Practice Management Insight

October 2011

A report on events affecting Oklahoma providers

October 2-8

Mental Illness Awareness Week

October 6

Mini Me Series: 1: Effective Process Facilitation

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October 7

Mini Me Series: 2: Skillful Participant Engagement

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October 10

SOC Family Support Provider Training

Oklahoma city

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October 10

Mini Me Series: 3:Results—focused Design

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October 10

Columbus Day

October 12

Behavioral Health Council Meeting

Oklahoma City

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October 12

Drug Utilization Review Board Meeting

Oklahoma City

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October 13

OHCA Board Meeting

Oklahoma City

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October 12-13

Advance Coalition Capacity Training

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October 13-14

Case Management Training

Oklahoma City

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October 13-14

Problem Gambling Core Level Training

Tulsa OK

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October 17-18

Combined ASAM and ASI Training

Oklahoma City

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October 17-21

RSS Training

Oklahoma City

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October 18

Child Health Task Force Advisory Board Meeting

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October 20

Oklahoma Prevention
Network Training & Meeting

Oklahoma City

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October 20-21

“7th Annual Conference on the Future of Technology in Behavioral Health”

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October 21

Mapping the UAD Issue

Teleconference

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October 21-22

State Advisory Group
Board Retreat

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October 22

PTSD: Healing the Hidden Wounds—Joseph Benamati

Norman

October 22

Helping Families with
Special Education Issues

Tulsa Technology Center—Riverside Campus

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October 23-31

Red Ribbon Week

National Family Partnership

October 25-26

Case Management Training

Tulsa, OK

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October 27-28

SOC Wraparound Training

Oklahoma City

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October 28

Intensive Case Management Training for Mental Health

Oklahoma City

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Online Registration

October 31-November 6

National Drug-Free
Work Week

Working Partners for an Alcohol- and Drug-Free Workplace

Scientists have been searching for decades to understand why some people survive drug and alcohol abuse and other succumb to it.  Usually beginning in adolescence, illicit drug use is very common in the United States. A 2008 National Survey of Drug Use and Health stated that “46 percent of Americans have tried an illicit drug at some point in their lives, yet only 8 percent have used an illicit drug in the past month. By comparison, the survey found 51 percent have used alcohol in the past month.”

Since most people who experiment with drugs do not become addicted, clinicians are seeking answers to the question: Who is at risk?  It has long been known that patients with certain types of psychiatric illnesses were more likely to become addicts – nearly three times more likely according to the National Institute of Mental Health’s Epidemiologic Catchment Area Study.

While it is unclear as to whether addiction predisposes someone to mental illness, or vice versa, scientists do know that having a mental illness can increase the chance of intermittent drug abuse as well as significantly raise the risk of dependence and addiction.

Social environmental factors also influence the susceptibility of individuals to yield to addiction. Studies have found that even people who are not inclined to addiction can become dependent on drugs and alcohol if they are constantly exposed to them.  Drug use changes the brain. Primates that are not predisposed to addiction will become compulsive users as the number of dopamine receptors declines in their brains. A stressful environment in which there is ready access to drugs can trump a low genetic risk of addiction.   Just about anyone, regardless of baseline genetic risk, can become an addict under the right circumstances.

This understanding has profound implications for intervention and treatment since long-term drug use usually begins during adolescence when the brain is the most plastic.

In those who are most vulnerable, substance abuse must be confronted early in adolescence, before it has set the stage for a lifetime of addiction.  Who can experiment uneventfully with drugs and who will be undone by them results from a complex interplay of genes, environment and psychology, which is, unfortunately, just plain chance.   Full story

ADDICTION:  WHO IS AT RISK?

NCOA Medicare Education Initiative

During this first year of historic growth in the Medicare population as baby boomers begin turning 65, UnitedHealthcare and the National Council on Aging (NCOA) are partnering to help Medicare beneficiaries, their caregivers, and baby boomers learn more about their health care options now and in the years ahead.

Recent surveys suggest that seniors and other beneficiaries have trouble understanding the Medicare program, including changes from health reform and how they will plan for and manage their health care as they age. With the oldest baby boomers becoming eligible for Medicare this year at a rate of 10,000 a day, the need for clear, easy-to-understand information about the program and how it works will increase dramatically

“Our goal is to help improve the health and well-being of America’s older adults by empowering them to ask the right questions and know their options,” said Tom Paul, CEO, UnitedHealthcare Medicare & Retirement. “Consumers who understand Medicare are more prepared to make informed health care decisions. Better decisions contribute to better health outcomes.”

More information is available at www.NCOA.org/Medicare and www.MedicareMadeClear.com.

Clyde Wafford, President of OrionNet Systems and his team, have worked many long hard hours and days to make sure everything with Optum Health worked out smoothly. OrionNet Systems had been testing the software to verify that all uploads, downloads and Master PA changes are in affect as they should be.

If you're a ThinkHealth member, you would know that there have been many serious issues with the PA and CDC since Optum took over. Taking phone calls for us at OrionNet Systems has been chaotic to say the least and we have had issues with the whole process since Optum Health came on board Saturday, October 1st.

While there still seems to be issues, we assure you, we will be working diligently along with Optum to stay on top of the situation, to ensure thing run smoothly and come to a resolution as soon as we possibly can.  Our #1 goal right now is to make as much of this as painless and easy for our members as possible.

To check Optum website http://innovate.optumhealth.com/Oklahoma/index.html?siteId=1071

Transition from APS to OptumHealth

Current Issues with Optum Health

“Optum Health has been saying for weeks…….”We understand the EDI response file”. They now, finally admit, they have no idea how these should really look or be laid out. They have encountered many issues and currently, there are no solutions. Keeping information to themselves, they are not elaborating on their plans or what their intentions are in resolving these issues.  As of now, we are in a standstill while waiting for Optum Health to make adjustments to resolve these issues.

Information from a very reliable source reports that Optum is blaming NetSmart for all the current issues at hand. NetSmart, a software vendor who has worked for the state before, on other projects that has not been so successful, has put pressure on Optum to up the level of their software team which has yet to be successful in finding the necessary solutions to correct the issues that currently plague everyone.

The issues with Optum system are many:

Users Not having accounts to get on their web site

Logons working but no data showing up

VARIOUS errors with the CDC and PA data entry process

Nothing going from Optum system to MMIS

EDI uploads working for some but not others

EDI response files coming back but in the wrong format

EDI response file has VARIOUS errors

All of this is unfortunate for the end users and we certainly hope that the issues are resolved in a quick & timely manner.  But many centers are getting ready for the long haul since billing across the state will drop.

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Non–ThinkHealth

Members!

Sign a year contract with ThinkHealth and be entered  to Win a

FREE iPad2!

Offer good until the end of  January 2012. Any centers that sign up after January 31, 2012 will not be eligible for this offer.

To be entered in to win a free iPad2 , you must sign up for 1 full year of ThinkHealth. Installation and set up costs still apply.

Centers must submit signed contract and first installation payment (as discussed) to qualify.

NOW…..

What OrionNet Systems Suggests

But in the end using a Temporary Prior Authorization process build in ThinkHealth will allow all of our members to keep working.

We understand the importance of your clinicians needs to meet with their clients and write their notes so that everyone can keep their staff working the process that they have come to know. Unfortunately, Optum is missing this very important step in the process and they just do not seem to understand the importance of having this information readily available.

On October 13, 2011, OrionNet Systems will be hosting an all members webinar on the Creation and use of PA temporary codes. You don't want to miss being able to keep writing notes and seeing clients on PA that you have not gotten an approval back on.

“Clyde Wafford, President of OrionNet Systems, suggest a few things to his members at this time while Optum Health is correcting their issues. If you are experiencing issues with the PA or CDC that you sent APS’ that is not in the MMIS system, please resend it again through Optum.

Put in the Interpretive Summary this special string, “This plan was sent to APS on date mm/dd/yyyy, but is being sent again because we never received a response.” which will help the Optum reviewers.

Also, date your plan with your originally sent date. We have been told that they will read it and will most likely approve and send it through.

We have been told that EDI items have a HIGH chance of not appearing on the Optum web site. If this is correct, you should check to verify that CDC and PA passed by going to the MMIS system.  Apparently, NetSmart and Optum development team created the EDI to dump into MMIS, but not into Optum web site.

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