine + fluoxetine Molindone Paliperidone Perphenazine Quetiapine Pimozide Risperidone Thioridazine Ziprasidone Thiothixene     Trifluoperazine

POLICY UPDATE

News on Medicaid policies & procedures

These sample documents, an informed consent and a flowsheet for monitoring biological side effects  of antipsychotic medications, are available at no charge  from AFMC’s and Arkansas Medicaid’s websites.

(5)

PAGE 6 MMCS Update   •   WINTER 2012

P

regnant women have the lowest

influenza vaccination rate of all adult priority groups in Arkansas. The numbers are even lower for pregnant women on Medicaid.

In a survey conducted by the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS)

covering the 2009-2010 flu season, less than half the women who responded to the question (46.7 percent) said they had received an influenza vaccine. The percentages were even lower for women under the age of 19 (39 percent), African-American women (35.1 percent), women who received no prenatal care in the first trimester (36.2 percent), women who

were on Medicaid (37.5 percent vs. 46.8 percent of women not on Medicaid), and women whose provider did not recommend the vaccination (19.4 percent, compared to 59.1 percent of women whose provider did recommend it).

Influenza vaccination is especially important for pregnant women because the changes that occur during pregnancy leave them more vulnerable to the illness

and its complications. Vaccination during pregnancy also protects women’s babies until they can be vaccinated themselves.

Studies have shown that pregnant women are much more likely to get a flu shot if their prenatal care provider recommends or provides it. In fact, 30 percent of pregnant women in the survey

who said they hadn’t been vaccinated listed “My doctor didn’t mention anything about a flu shot” as one of the reasons.

The CDC suggests the following steps for providers to help increase the number of pregnant women who are vaccinated:

n Educate staff and pregnant women

about the importance of influenza vaccination during pregnancy and evidence related to its safety, and

provide a strong recommendation for vaccination.

n Issue standing orders for influenza

vaccination of pregnant and postpartum women.

n Establish an influenza vaccination

reminder system in their practices

n Post influenza prevention announcements and provide brochures to prompt vaccination requests. n Offer vaccination to pregnant women at the earliest opportunity and throughout flu season (October–April).

n Vaccinate postpartum

women who were not vaccinated during pregnancy, preferably before hospital discharge or at the six-week postpartum visit.

n Know where to refer patients if

influenza vaccine is not available in the practice.

n Educate staff and postpartum

women that vaccination is safe for breastfeeding women and babies.

n Advise family members and other close

contacts of pregnant and postpartum women and infants that they should

also be vaccinated against influenza. s

REMINDERS

Important updates you need to know

Pregnant women’s flu vaccination rates lag

(6)

MMCS Update   •   WINTER 2012 PAGE 7

T

he results of a recent survey of

Medicaid-enrolled primary care physicians suggest that the majority of PCPs surveyed are meeting Medicaid requirements for after-hours communica-tions with patients, but there is room to

improve, particularly in rural areas.

Medicaid requires enrolled PCPs to provide parients 24-hour/seven-days-a-week access to a live voice (clinic staff or an answering service) or an answering machine that will immediately page an on-call medical professional. The on-call professional must respond to non-emer-gency calls within 30 minutes, and must provide information and instructions for treating emergency and non-emergency conditions; make appropriate referrals for non-emergency services; and provide information about accessing other services and handling medical problems when the PCP’s office is closed.

The Arkansas Foundation for Medical Care (AFMC) re cently surveyed Medic-aid primary care physicians with a casel-oad of at least 100 about the after-hours access they provide to patients. Of the 801 providers contacted, 456 completed the survey, which was done at the request of the state Division of Medical Services.

Highlights of the results include:

n Overall, 55 percent of responding

pro-viders offer an after-hours call system where patients are able to speak with a live person, such as clinic staff or an answering service.

n More than 40 percent of practices,

how-ever, offer only an answering machine that is not checked until the practice reopens. Of these, 70 percent tell patients to leave a message and go to the ER in case of an emergency, while 30 percent tell patients to call an answering service.

n Less than 12 percent of providers use

a clinical triage service such as a nurse hotline to answer after-hours calls.

n Less than 3 percent of providers offer

direct contact with an on-call physician after hours.

n At least one in three providers uses

an answering service. At least half of these page an on-call professional who responds within 20 minutes.

n Of 93 phone calls made for

verifica-tion, 69 providers (74 percent) had after-hours systems that matched their survey responses, while 24 providers’ (26 percent) systems did not match..

n AFMC also called providers who did not

complete the survey to determine if their

after-hours calls system differed from pro-viders who did complete the survey. Pro-viders who answered the initial phone call but did not complete the survey were significantly more likely to use answer-ing machines and significantly less likely to use answering services compared to providers who completed the survey. All answering services from both verification groups stated that the practice responds within 20 minutes and that the answer-ing service, if requested, will send a log of all calls to the practice.

DMS is interested in working with clinicians across the state to improve access as envisioned by the original Primary Care Case Manage-ment concept. Please send your com-ments to Gary Wheeler,

MD, at gwheeler@afmc.

org, Tereasa Holmes at

tholmes@afmc.org, or

Julie Kettlewell at

jket-tlewell@afmc.org. s

QI UPDATE

Helping you stay on top of quality in your practice

Survey shows room to improve

after-hours access to primary care

(7)

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