Office Visit

Quality drives everything we do at EmblemHealth and ConnectiCare. Our Quality Improvement information and programs are developed, implemented, and evaluated to preserve and promote clinical excellence that fosters the safety and well-being of our members.

We encourage you to visit our newly developed Quality Improvement web page in the Clinical Corner of the EmblemHealth provider website. Learn about our quality incentive programs for providers, risk adjustment opportunities, how to determine the quality of our contracted skilled nursing facilities, what we are telling our members about quality, and more. You may also learn more about improving the patient experience in the Provider Toolkit and the 2022 Quality Incentive Program booklet on the ConnectiCare website.

Many children missed checkups and recommended childhood vaccinations the past two years during COVID-19. The CDC and the American Academy of Pediatrics (AAP) recommend that children catch up on routine childhood vaccinations. Remind your patients to schedule well-child visits. The summer is a good time to catch up on missed checkups. Telehealth visits are acceptable if the appropriate CPT code is submitted with GT modifier.

Helpful Tips for Child Wellness:

• Conduct or schedule well-care visits when patients present for illnesses, or other events – add modifier for separate and distinct services.
• Document all the required elements of a well-child visit.
• Preschedule the next well-visit before the patient leaves the office. Relay the importance of returning even if the child is doing fine.
• Provide health education/anticipatory guidance.
• Take an opportunity to check and administer vaccines that are due at every visit.

This measure is based on the American Academy of Pediatrics Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents (published by the National Center for Education in Maternal and Child Health). 

Care/Case Management Programs: NICU Aftercare Program & Medically Fragile Program (Medicaid Youths)

EmblemHealth Clinical Practice Guidelines: 

• Obesity and Weight Management in Children and Adolescent
• Pediatric and Adolescent Preventive Services
• Preconception Care 
• Prenatal/Postpartum Care

June is Men’s Health Month and the ideal time to spotlight health challenges that men face. The top health conditions affecting men are heart disease, cancer, respiratory diseases, and stroke. Many men also face infertility, a growing, but under-discussed challenge among men.

Of the 1 in 6 couples struggling to conceive today, 30-50% of their issues are attributed to male-factor infertility*. Along with age, sperm health is impacted by diet, chemicals found in the environment, and other lifestyle factors. All of these conditions may be reversible with early intervention, such as sperm analysis and preservation. And, in particular, cancer poses unique challenges as men undergoing  treatment will likely experience a loss of fertility. 

EmblemHealth has created a new arrangement beginning July 15, 2022 with Legacy – a Harvard-backed, digital fertility management service helping men test, improve, and freeze their sperm-from home. This arrangement complies with the changes to the Infertility Mandate of 2019 that the State of New York passed for the IVF and Fertility Preservation Law, updated Jan. 1, 2020.

The EmblemHealth/Legacy arrangement aligns with our ongoing efforts to improve services to the communities we serve that have unique health challenges. Legacy’s goal is to preserve fertility in men to secure their future options. 

You may notice Legacy’s advertisements around the city on subways and buses. Learn more at Legacy. 

*Male infertility as a window to health.  Jeremy T. Choy, M.D., Michael L. Eisenberg, M.D. 

EmblemHealth and ConnectiCare are required to respond to the annual HHS-Risk Adjustment Data Validation Audit (HHS-RADV) of its Affordable Care Act (ACA) exchange members.

Beginning in July 2022, our contracted Initial Validation Auditor (IVA), Cognisight, Inc., will contact those practitioners who provided care to EmblemHealth and ConnectiCare members that are part of the HHS-RADV sample. Cognisight will request the submission of the complete medical record for specific patients and dates of service between Jan. 1, 2021 and Dec. 31, 2021. 

NOTE: A member authorization is not required to release the medical records based on the business associate agreement between EmblemHealth, ConnectiCare, and Cognisight. 

We ask that you respond promptly when contacted by Cognisight and submit the required documentation using a secure delivery method. Cognisight will provide detailed submission instructions in its communication materials.

Providers who work with a vendor to manage medical records are encouraged to notify their service suppliers now so they can respond promptly to Cognisight’s requests.  

When guiding your patients through the various stages of COVID-19, the words you use will matter. For insight on how you can be more impactful, we are sharing the results of a study we conducted to determine how terms such as “pandemic” vs. “endemic” are perceived and their potential for influencing behavior such as planning to get a booster dose.

 Here are some highlights you may find useful:

• Use caution and provide context when introducing the term “endemic.” Practicing safe public health behaviors — such as wearing a mask, testing, quarantining, and more — are less likely to occur in an endemic vs. a pandemic.
• Addressing COVID-19 as a disease with seasonality could promote higher vaccination rates.
• The word “immunization” continues to be the most positively associated word of choice even among those who are currently unvaccinated. To drive booster adoption, communications should focus on achieving full immunity and keeping loved ones and high-risk consumers safe.
• Concerns about booster side effects are a top reason why respondents have not gotten the COVID-19 booster.

For more insights, see the full White Paper: Living With COVID-19: How Language and Public Health Actions Can Shape the Transition from Pandemic to Endemic.