Connection supplemental articles and policies - September 2009

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Connection - September 2009 (pdf, 193 KB)

Supplemental articles

• FCHP support for high-risk pregnancies
• FCHP program continues to help smokers quit
• Formulary update

Payment policies

The following policies are new:

• Outpatient Drugs Payment Policy

The following policies have been reviewed. Changes are indicated on the policies and summarized in the print version of Connection:

• Ambulance and Transportation Service Payment Policy
• Anesthesia Payment Policy
• Assistant Surgeon Payment Policy
• Gastroenterology Services Payment Policy
• Global Obstetrical Services Payment Policy
• Hospice Payment Policy
• Medical Supplies and Surgical Dressings Payment Policy
• Radiology Payment Policy (Renamed Radiology/Diagnostic Imaging Procedures Payment Policy)

The following policy has been retired:

• Physician Owned Diagnostic Imaging Center Payment Policy

Every day affairs

FCHP support for high-risk pregnancies

The practical and emotional costs of premature delivery are immense. In an average week in the United States, 10,056 babies are born preterm—and are at risk for expensive, lifelong health problems.

That’s why Fallon Community Health Plan offers a focused obstetrical program, called Special Deliveries, that supports pregnant women at risk for complications—including premature delivery. We provide this program at no additional cost to our members.

Our goal is to help these mothers and their babies have the healthiest pregnancy possible and to help mothers deliver closer to full term. We encourage our providers to refer appropriate FCHP members to the program. These might include women who are carrying multiple babies, or who have hyperemesis, vaginal bleeding, certain chronic conditions, pregnancy-induced hypertension or other conditions.

Special Deliveries gives a woman who has pregnancy-related risks the extra case management support she needs throughout the pregnancy. We also offer education, home health services when necessary and identification of community resources to support or supplement care.

We encourage our obstetrical providers to make a referral to Special Deliveries so we can tell their patients about this FCHP program. Please call one of our nurses at 1-508-368-9379 or 1-508-368-9355 or use the Outpatient Care Services Referral Form at fchp.org/Providers/Forms.htm. ■

FCHP program continues to help smokers quit

Every patient who sees a Fallon Clinic provider is eligible to participate in the highly successful Quit to Win tobacco cessation program, regardless of insurance affiliation. These services are especially valuable today as economic and legislative issues cause more smokers to consider quitting.

Several years ago, Massachusetts residents interested in quitting smoking had lots of options. Back in those days, the state had a highly successful program that was funded using a small portion of the taxes on tobacco products. Across the state, approximately 90 centers offered counseling and nicotine replacement patches and/or gum. When the program was funded, smoking rates declined. Massachusetts’ programs were heralded as among the best in the nation.

Sadly, those state-funded programs were virtually eliminated when tobacco prevention suffered a 95% budget cut. Ironically, the elimination of services for smokers coincided with the doubling of state taxes on tobacco! Smokers now find themselves as a source of tax revenue and without access to cessation services. Recent budgetary shortfalls in Boston have led to even deeper cuts in tobacco prevention funding and talks of even higher taxes.

For this and other reasons, FCHP has continued to make its Quit to Win program available to any patient who sees a Fallon Clinic practitioner, regardless of their insurance affiliation. The program offers competent advice and compassionate support that really boosts a quitter’s chances of success! The free weekly groups are offered in Worcester, Spencer, Auburn and Leominster. To refer patients, e-mail QuitToWin@fchp.org or call 1-888-807-2908.

Quit to Win truly values the partnership with Fallon Clinic practitioners. To request posters for your office and/or fliers to distribute to your patients, please e-mail Timothy.Sweeney@fchp.org or call TJ Sweeney at 1-508-368-9713. ■

Script alert

Formulary updates

Fallon Community Health Plan often makes changes to its formularies, including changing prior authorization requirements and adding new medications.

* FCHP’s New to Market Policy was enacted to ensure patient safety and to allow for adequate time for the development, review and approval of clinical criteria. When a new medication first becomes available, it will fall under this policy and be excluded from coverage. A process is in place that allows for the quick review of provider requests for non-covered pharmaceuticals. ■