Medical Management: A Note from Dr. Bruce Croffy Getting at the Waste in Health Care The 2017 Plan year was frustrating from the standpoint of significant over-expenditures with not only excesses in numbers of services billed but in many areas,…

Medical Management: A Note from Dr. Bruce Croffy Should patients with stable ischemic heart disease undergo coronary intervention?. The Appropriate Use Criteria (AUC) for Coronary Revascularization were developed to critically examine and improve patient selection for PCI as well as…

Medical Management: A Note from Dr. Bruce Croffy Carotid Artery Stenosis- Choosing Wisely with Screening The U.S. Preventive Services Task Force guidelines currently state that the use of carotid Doppler Ultrasound should be limited to symptomatic cases of carotid stenosis.…

Practice Tactics Welcome to a new section of Umpqua Health Alliance’s provider newsletter. In this section, we’ll detail any changes that may affect practice management or operations. This month, we’ll take a look at changes to the Prior Authorization Grid for…

Practice Tactics Prior Authorizations The communication about the changes to the Prior Authorization grid (effective 7/1/2018) has prompted healthy dialogue with provider offices. Our Provider Forum on May 22 was well attended and generated lots of questions at the event,…

Practice Tactics CCO Quality Metrics for 2017 Umpqua Health Alliance (UHA) has met the benchmark or improvement target on 14 of the 17 CCO incentive measures for calendar year 2017; earning 100% of the quality pool. UHA final metrics are…

Practice Tactics A Look Back UHA Prior Authorization (PA) requirements have undergone multiple incremental changes in 2018. Provider offices have felt the challenges of adopting new processes, but as we reflect on the current state, the provider network overall has…

Practice Tactics October Prioritized List Updates The Prioritized List has been updated for October 1, 2018.  The proposed list can be accessed here, and a complete discussion of the changes are discussed in detail here. Notable changes include: Guideline Note changes: New…

Practice Tactics Changes to the Prioritized List of Health Services effective 10/1/2018 The Health Evidence Review Commission (HERC) has updated the Prioritized List of Health Services and guideline notes, effective October 1, 2018. Changes include: Umpqua Health Alliance has updated…

Practice Tactics Rx after Home Sleep Study After you have confirmed the diagnosis of Obstructive Sleep Apnea on a home sleep study, the next step is to prescribe Auto-titrating PAP for your patient.  UHA authorizes a 3-month trial period for…