Talking about Mental Health at Work

Tools and Partnerships to help your organization raise awareness, reduce stigma surrounding mental illness, and facilitate help-seeking behavior.

If you or a co-worker are in immediate crisis, reach out to a crisis hotline at 800-273-8255 or text 741741. Trained professionals are available to provide confidential support.

MENTAL HEALTH @ WORK

Treatment can help people feel better and perform better. By sharing information and solutions, we can help reduce the stress on employees and company resources.

Tools and Partnerships to help your organization raise awareness, reduce stigma surrounding mental illness, and facilitate help-seeking behavior.

Talking about Mental Health at Work

Putting tasks off, missing deadlines or feeling indecisive. If you notice these signs in a co-worker and it just doesn’t seem right, be courageous and act.

Depression can be lonely and scary but starting a conversation can help a person feel supported. Here are some ways to start the conversation …

How to start the conversation. 

Talking about feelings and emotions may be uncomfortable for some people.  So start by finding a private place to talk and asking, “are you okay?” or “what’s going on, you don’t seem like yourself?” Describe what you’re seeing and how it seems out of character for that person.

Ask twice. 

A person may deflect the conversation if the topic feels uncomfortable. Talking about an issue that makes a person feel vulnerable is often not easy. For many, hearing someone ask “how are you doing,” it makes them think the person asking really does not want to hear anything negative.  We often say that we’re fine when we may not be feeling that way at all.

To get past this natural response, consider asking twice:

“How are you?”

“Fine.”

“Hey…  is everything okay?”

Try extra hard to show sincerity and compassion (through changes in vocal tone and body language) when you ask the second time.  This can really demonstrate your genuine concern for the other person’s wellbeing.

Listen. 

Take a minute to pause and just listen. When people share their feelings, they are vulnerable. Try to listen non-judgmentally and resist jumping in with a proposed solution. The person will benefit just from talking and having a good listener. If the person is defensive, it may be their feelings and emotions responding, so be patient. Try responding with “I just wanted to make sure that you’re okay and to let you know that I’m here if you ever want to talk.”

Ask for more context, don’t answer. 

Instead of a quick response or offering solutions, ask follow-up questions. You might ask why the person thinks that he or she feels this way or what is needed to feel better.  Ask if the way the person is feeling is impacting his or her daily life. You may also ask whether the person has considered talking with someone who can help. It is easier for someone to seek help if they find the answer themselves, rather than being told how to fix it.

Provide support. 

It is common to sometimes feel stressed, lonely, overwhelmed, frustrated, sad, and depressed. Let your co-worker know that it is okay to feel that way and it is a natural part of the human experience. It’s when it interferes with daily life that it’s time to consider getting help. Express your willingness to help with supportive statements like:

“I want to support you. Let’s talk about how I can help.”

“What can I do to help?” or “How can I help?”

Follow up. 

Be sure to check back in whether the person accepted your offer of support or not. This sends the clear message that you care and are there for support. Also, keep conversations and information shared with you confidential unless you’re worried a person may pose a danger to him or herself or others. In those cases, talk to HR, a manager or someone you trust immediately. Self-harm or potential harm to others require immediate attention.

Remember, a person may not be ready to talk or seek help. Remind him or her that you’re here to help when it is needed.

https://www.shatterproof.org/

If you or a co-worker are in immediate crisis, reach out to a crisis hotline at 800-273-8255 or text 741741. Trained professionals are available to provide confidential support.

Right Direction is an initiative from the American Psychiatric Association Foundation’s Center for Workplace Mental Health and Employers Health, a professional benefits organization. Right Direction is supported by Takeda Pharmaceuticals U.S.A., Inc. (TPUSA) and Lundbeck U.S. The information on this website is not intended to replace medical advice from your doctor. ©2013 – 2021 Right Direction.

Managed Care Contracts and Health System Operational Alignment

CASE EXAMPLE of how we breakdown contracts and tie the terms to operational alignment

Because the business of healthcare is to deliver the highest quality care to patients, improving clinical performance is the driving focus. However, understanding and responding to financial pressures through increased efficiency and enhanced revenue capture is what makes high-quality clinical delivery possible and sustainable.

Reimbursement StructureActivity triggering a more robust financial return
Reimbursed primarily on a fee-for-service basis, generate more revenue by using your care team as a provider–extender, enabling more patients to see the provider for a billable visit each day
The organization accepts full risk for patient costs, Ensuring patients are taught how best to manage their illness and avoid specialist or emergency room visits. 
Capitated fee for primary care services, experimenting with alternative visit types may maximize your ability to care for more patients
Nonphysician payment for CCMPractices that rely on nonphysician team members to deliver CCM services will probably experience substantial net revenue gains but must enroll a sufficient number of eligible patients to recoup costs.
“If nonphysician staff were to deliver CCM services, net revenue to practices would increase despite opportunity and staffing costs. Practices could expect approximately $332 per enrolled patient per year (95% CI, $234 to $429) if CCM services were delivered by registered nurses (RNs), approximately $372 (CI, $276 to $468) if services were delivered by licensed practical nurses, and approximately $385 (CI, $286 to $485) if services were delivered by medical assistants. For a typical practice, this equates to more than $75 ,00 of net annual revenue per FTE physician and 12 hours of nursing service time per week if 50% of eligible patients enroll. At a minimum, 131 Medicare patients (CI, 115 to 140 patients) must enroll for practices to recoup the salary and overhead costs of hiring a full-time RN to provide CCM services.”
Non-visit-based payment for chronic care management (CCM)Measuring Net revenue per full-time equivalent (FTE) physician; time spent delivering CCM services.

Medicaid MCO Quality Ratings

https://www.kff.org/medicaid/state-indicator/medicaid-mco-quality-ratings/view/print/?currentTimeframe=0&print=true&sortModel=%7B%22colId%22:%22State%22,%22sort%22:%22asc%22%7D

NOTES

Notes

Data reflect NCQA’s 2019 ratings of Medicaid managed care plans. The plans included in the NCQA data do not always match the MCOs in other tables in the Medicaid Managed Care Market Tracker, or they may appear under different names. Discrepancies may be due to differences across reports and sources, timeframes, and other factors. MCOs not accredited or rated by NCQA may be accredited or rated by other organizations.

The NCQA plan overall rating scale is 0-5 (0 is lower performance, 5 is higher performance). NCQA accreditation is as of June 30, 2018. For more information about how NCQA rates plans, please see NCQA’s methodology.

Sources

NCQA Health Insurance Plan Ratings 2018-2019 – Summary Report (Medicaid). Special Data Request, October 2019.

Definitions

Partial Data Reported: Plans with partial data do not receive a rating, but NCQA lists them in the ratings and shows their scores on the measures they report. A plan is considered to have partial data if it submits HEDIS and CAHPS measure data for public reporting, but has insufficient data for one or more measures, submits HEDIS data for public reporting but does not submit CAHPS data, or vice versa, or earned NCQA Accreditation without HEDIS data (health plan accreditation standards only) and did not submit HEDIS or CAHPS data for public reporting.

No Data Reported: Plans that submit results but do not report data publicly, or plans that report no HEDIS, CAHPS or accreditation information to NCQA, are given a rating status of “No Data Reported”.

Insufficient Data: Plan has “missing values” (i.e., NA or NB) in more than 50 percent of the weight of the measures used in the methodology.

CMS Bundled Payments for Care Improvement (BPCI) Initiative: A Discussion on Bundled Payments

There is a large disconnect between what occurs after a patient is discharged from a hospital (acute) and what occurs thereafter. The quality of care is entirely unmanaged, uncontrolled, and unmonitored. Moreover, the patient is placed at greater risk whe

Understanding the CMS Bundled Payments for Care Improvement (BPCI) Initiative

In recent years, healthcare has been undergoing a significant transformation, driven by the need to improve care delivery and reduce costs. One of the key initiatives in this transformation is the Bundled Payments for Care Improvement (BPCI) program, introduced by the Centers for Medicare & Medicaid Services (CMS). The BPCI program is part of a broader effort to move the U.S. healthcare system towards value-based care, focusing on quality outcomes rather than the volume of services.

What is the BPCI Initiative?

The BPCI initiative was launched as part of the Affordable Care Act (ACA), which allowed the establishment of the Center for Medicare and Medicaid Innovation. The goal of this center is to pilot and expand innovative payment models that improve healthcare quality while reducing costs. BPCI is one of the many alternative payment models (APMs) being tested to align financial incentives with the quality of care provided, particularly in the post-acute care (PAC) setting.

The BPCI program focuses on bundled payments, which means that instead of paying for each service separately, healthcare providers receive a single, comprehensive payment for an entire episode of care. This “bundle” covers all services related to a patient’s treatment, including post-hospitalization care, for a specified period (e.g., 30 or 90 days). The goal is to incentivize providers to deliver coordinated, high-quality care that reduces unnecessary services and prevents avoidable readmissions.

Why Focus on Post-Acute Care?

One of the most challenging areas of healthcare to manage, particularly within the Medicare Fee-For-Service (FFS) program, is post-acute care. After patients are discharged from the hospital, they often require further care in settings such as inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), or home health agencies (HHAs). The costs and quality of care in these settings vary significantly across the country, contributing to wide regional disparities in Medicare spending. In fact, 73% of the variation in Medicare spending is attributed to differences in post-acute care settings.

The BPCI initiative specifically targets these post-acute care settings because of the high cost and the potential for improvement. For example, about 20% of Medicare patients are readmitted to the hospital within 30 days of discharge, and research suggests that 75% of these readmissions could be prevented with better care coordination.

The BPCI Models

The BPCI initiative includes four different models, each offering a different approach to bundled payments:

  1. Model 1: Retrospective Acute Care Hospital Stay Only – This model focuses on hospital costs for acute care stays.
  2. Model 2: Retrospective Acute and Post-Acute Care Episode – In this model, hospitals are financially responsible for both the acute care and all post-acute care services provided within 30 or 90 days of discharge.
  3. Model 3: Retrospective Post-Acute Care Only – This model places post-acute care providers (e.g., SNFs, HHAs) at financial risk for the services they provide after a hospital discharge.
  4. Model 4: Prospective Acute Care Hospital Stay Only – In this model, hospitals receive a single, upfront payment for an acute care stay, and they cannot bill for any additional services, even if the patient is readmitted within 30 days.

Model 2 is the most complex and widely adopted model, as it requires hospitals to manage the entire episode of care, including both acute and post-acute services. The financial risk is reconciled retrospectively, meaning that CMS reviews the total cost of care after the episode is complete and compares it to a pre-determined target price. If the costs are lower than the target, the hospital may share in the savings; if the costs are higher, the hospital is responsible for the excess.

Implementation Strategies for Success

To succeed in the BPCI initiative, hospitals and post-acute care providers need to collaborate closely. Many hospitals are implementing strategies such as narrowing their networks to include only high-performing post-acute care providers. This ensures that patients are discharged to facilities with strong track records in quality care and low readmission rates.

Hospitals are also using tools like patient choice letters, which list all available post-acute care providers but highlight those that have been vetted for quality. This approach, known as “soft steerage,” helps guide patients toward the best providers without restricting their choices.

In addition to collaboration, data sharing and technology play a crucial role in the success of BPCI. Hospitals need visibility into the patient’s care journey after discharge, which can be facilitated through electronic health records and other data integration tools. This allows for better coordination and monitoring of patient outcomes across the continuum of care.

Challenges and Opportunities

While the BPCI initiative offers significant opportunities for improving care and reducing costs, it also presents challenges. One major issue is the complexity of managing bundled payments, especially with the retrospective reconciliation process that introduces delays in financial feedback. Hospitals need to track performance in real-time and adjust their strategies based on ongoing data, rather than waiting for quarterly reconciliations from CMS.

Another challenge is managing high-risk patients and outlier cases, which can significantly skew financial outcomes. However, as bundled payment models continue to evolve and expand, hospitals that proactively adapt to these challenges will be better positioned for success in the shifting healthcare landscape.

Conclusion

The BPCI initiative is an important step towards a value-based healthcare system, particularly in managing the costly and often fragmented post-acute care segment. By aligning financial incentives with quality outcomes, the BPCI program encourages providers to deliver more coordinated, efficient care, reducing unnecessary services and preventable readmissions.

As bundled payment models continue to expand, healthcare providers who embrace this shift now will be better prepared for the future. By focusing on collaboration, data integration, and patient-centered care, hospitals can succeed in the BPCI initiative and contribute to a more sustainable healthcare system.

Payer Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage

Carenodes Health Enterprise
Office of the Executive

Dear Health Plan Representative,

Please see attached Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage.



Carenodes Health Enterprise 

Office of the Executive 


Dear Health Plan Representative, 



Please see attached Payer Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage.


 


February 25 , 2021

 

TO:  PAYER PARTNERS

 

 

RE:  DMHC All Plan Letter directing commercial full-service health plans and  specialized health plans offering behavioral health services to demonstrate  compliance with the amended California Mental Health Parity Act (SB 855, 2020).

 

On Jan. 5, the Department of Managed Health Care (DMHC) issued All Plan Letter (APL) 21-002 to all commercial full-service health plans and specialized health plans offering behavioral health services that are regulated by the department. The guidance is designed to ensure health plans comply with amendments made to Senate Bill (SB) 855 (Wiener, D-San Francisco), the mental health and substance use parity law that took effect on Jan. 1.   


SB 855 requires commercial health plans and insurers to provide full coverage for the treatment of all mental health conditions and substance use disorders. It also establishes specific standards for what constitutes medically necessary treatment and criteria for the use of clinical guidelines. The APL outlines filing and compliance requirements of plans, including revised policies and procedures to accommodate new coverage requirements and implementation procedures related to utilization review of covered benefits. 


In addition, the 2020-21 state budget approved strategies to strengthen enforcement of behavioral health parity laws, including focused investigations of commercial health plans regulated by DMHC. These investigations, which are expected to begin in the first quarter of 2021, will help DMHC further evaluate health plan compliance with parity and assess whether enrollees have consistent access to medically necessary behavioral health care services. 





Sincerely,

 




 

A Alex Yarijanian

Chief Executive Officer and Founder

Alex@carenodes.com

(310) 626-0149 (main)

(310) 525-5498 (direct)




Health Care Consumer Assistance

Department of Managed Health Care (DMHC) Help Center
Assistance with problems with health coverage and with health plan grievances and appeals.
http://www.Healthhelp.ca.gov 


California Department of Insurance
Assistance with health insurance problems for non-managed care plans
1-800-927-4357
http://www.insurance.ca.gov 


Health Consumer Alliance
Consumer assistance program to help people with low incomes get the health care they need.
1-888-804-3536
http://www.healthconsumer.org/


HICAP (California Health Insurance Counseling and Advocacy Program)
Information, counseling, and assistance for people who have or will soon have Medicare
1-800-434-0222
http://www.aging.ca.gov/hicap/


MediCaManaged Care Ombudsman
Assistance for people enrolling in or changing Medi-Cal managed care plans
1-888-452-8609
http://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx





Pandemic Creates Extra Cyber Risk For Health Care Providers

Unfortunately, it is in these times of dogged, urgent focus on patient care that health care organizations may be most vulnerable to another invisible danger: cybercrimes targeting the very hospitals tasked with protecting us.

A recent report estimates that, in 2019 alone, cybercriminals compromised over 41 million patient records, costing the health care industry billions of dollars. (Protenus Inc. & DataBreaches.net, 2020 Breach Barometer (2020); HIPAA Journal, Healthcare Data Breaches Predicted to Cost Industry $4 Billion in 2019 (Nov. 7, 2019).) We also know that health data breaches have increased steadily year over year, and can be expected to increase sharply in times of political or social turmoil.

In short, the global health crisis creates an opportunity for cybercriminals, and health care organizations and hospitals should consider taking steps now to minimize the risk to their systems, their data and, most importantly, their patients.Hospitals as Targets

The health care industry is a favorite target of cybercriminals, and hospitals are particularly vulnerable. There are numerous reasons for this.

Owing to their commendable focus on patient care, many health care organizations have invested less in technology and cybersecurity than other major industries. Recent digitization of patient health records has left many hospitals without robust security infrastructure vulnerable.

In addition, hospitals increasingly are using interconnected medical devices that sometimes have limited security protection. In 2013, these security considerations led doctors for former Vice President Dick Cheney to disable the wireless feature in his pacemaker, for fear that hackers could otherwise access the device. (Dana Ford, Cheney’s defibrillator was modified to prevent hacking, CNN.com (Oct. 24, 2013).)

Further, doctors and nurses on the front lines of patient care sometimes do not receive robust training on cybersecurity measures. Compounding the threat is the enormous value of electronic health records on the black market: Stolen records reportedly can fetch prices of up to $1,000 each. (Mariya Yao, Your Electronic Medical Records Could Be Worth $1000 To Hackers, Forbes (April 14, 2017).)

In short, hospitals and health care organizations are particularly exposed, even in the best of times.Crisis Creates Opportunity

In more challenging times, the picture is darker. In the few short weeks since the World Health Organization declared COVID-19 a global pandemic, cybercriminals already have sought to capitalize on the crisis.

The Wall Street Journal recently reported that hackers targeted two hospital systems, one in the U.S. and another in the Czech Republic — the latter attack compromising the country’s second largest hospital for almost two weeks. (Wall Street Journal, Cybercriminals Sweep In to Take Advantage of Coronavirus (March 24, 2020).)

Although cybercriminals have a number of tools at their disposal, ransomware attacks are perhaps the most concerning in the current climate because they have the potential to lock hospital administrators and staff out of their own systems for lengthy periods of time, compromising patient health. Late last year, for example, a ransomware attack on a cancer center disabled its systems and forced it to halt radiation treatment for cancer patients. (Jessica Davis, Ransomware Attacks Disrupts Patient Care at Hawaii, NJ Hospitals, HealthITSecurity.com (Dec. 16, 2019).) Hospitals often are asked to pay attackers hefty ransoms to resolve such attacks.

The rapidly evolving global health crisis caused by the spread of COVID-19 is also creating new windows of opportunity for cybercrime. The increase in telemedicine and makeshift hospital facilities, in addition to overcrowded conditions in hospitals and emergency rooms across the country, mean that hospital IT systems are at maximum capacity.

Under the circumstances, just one click on an email or attachment by an unsuspecting and exhausted hospital worker could unleash malware that compromises an entire hospital’s financial and clinical information systems, as well as its interconnected medical devices. The global pandemic is a crisis — but without functioning hospital systems and critical care, it could become a disaster.Litigation Risks Abound

Adding to the burdens already faced by health care organizations, cybercrime victimizes health care targets on several fronts, and could lead not only to substantial business costs, but also to potential third-party claims from affected patients.

In one example, a ransomware attack on a Wyoming-based health care company disabled hospital systems, resulting in service disruptions to the organization’s outpatient lab, respiratory therapy and radiological exams. Surgeries were canceled, new patients were turned away, and emergency room patients were transferred to other hospitals. (Jessica Davis, Campbell County Health Ransomware Attack Disrupting Patient Care, HealthITSecurity.com (Sept. 23, 2019).) Plaintiffs lawyers began advertising a potential class action shortly thereafter.

Such lawsuits have become increasingly common in the aftermath of health-care-related cyberattacks. (See, e.g., Aranowitz v. Hackensack Meridian Health Inc., 2:20-CV-01409 (D.N.J. Feb. 10, 2020); Quintero v. Metro Santuce Inc., Case No. 20-1075 (D. Puerto Rico, Feb. 11, 2020); Edwards v. Univ. of Washington, Case No. 19-2-12285-4 (Wash. Super. Ct., Oct. 21, 2019).) Moreover, as cybercriminals become more sophisticated, and the internet of things is extended to include interconnected medical devices, a new wave of product liability lawsuits stemming from malware attacks that compromise patient-worn medical devices or wired devices used for patient care may be on the horizon.

Hospitals and health care organizations are urged think now about how to mitigate the consequences of such attacks, if not prevent them altogether.Critical Care Requires Cybersecurity

The health care industry will require long-term investment, regulatory compliance, and cybersecurity prophylaxis to slow the tide of cyberattacks. But there are several short-term steps all health care organizations can take to protect themselves in this time of crisis.

First, health care companies should consider dusting off their cybersecurity contingency plans and, if necessary, hire outside professionals to update and implement those plans across facilities that are on the front lines of fighting the pandemic.

Second, hospitals should, where possible, provide updated training to emergency personnel on handling electronic health records. This is especially true where patients are being treated remotely or in temporary hospital facilities, where access to core IT systems may not be available.

Third, medical device manufacturers should be mindful of guidance from the U.S. Food and Drug Administration on the post-market cybersecurity in medical devices, particularly as regards updates and patches, and continuously work to improve device security as new technology becomes available. (See FDA, Postmarket Management of Cybersecurity in Medical Devices: Guidance for Industry and Food and Drug Administration Staff (Dec. 2016), available at https://fda.gov/media/95862/download.)

Further, medical device manufacturers and hospitals alike can revisit indemnity provisions in any agreements providing for the sale and distribution of wired medical devices. This will ensure that all parties know who is responsible in the event of a cyberattack affecting those devices.

Finally, all companies operating in the health care space should consider comprehensive cyber-liability insurance. The policies available are not one-size-fits-all, and can be negotiated to include both direct expenses resulting from a cyberattack (e.g., expenses associated with a malware infection, ransomware or business email compromise) as well as expenses resulting from third-party claims (e.g., litigation involving privacy breaches and product liability).

The bottom line is that consistent, reliable patient care requires secure health care systems. Hospitals and health care organizations can take precautions now to prevent cyberattacks from disabling critical systems and compromising patient care as the global health care crisis evolves.

The opinions expressed are those of the author(s) and do not necessarily reflect the views of the firm or any of its or their respective affiliates. This article is for general information purposes and is not intended to be and should not be taken as legal advice.

ALTERNATIVE CARE SETTINGS: TELEMEDICINE AND RETAIL CLINICS

Many firms provide coverage for health services delivered outside typical provider settings. Telemedicine is the delivery of health care services through telecommunications to a patient from a provider who is at a remote location, including video chat and remote monitoring. This generally would not include the mere exchange of information via email, exclusively web-based resources, or online information a plan may make available unless a health professional provides information specific to the enrollee’s condition. We note that during the coronavirus pandemic, some plans have eased their definitions to allow more types of digital communication to be reimbursed.

How alternative settings unlock healthcare access — and eat into hospitals





2021 Performance Period Eligible Professional / Eligible Clinician eCQMs

The document outlines 47 electronic clinical quality measures (eCQMs) for Eligible Professionals/Clinicians for the 2021 performance period. It categorizes various measures based on quality domains, including effective clinical care, community health, and patient safety, while indicating eligibility for telehealth in select measures.

2021 Performance Period Eligible Professional / Eligible Clinician eCQMs
Total number of EP/EC eCQMs: 47

Measure NameCMS eCQM IDQuality DomainNQF IDMIPS Quality IDMeaningful Measure AreaTelehealth Eligible*
Adult Major Depressive Disorder (MDD): Suicide Risk AssessmentCMS161v9Effective Clinical Care0104e107Prevention, Treatment, and Management of Mental HealthYes
Anti-depressant Medication ManagementCMS128v9Effective Clinical CareNot Applicable009Prevention, Treatment, and Management of Mental HealthYes
Appropriate Testing for PharyngitisCMS146v9Efficiency and Cost ReductionNot Applicable066Appropriate Use of HealthcareYes
Appropriate Treatment for Upper Respiratory Infection (URI)CMS154v9Efficiency and Cost ReductionNot Applicable065Appropriate Use of HealthcareYes
Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic FractureCMS249v3Efficiency and Cost Reduction3475e472Appropriate Use of HealthcareYes
Bone density evaluation for patients with prostate cancer and receiving androgen deprivation therapyCMS645v4Effective Clinical CareNot Applicable462Management of Chronic ConditionsYes
Breast Cancer ScreeningCMS125v9Effective Clinical CareNot Applicable112Preventive CareYes
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryCMS133v9Effective Clinical Care0565e191Management of Chronic ConditionsNo
Cervical Cancer ScreeningCMS124v9Effective Clinical CareNot Applicable309Preventive CareYes
Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentCMS177v9Patient Safety1365e382Prevention, Treatment, and Management of Mental HealthYes
Childhood Immunization StatusCMS117v9Community/Population HealthNot Applicable240Preventive CareYes
Children Who Have Dental Decay or CavitiesCMS75v9Community/Population HealthNot Applicable378Preventive CareNo
Chlamydia Screening for WomenCMS153v9Community/Population HealthNot Applicable310Preventive CareYes
Closing the Referral Loop: Receipt of Specialist ReportCMS50v9Communication and Care CoordinationNot Applicable374Transfer of Health Information and InteroperabilityYes
Colorectal Cancer ScreeningCMS130v9Effective Clinical CareNot Applicable113Preventive CareYes
Controlling High Blood PressureCMS165v9Effective Clinical CareNot Applicable236Management of Chronic ConditionsYes
Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)CMS145v9Effective Clinical Care0070e007Management of Chronic ConditionsYes
Dementia: Cognitive AssessmentCMS149v9Effective Clinical Care2872e281Prevention, Treatment, and Management of Mental HealthYes
Depression Remission at Twelve MonthsCMS159v9Effective Clinical Care0710e370Prevention, Treatment, and Management of Mental HealthYes
Diabetes: Eye ExamCMS131v9Effective Clinical CareNot Applicable117Management of Chronic ConditionsYes
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)CMS122v9Effective Clinical CareNot Applicable001Management of Chronic ConditionsYes
Diabetes: Medical Attention for NephropathyCMS134v9Effective Clinical CareNot Applicable119Management of Chronic ConditionsYes
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes CareCMS142v9Communication and Care CoordinationNot Applicable019Transfer of Health Information and InteroperabilityNo
Documentation of Current Medications in the Medical RecordCMS68v10Patient Safety0419e130Medication ManagementYes
Falls: Screening for Future Fall RiskCMS139v9Patient SafetyNot Applicable318Preventable Healthcare HarmYes
Follow-Up Care for Children Prescribed ADHD Medication (ADD)CMS136v10Effective Clinical CareNot Applicable366Prevention, Treatment, and Management of Mental HealthYes
Functional Status Assessment for Total Hip ReplacementCMS56v9Person and Caregiver-Centered Experience and OutcomesNot Applicable376Functional OutcomesYes
Functional Status Assessment for Total Knee ReplacementCMS66v9Person and Caregiver-Centered Experience and OutcomesNot Applicable375Functional OutcomesYes
Functional Status Assessments for Congestive Heart FailureCMS90v10Person and Caregiver-Centered Experience and OutcomesNot Applicable377Functional OutcomesYes
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)CMS135v9Effective Clinical Care0081e005Management of Chronic ConditionsYes
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)CMS144v9Effective Clinical Care0083e008Management of Chronic ConditionsYes
HIV ScreeningCMS349v3Community/Population HealthNot Applicable475Preventive CareYes
Initiation and Engagement of Alcohol and Other Drug Dependence TreatmentCMS137v9Effective Clinical CareNot Applicable305Prevention and Treatment of Opioid and Substance Use DisordersYes
Oncology: Medical and Radiation – Pain Intensity QuantifiedCMS157v9Person and Caregiver-Centered Experience and Outcomes0384e143Management of Chronic ConditionsYes
Pneumococcal Vaccination Status for Older AdultsCMS127v9Community/Population HealthNot Applicable111Preventive CareYes
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up PlanCMS69v9Community/Population HealthNot Applicable128Preventive CareNo
Preventive Care and Screening: Influenza ImmunizationCMS147v10Community/Population Health0041e110Preventive CareYes
Preventive Care and Screening: Screening for Depression and Follow-Up PlanCMS2v10Community/Population Health0418e134Prevention, Treatment, and Management of Mental HealthYes
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up DocumentedCMS22v9Community/Population HealthNot Applicable317Preventive CareNo
Preventive Care and Screening: Tobacco Use: Screening and Cessation InterventionCMS138v9Community/Population Health0028e226Prevention and Treatment of Opioid and Substance Use DisordersYes
Primary Caries Prevention Intervention as Offered by Primary Care Providers, including DentistsCMS74v10Effective Clinical CareNot Applicable379Preventive CareYes
Primary Open-Angle Glaucoma (POAG): Optic Nerve EvaluationCMS143v9Effective Clinical Care0086e012Management of Chronic ConditionsNo
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsCMS129v10Efficiency and Cost Reduction0389e102Appropriate Use of HealthcareNo
Statin Therapy for the Prevention and Treatment of Cardiovascular DiseaseCMS347v4Effective Clinical CareNot Applicable438Management of Chronic ConditionsYes
Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaCMS771v2Person and Caregiver-Centered Experience and OutcomesNot Applicable476Functional OutcomesNo
Use of High-Risk Medications in Older AdultsCMS156v9Patient SafetyNot Applicable238Medication ManagementYes
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and AdolescentsCMS155v9Community/Population HealthNot Applicable239Preventive CareYes

Carenodes, a Healthcare Infrastructure Developer, Wins Two Best in Class Awards From Health Net and ComPsych for its Pandemic Response

Jan 25, 2021 (AB Digital via COMTEX) — Los Angeles, CA – ComPsych® revealed the 2020 winners for its 16th-annual Health at Work Awards. This award honors organizations that assist employees with outstanding wellness systems.  Carenodes was named as the winner of the best-in-class gold award for organizations with less than 100 employees.

In an unprecedented year, Carenodes has created jobs where others have, unfortunately lost jobs. Carenodes has not only grown its team substantially, but it has led through these trying times with award winning performance. 

Carenodes has done so by implementing a community-based approach to workforce development, wellness, and resilience. Alex Yarijanian, CEO of Carenodes, stated, “All employers and companies had to make sudden and immediate changes to adapt to the pandemic. Carenodes took the approach of deploying forces to provide business administration support to critical Healthcare provider organizations”. Carenodes partnered with its provider network to help implement administrative supports and workforce development, wellness, and resilience across various sectors of healthcare. 

Here are some of the ways Carenodes and its provider network collaborated to scale workplace innovation in wellness:

  • Overnight attainment of grant funding for a new model of remote staff decentralization, management, and engagement.
  • Wholistic suicide prevention programs to include staff training, patient engagement, and supports.
  • Collocation of emergency department and acute-center behavioral health support for patients, healthcare providers, and caregivers.

“…these outstanding organizations for making employee health and wellness top priorities, especially during these difficult times. Given the current climate, employee well-being is more important than ever, and I applaud the exceptional efforts of these companies.”

Dr. Richard Chaifetz, Founder, Chairman and CEO of ComPsych,

Earlier in 2020, carenodes secured a Health Net grant proposal for its behavioral health provider network to expand its virtual healthcare delivery capacity and accessibility. In response to the ongoing COVID-19 pandemic, Carenodes Behavioral, in collaboration with Insight Choices, was awarded $125,000 to rapidly expand its telehealth infrastructure.

The grant was used to help Carenodes Behavioral Health networks launch new telehealth technologies to increase prevention and intervention efforts for patients with mental health conditions.

Furthermore, the availability of funding has enabled the provision of crisis intervention services, mental and substance use disorder treatment, crisis counseling, and other related supportive services for communities impacted by the COVID-19 pandemic.

“Providing increased access to care during this unprecedented time is critical to ensuring our most vulnerable populations stay healthy and safe. The amount of difficult news, confusion and tragedy surrounding all of us in a short period of time can feel insurmountable. Reaching out for help is incredibly important and telehealth is key to ensuring access to care is not interrupted.”

Brian Ternan, President and CEO, Health Net of and California Health & Wellness.

Recognizing the urgency of the situation, Carenodes saw the need to increase its telehealth offering to benefit its patients who are coping with increased anxiety, deep depression and unfortunately, suicidal ideation. The organization also saw an increased need to provide mental health services for health care workers on the frontline of the pandemic.

“Our nation’s health care providers are under incredible, and still increasing, strain as they fight the pandemic. Insight Choices plan for the COVID-19 Telehealth Program is a critical tool to address this national emergency — starting in California and the counties we serve with a focus on mental health care and emotional wellbeing. This grant will provide Insight Choices, and the communities it serves, vital funding to assist in a more robust response to the mental health crisis exasperated by the COVID-19 pandemic,”

Alex Yarijanian CEO of Carenodes and Interim COO of Insight Choices.

Carenodes will support infrastructure modernization efforts to include telecommunications services, information services and devices necessary to enable the provision of telehealth services during this emergency period and beyond. In addition, such capacity-building funds have the potential to substantially stimulate the deployment of innovative access to care models.

ABOUT CARENODES

Carenodes is the delegated authority acting on behalf of providers troubled by the present multi-payer, disjointed, and cumbersome way healthcare has been, as an industry, running payer/provider operations. In partnership with providers (medical and non-medical, behavioral, primary, substance abuse, and others), it has developed community-wide coalition efforts geared towards addressing larger systemic health, infrastructure or social determinant issues with a large impact on health. 

ABOUT COMPSYCH

ComPsych® Corporation is the world’s largest provider of employee assistance programs (EAP) and is the pioneer and worldwide leader of fully integrated EAP, behavioral health, wellness, work-life, HR, FMLA and absence management services under its GuidanceResources® brand. ComPsych provides services to more than 53,000 organizations covering more than 118 million individuals throughout the U.S. and 170 countries. By creating “Build-to-Suit” programs, ComPsych helps employers attract and retain employees, increase employee productivity and improve overall health and well-being. 

ABOUT HEALTH NET

Health Net believes every person deserves a safety net for their health, regardless of age, income, employment status or current state of health. Founded 40 years ago, we remain dedicated to transforming the health of our community, one person at a time. Today, Health Net’s 3,000 employees and 85,000 network providers serve more than 3 million members. That’s nearly 1 in 12 Californians. Health Net of California, Inc., Health Net Life Insurance Company and Health Net Community Solutions, Inc. These entities are wholly owned subsidiaries of Centene Corporation (NYSE: CNC), a Fortune 100 company providing health coverage to more than 20 million Americans.