To help improve quality scores and patient care, MVP is here to support you in closing gaps in care and avoid negative health outcomes, which can result in readmission, lower patient satisfaction, and increased costs to you and your patients.

  • Care for Older Adults (COA)

    Published January 2023

    A New HEDIS Hybrid Measure

    Eligibility Criteria:

    • Members who are enrolled in MVP DualAccess (HMO-DSNP), a new plan offering in 2022 for dual-eligible individuals (Medicare/Medicaid)
    • Members must be 66 years of age or older in 2022 and had each of the following services completed during the measurement year:
    1. Medication Review documented by a clinical pharmacist or prescribing provider in 2022. The review must occur in an outpatient setting or non-acute facility and may include telephone encounters or telehealth visits. The Member does not need to be present for a medication review. A current medication list must be filed in the medical record.NOTE: Members who received Transitional Care Management Services in 2022 are also compliant for this sub-measure.
    2. Functional Status Assessment performed in an outpatient setting or non-acute facility and may include telephone encounters or telehealth visits. All components must be documented in 2022 but may take place during separate visits. Functional Status Assessment components include:
      • Documentation of a complete functional status assessment that includes the ability to perform activities of daily living (ADLs) and instrumental ADLs (IADLs); or
      • Completion of a Functional Status Assessment Tool filed in the medical record.
    3. Pain Assessment performed in an outpatient setting or non-acute facility and may include telephone encounters or telehealth visits. At a minimum, documentation must show that:
      • The patient was assessed for pain; or
      • A standardized pain assessment tool was completed.

    MVP publishes various tools and resources to help support Participating Providers close gaps in care for COA and other HEDIS measures. Visit, select Reference Library, and then select HEDIS Measures and Gaps in Care Resources.

  • 2023 Annual HEDIS Medical Record Collection

    Published January 2023

    The annual HEDIS medical record collection project will begin the first quarter of 2023. MVP is contracting again with Inovalon to conduct record collection on behalf of MVP. Reminder letters will be sent out to Participating Providers. 

    We understand this is a highly intensive process that requires a lot of your staff’s time. To help reduce the burden, consider granting MVP access to your electronic health record (EHR). This will allow MVP to collect the information needed instead of utilization of your valuable staffing resources. For further information or if you would like to grant MVP EHR access, please contact Melissa Alter at As always, we appreciate your partnership.

  • Data Submission and Coding Accuracy

    Published January 2023


    As a Medicare Advantage Plan and an ACA Qualified Health Plan, MVP must meet standards for data submission and coding accuracy. The MVP Risk Adjustment team conducts annual reviews of Member records to meet these standards, and throughout the year we will randomly request to collect EHR or paper charts, depending on your system’s capabilities. The purpose is to verify that serious or chronic medical conditions are being reported with the right diagnosis as well as being coded to the highest level of specificity for those diagnoses.


    Starting at the end of December 2022 through April 2023, MVP will collect records for services performed in 2022 for the Commercial Chart Review Project. We will follow that with the Medicaid Chart Review beginning February 2023 through July 2023. Lastly, the Medicare Chart Review will run April 2023 through December 2023. For any questions, please contact Anselmo Nieves at

  • Ensure the Right Statin Medication for Your Patients

    Published January 2023


    Adherence to statin medications can aid in risk reduction of clinical atherosclerotic cardiovascular disease (ASCVD) for patients living with cardiovascular disease (CVD) and/or diabetes. As such, the National Committee for Quality Assurance (NCQA) has two unique statin therapy measures.


    Statin Therapy for Patients with Cardiovascular Disease (SPC) assesses males 21-75 years of age and females 40-75 years of age during the measurement year, who are identified as having ASCVD and meet the following criteria:

    • Received at least one high or moderate intensity statin medication during the measurement year.
    • Had adherence to the statin medication regimen for at least 80% of the treatment period.


    Statin Therapy for Patients with Diabetes (SPD) assesses individuals 40-75 years of age with a diagnosis of diabetes and no diagnosis of ASCVD, and who meet the following criteria:

    • Members who have received at least one statin medication of any intensity during the measurement year and
    • Had adherence to the statin medication regimen for at least 80% of the treatment period.


    As a point of reference, the American Diabetes Association recommends that individuals living with diabetes and a history of CVD, as well as those older than 40 years of age without CVD but with CVD risk factors, should be treated with a statin regardless of their baseline LDL cholesterol concentration.


    When prescribing statins to Patients living with cardiovascular disease or diabetes, please ensure the medication is included in the MVP Formulary. To review the following a table for High, Moderate, and Low-intensity statin medications that will best suit your Patient, see the table below.



    High-Intensity Statin Therapy

    • Atorvastatin 40-80 mg
    • Amlodipine-atorvastatin 40-80 mg
    • Rosuvastatin 20-40 mg
    • Simvastatin 80 mg
    • Ezetimibe-simvastatin 80 mg         


    Moderate-Intensity Statin Therapy

    • Atorvastatin 10-20 mg
    • Amlodipine-atorvastatin 10-20 mg
    • Rosuvastatin 50-10 mg
    • Simvastatin 20-40 mg
    • Ezetimibe-simvastatin 20-40 mg
    • Pravastatin 40-80 mg
    • Lovastatin 40 mg
    • Fluvastatin 40-80 mg
    • Pitavastatin 1-4 mg


    Low-Intensity Statin Therapy

    • Ezetimibe-simvastatin 10 mg
    • Fluvastatin 20 mg
    • Lovastatin 10-20 mg
    • Pravastatin 10-20 mg
    • Simvastatin 5-10 mg


  • Closing Gaps in Care: Off-Cycle HEDIS Measures

    Published January 2023


    Off-cycle HEDIS measures do not follow the January-December measurement year (MY) like other HEDIS measures. Here is what you need to know to help close gaps in care for off-cycle measures:

    MeasureName Timeline  What Needs to Be Done How Can I Get This Done Last Date of Service for MY 2022
    Follow-Up Care for Children Prescribed ADHD Medications (ADD) Start Date: March 1 of the year prior to the MY

    End Date: February 28 or February 29 (leap year) of the MY
    Members 6-12 years of age prescribed ADHD medications need a provider visit with prescribing authority in first 30 days of new prescription being dispensed and then follow-up with two additional visits over the next nine months as well as the member staying adherent to their medication for at least 210 days in the measurement period. Either by in-person or telehealth visits, if the practitioner has prescribing authority in case medication dosages need adjustments. February 28, 2023.

    (Note: March 1, 2023, starts the new measurement period for ADD.)
    Osteoporosis Management in Women Who had a Fracture (OMW) Start Date: July 1 of the year prior to the MY

    End Date: June 30 of the MY
    Women 67-85 years of age who suffered a fracture and had either a bone mineral density (BMD) test or prescribed medication to treat osteoporosis. REMEMBER you only have six months from the fracture date to do a BMD or start medications. Be aware of females at risk; do BMD testing and educate your members on safety factors, etc. Members are excluded from measure who have had a BMD testing within 24 months of the episode date. June 30, 2023, for new fractures, but you have six months to do the BMD test and/or medication prescribing if not already done.

    Watch your coding; “new fracture” coding should be updated once it’s no longer considered a new fracture.
    Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR) Start Date: July 1 of the year prior to the MY

    End Date: June 30 of the MY
    Members 40 years of age and older with a NEW diagnosis of COPD or a NEWLY ACTIVE (has been symptom free for two years prior) COPD who received spirometry testing to confirm diagnosis. Spirometry testing to confirm a COPD diagnosis. June 30 for diagnosing; treatment must be completed within six months of diagnosing.

    e.g.: A member diagnosed with COPD on June 30 has 180 days (or until December 27) to have Spirometry testing.
    Prenatal and Postpartum Care (PPC) Start Date: October 8 of the year prior to the MY

    End Date: October 7 of the MY
    Prenatal looks at the timeliness of care.

    Postpartum looks at postpartum visits after delivery.

    This measure assesses that the delivered live birth has had at least one:

    *Visit in the first trimester and

    *Visit between seven and 84 days after delivery
    Prenatal and Postpartum care visits are to be with an OB/GYN or other prenatal care practitioner or PCP. (For a visit to a PCP, a diagnosis of pregnancy must be present.) Remember: for visits to count, documentation in the medical record must show the date when the prenatal/postpartum care visit occurred and evidence of the care and/or examination during the visit that pertains to either the prenatal or postpartum time period. Prenatal and postpartum care are necessary for the health and well-being of the mother and the fetus. Make every attempt to have the mom seen regularly during the prenatal period, and between 7-84 days after the delivery. If you are having difficulty getting mom into the office, the MVP Case Management team can assist with member outreach.
  • Using CPT II and LOINC Codes for Diabetes Gap Closures

    Published November 2022


    MVP encourages the use of CPT II and LOINC codes when submitting claims for Controlling High Blood Pressure (BPD, CBP), Eye Exam (EED), and Kidney Evaluation (KED) measures for patients living with diabetes. 


    CPT II codes are not billing codes. They are used for the purpose of quality measurement. They may be submitted to MVP independently of billing codes. They provide results of a service.


    LOINC codes are not billing codes. They are used to identify laboratory tests and clinical assessments. They provide results of a lab test.

    View CPT II Codes for Eye Exam (EED)

    View CPT II and LOINC Codes for Kidney Health Evaluation (KED)

    CPT II Codes for BPD, CBP

     Diastolic 80-89  3079F  Most recent diastolic blood pressure 80-89 mm Hg, (HTN, CKD, CAD) (DM)
     Diastolic ≥ 90  3080F  Most recent diastolic blood pressure greater than or equal to 90 mm Hg, (HTN, CKD, CAD) (DM)
     Diastolic <80  3078F  Most recent diastolic blood pressure less than 80 mm Hg, (HTN, CKD, CAD) (DM)
     Systolic ≥ 140  3077F  Most recent systolic blood pressure greater than or equal to 140 mm Hg, (HTN, CKD, CAD) (DM)
     Systolic < 140  3074F  Most recent systolic blood pressure less than 130 mm Hg, (HTN, CKD, CAD) (DM)
     3075F  Most recent systolic blood pressure 130-139 mm Hg, (HTN, CKD, CAD) (DM)  
  • Closing the Gap on HbA1c (HBD)

    Published November 2022

    An A1c should be completed at least twice a year, or every three months for unstable patients or those with medication changes. CPT II Codes can be used to close this gap.

    Members are encouraged to talk to their Provider about scheduling their A1c test, either by calling your practice or during well visits.

  • Tips for Retinal Eye Exams (EED)

    Published November 2022


    Screening or monitoring for diabetic retinal disease for individuals with type 1 or 2 diabetes is an important testing tool for detection or monitoring of diabetic retinopathy. To close gaps in care for the Eye Exam for Patients with Diabetes (EED) measure, any of the following are needed:

    • Retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year.
    • A negative retinal or dilated eye exam for retinopathy by an eye care professional in the year prior to measurement year.
    • Bilateral eye enucleation any time during the member’s history through December 31 of the measurement year


    CPT II Codes can be used to close an EED Gap

    Use of Retinal Hand-Held Cameras

    Primary Care practices who have point of care services with retinal hand-held cameras can close gaps in care by submitting a claim with the appropriate codes showing that the exam was completed, the results, and noting that the exam and results were read by an eye care professional. Review the Coding Reference Guide for EED.

    Primary Care practices without retinal hand-held cameras can help close gaps in care by recommending patients see an optometrist or ophthalmologist and completing the MVP Eye Care Consultation for Diabetic Patients form. This form is also available in Spanish.

  • MVP Joins the CVS Caremark™ Adherence Program

    Published October 2022


    Medication adherence for chronic conditions is an ongoing challenge. One in 2 Americans has a chronic condition1, yet 50% of medications for chronic conditions are not taken as prescribed2. As a result, the estimated annual cost for medication nonadherence in the Unites States is $298 billion3.

    To help promote medication adherence for prescribed therapies and to support our Members stay on track with what may be complex medication regimens, MVP is participating in the CVS Caremark™ (CVS) Adherence Program.

    Program Overview

    As of July 1, 2022, CVS has been notifying prescribers via fax that an MVP Member is late to fill their medication or is considered off therapy.

    • Late to Fill communication – Prescribers are notified 10 days past the first refill due date (with no refill claim)
    • Off Therapy communication – Prescribers are notified 10 days past the second refill due date (with no refill claim)


    Prescriber communications are sent within 72 hours of claim adjudication for Medicaid, Medicare, Commercial, and Marketplace Members with prescribed therapies for:

    • Behavioral health
    • Benign prostatic hypertrophy (BPH)
    • Breast cancer
    • Coronary artery disease/ischemic heart disease
    • Diabetes
    • Heart failure
    • High cholesterol
    • Hypertension
    • Osteoporosis
    • Parkinson’s disease
    • Respiratory disease


    CVS will also outreach MVP Medicare, Commercial, and Marketplace Members directly via direct mail, telephonic outreach, and/or email (if email address is on file):

    • 10 days past the first refill due date (with no refill claim)
    • 10 days past the second refill due date (with no refill claim)
    • 15 days prior to refill due date, if utilizing CVS prescription mail order service


    Better Adherence, Better Outcomes

    Engaging with MVP Members and prescribers can help to improve adherence and close medication therapy gaps. Automatic refills and alerts can help Members avoid lapses in their medication therapy. By working together to help close medication adherence gaps, prescribers are equipped with evidence-based information to enhance their patient’s drug therapy. Adherence promotion and alignment with our Providers will lead to enhanced support and improved outcomes, and more importantly, a more personal and positive health care experience for our Members, your patients.

    1. Cassil, Alwyn. Rising rates of chronic health conditions: What can be done? Center for studying health system change 2008; no.125.
    3. DeVol, R., Bedroussian, A. An Unhealthy America.
  • Diabetes Management: HbA1c Gap Closures

    Published October 2022


    Blood glucose control remains a critical component of managing diabetes and avoiding complications. This summer, MVP communicated with Members living with diabetes who have a gap for an A1c test, reminding them that this simple blood test is an important way for them and their Provider to know if their diabetes is in good control. An A1c should be completed at least twice a year, or every three months for unstable patients or those with medication changes.

    Members are encouraged to talk to their Provider about scheduling their A1c test, either by calling your practice or during well visits.

    We appreciate your support and collaboration in helping to close these important gaps in care.

  • Member Outreach to Support Diabetes Management
    Published October 2022


    In an effort to support the health of Members who are living with diabetes, while also helping to close gaps in care, MVP is conducting Member outreach to Medicare and Medicaid Members who have a gap in two of the following measures: retinal eye exam, A1c test, and/or kidney health evaluation. Through this outreach effort (starting late September and running into early October), MVP will assist Members with scheduling PCP appointments and educate them about the importance of diabetic screenings. Please be aware that this effort may lead to increased calls to your office as patients inquire about which preventive screenings and tests are appropriate. We appreciate your support and care of our Members in need of these services.

  • Follow-Up Care for Children Prescribed ADHD Medication (ADD)

    Published October 2022

    Attention-deficit hyperactivity disorder (ADHD) is one of the most common behavioral health disorders in children. To ensure medication is prescribed and managed correctly, it is essential that children be carefully monitored by their health care provider. The HEDIS ADD measure evaluates follow-up care and medication compliance for children six to 12 years old who are prescribed medication to treat ADHD; it includes two phases, both of which must be passed to close this measure:

    Phase 1 – Initiation Phase (ADD-I)

    • One or more follow-up visits within 30 days from the date the prescription was filled, with a provider with prescribing authority that meet criteria.
    • This visit can be in-person or via telehealth. 


    Phase 2 – Continuation and Maintenance Phase (ADD-C)

    • Member remained on the ADHD medication for at least 210 days.
    • Two or more follow-up visits within 270 days after the end of the initiation phase (day 31 to 300 from the prescription fill date).
    • Both visits can be done in-person or via telehealth.

    Only one of the two visits can be on-line e-visits or virtual check-in. The other visit would have to be in-person or via telehealth.
    To help support Participating Providers, MVP conducts outbound telephonic outreach and letter campaigns to the caregivers of:

    1. Newly prescribed members as a reminder to set up an initial visit within the first 30 days of the prescription dispensing date.
    2. Members who have passed the Initiation phase are reminded to schedule at least two more visits within nine months of the start of the medication.


    Tips and Best Practices for Provider Offices to Help Improve ADD Performance

    • Comply with the American Academy of Pediatrics (AAP) recommendation of both behavioral therapy and medication for children six to 12 years old.
    • Understanding what the medication is going to do and how it will make them feel is an important part of establishing awareness and ensuring better compliance. Educate the patient and caregivers about:
    • How and when to take the medication.
    • Common side effects such as increased blood pressure, weight loss, anxiety, agitation, and insomnia.
    • Potential for abuse and use of legal medication for illegal purposes.
    • Set up a follow-up visit plan with the parent or guardian, and child if necessary.
    • Establish this visit within 2–3 weeks of the initial medication therapy.
    • Once the child attends the initial follow-up visit, schedule the additional two visits within nine months of the start of the medication.
    • Ask questions to assess the child’s response to the medication, as it is often necessary to adjust to establish the correct dosage.
    • Reach out to members/caregivers who cancel appointments and assist them with rescheduling as soon as possible.
    • Refer the member to a behavioral health provider for consultation when clinically appropriate.
    • Ensure coordination of care by sending progress notes and updates
  • Get the Facts on Cancer Virtual Education Series

    Published October 2022


    Presented by the Cancer Services Program of the Finger Lakes Region

    These virtual programs are free and available to everyone. Pass it on to your patients, family, or friends who may need their preventive cancer screenings!

    Get the Facts on Breast Cancer Screenings, Risks, and Resources

    Thursday October 20, 2–3 p.m. Register Now

    Get the Facts on Cervical Cancer Screenings, Risks, and Resources
    Thursday October 27, 2–3 p.m. Register Now

    Get the Facts on Colorectal Cancer Screenings, Risks, and Resources
    Thursday November 3, 2–3 p.m. Register Now

    Each program will also be presented in Spanish.

    To find more Living Well Programs, visit our MVP Living Well Calendar. 

  • 2022 Supplemental Data for Gap Closure

    Published October 2022


    Providers can submit supplemental data for 2022 dates of service gap closure at any point during the year. Access your MVP Gaps in Care Report for submission instructions.

  • 2022 Primary Care Provider Medicaid Incentive Program

    MVP Health Care® (MVP) is pleased to announce the launch of a 2022 Primary Care Provider Medicaid Incentive Program.


    Program Overview

    Eligible primary care provider groups have an opportunity to earn incentives for closing gaps in care for Members in need of preventive or health monitoring services. This Incentive Program includes 19 quality measures. Participating Providers will earn $20 for each claim-basedmember gap in carethat is closed from August 1, 2022-December 31, 2022.

     Eligibility Criteria

    To be eligible for this TIN level Provider Incentive Program, primary care provider groups must have at least 30 or more attributed MVP Medicaid Members by December 31, 2022. Additionally, eligible provider groups cannot be in a current quality pay-for-performance arrangement with MVP.

    Eligible groups should have received a letter from MVP that outlined the Incentive Program, along with information on the quality measures, resources, and potential earnings available.

    If you have questions about the program or your eligibility, please call the MVP Quality Incentive Hotline at 1-866-954-1869 or email

  • Tips for Providers (FUA, FUM)

    Follow-Up After Emergency Department Visit for Alcohol and Other Substance Use or Dependence (FUA) measures the rate of your patients ages 13 and older with a diagnosis of alcohol or other substance use or dependence, who have had an emergency department (ED) visit and need a follow-up visit within seven or 30 days of the ED visit.


    Follow-Up After Emergency Department Visit for Mental Illness (FUM) measures the rate of your patients ages six and older with a diagnosis of mental illness or intentional self-harm, who have had an ED visit and need a follow-up visit for mental illness within seven or 30 days of the ED visit. 

    Why follow-up care after an ED visit matters 

    Timely follow-up care after your patient has been discharged from the ED, whether it be for a physical or behavioral health event, may reduce repeat ED visits, increase compliance with follow-up treatment plans, and help to improve overall health outcomes. Closing these gaps for your patients will also help to improve your HEDIS quality performance scores. Follow-up visits can be with any provider if the primary diagnosis for the ED visit is due to alcohol or other substance use/dependence, mental illness, or intentional self-harm. 

    Primary care providers are encouraged to establish continuity of care by connecting patients with appropriate behavioral health providers in their area. You can further facilitate integrated health care by encouraging your patients to sign a release of information.

    For additional information and best practices to help improve quality performance, download the MVP HEDIS Reference Guides for Primary Care:

  • MVP Strategic Provider Engagement Team – Helping Members Live Healthier Lives

    Every MVP Member deserves quality health care. MVP’s Strategic Provider Engagement Team helps drive clinical innovation and collaboration with our provider partners to help achieve the best outcomes for our Members. Utilizing a regional approach to engage with high volume hospitals, health systems, and provider groups, together we can:

    • Improve member/patient care, efficiency, and coordination.
    • Be more efficient with decision-making and transparency to help reduce multiple member/patient touches while still providing focused care.
    • Increase quality performance.


    Clinical alignment with our providers will lead to enhanced support and improved outcomes, and more importantly, a more personal and positive health care experience for our Members, your patients. 


    To learn more contact:

    Tracy Tadarro-Ott 
    Director, Member and Client Advocacy


    Lauren Dyroff 
    Leader, Strategic Provider Engagement 

  • 2022 Asthma Action Plan Mailing

    Published July 2022


    Each year before the back-to-school season begins, MVP mails Asthma Action Plans to New York State and Vermont Members aged 6–17 who have an asthma diagnosis. MVP wants to make sure that families are prepared and thinking about the care of their child’s asthma while at school. The 2022 Asthma Action Plans will mail this summer, along with a letter encouraging parents to take the Asthma Action Plan to their child’s doctor to complete. The purpose of this Plan is to help families become proactive and anticipatory with respect to asthma exacerbations and their control. The Asthma Action Plan should be used as an education and communication tool between the provider, the Member living with asthma, and his or her family. 

    Questions that you can discuss with the Member and his/her parents include:

    • What would you like to see happen when managing your child’s asthma at school?
    • What is the most important thing about managing your child’s asthma in school?
    • What do you need to do to have this happen?


    The Member/family should be able to demonstrate an understanding of the plan and the appropriate use of medicines. In addition, this form has been designed for the PCP to use with families who need a simple asthma management regimen. Once a family has become more informed about asthma, a plan can be developed with additional flexibility in treatment. Families should be given additional educational materials about asthma, peak flow monitoring, and environmental control. A spacer should be prescribed for all patients using an MDI.

    A copy of the Asthma Action Plan should stay with the family, another copy should be provided to the school or daycare, and a copy should be on file with the Provider. For additional tools and resources on Asthma management, visit, then select Respiratory.

  • Gaps in Care Reports


    Published July 2022


    MVP would like to stress the importance of scheduling Members for preventive health maintenance screenings and diagnosis related services that need to be performed by 12/31/2022. The monthly Gaps in Care (GIC) report helps provider practices find those Members and is a valuable tool to help improve HEDIS/quality rates.


    Here Are Helpful Reminders About Medical Record Submissions

    • Make sure Membername and date of birth (DOB) are shown on each document. If a report does not include DOB, add a demographic sheet (or similar) to avoid a call for date of birth validation.
    • If a Member has had a name change and documentation needed shows a former name, include a demographic sheet showing both names and DOB to avoid a call for name validation. If the patient is registered with your local RHIO, a list of all names that have been used can be found in their demographic documents.
    • Send all pages of office notes to include provider signature. This will help avoid calls for the complete note.
    • Please do not send documentation not specifically outlined in the GIC cover page detail.
    • Contact us: for more guidance with your submissions.


    MVP offers additional tools and resources to help your practice close gaps in care. Visit, select Reference Library and then select the HEDIS Measures and Gaps in Care Resources accordion.

  • New York State (NYS) 2022-2023 Performance Improvement Project (PIP)

    Improving Rates of Preventive Dental Care for MMC Adult Members Ages 21-64 Years

    Published July 2022


    Low-income adults suffer a disproportionate share of dental disease and are nearly 40% less likely to have a dental visit in the past 12 months, compared to those with higher incomes. Poor oral health can increase risks for chronic conditions such as diabetes, heart disease, and tooth decay—currently the most common chronic disease in the US. The NYS Department of Health (NYSDOH) recognizes the importance of annual dental visits and good oral health for the Medicaid Managed Care (MMC) population and is the foundation for the NYS PIP Improving Rates of Preventive Dental Care for MMC Adult Members Ages 21-64 Years. To help improve preventive dental care rates among this population, MVP will focus on three areas:

    • Annual dental visits
    • Emergency department for non-traumatic dental conditions
    • Social determinants of health

    Visit and select Closing Gaps in Care, then select Improving Rates of Preventive Dental Care to review the NYS PIP and how primary care teams can help Members understand the importance of oral health in the context of their overall health and reinforce the importance of annual dental visits and preventive care.

  • Fall Risk Management

    Published July 2022


    The fear of falling becomes more common as people age. Studies show that a fear of falling can keep older adults from going about their normal activities and, as a result, they may become frailer, which actually increases their risk of falling. Talk to your older patients about their risk for falling and create a personal prevention plan that best fits their lifestyle. To help get the conversation started, download the MVP brochure. To request printed brochures, contact your MVP Professional Relations Representative.

  • HEDIS Chart Collection

    Published July 2022


    MVP would like to extend a sincere thank you for your participation in the annual HEDIS chart collection and making it a successful season! We know this is a busy time for you and your staff. MVP appreciates your ongoing support and collaboration to ensure our Members continue to receive excellent care. If you have any questions on submission of data to support gap closures year-round, please email to connect with the appropriate Quality staff.

  • Lab Test Collection Pilot Program
    Published July 2022

    Last quarter, MVP announced our collaboration with BioReference Laboratories to provide MVP Members an easy way to complete their medically necessary lab testing. Since then, we have launched a pilot program for what we hope will be a simple and easy way for Members—and their Providers—to close certain gaps in care.

    The pilot program uses a standing order protocol to trigger home-based lab test collection orders for MVP Medicaid Members who are overdue for diabetes-related testing.


    Currently, the pilot includes MVP Medicaid Members who:

    1. Have a diagnosis of type 2 diabetes; and
    2. Have no record of recent HbA1c test, urine Albumin-Creatinine Ratio, or fasting lipid panel.

    Identified Members are offered the option to schedule home-based lab collection with Scarlet Health®. Scarlet lab technicians will send lab specimens to be processed at a BioReference Laboratories facility. Results are available to the patient through the BioReference secure patient portal and will also be sent to the listed Primary Care Provider via fax.


    MVP is working with our virtual care partner to conduct immediate clinical outreach for all patients with an abnormal result. The virtual care Provider will assess the patient and facilitate next steps, including follow up directly with the patient’s Provider. The patient’s Provider will be sent a copy of that visit note for your records.


    The gap closure will be credited to the Member’s attributed Provider. We expect this to have positive results for both Providers and MVP’s quality scores. We appreciate your support of this initiative. For more information, or if you would like to partner with MVP in bringing this solution to your patients, please contact your Professional Relations Representative.

  • Men's Health: Hypertension and Heart Disease

    Did you know?

    • 51.9% of men aged 20 and over have hypertension
    • 24.1% of men aged 20 and over have heart disease
    • 13.2% of men aged 18 and over are in fair or poor health

    June is men’s health awareness month, and studies conducted throughout the last two decades have shown that men are less likely (than women) to get routine physical exams and screenings. In fact, most will not go to the doctor unless they feel sick and even then, they often choose a walk-in urgent care facility over a visit to a primary care provider. A study published in June 2021 by the insurance company Aflac found that in the United States, out of 1,000 men (ages 18 years and older) surveyed, 45% had not had an annual wellness visit or checkup in the past 12 months and 60% missed visits for preventive care services such as screenings and vaccines. As primary care providers, you and your staff can directly affect the health and wellness of your male patients, but the first step is getting those Members into the exam room. Some potential strategies to help overcome that first hurdle include:

    • Focus on member priority rather than clinical importance.
    • Describe to the member what this visit includes and try to identify what appeals most to him (i.e., risks due to family history, previous injuries, sexual health, physical activities, etc.)
    • Provide a health risk appraisal for the member to complete ahead of the visit so that he has a sense of what to expect.
    • Identify barriers such as transportation, time off from work, or lack of childcare and discuss potential solutions to overcome these barriers.


    Maintaining annual wellness exams, completing preventive care services, and managing chronic conditions with blood pressure checks, cholesterol screenings, and medication adherence will also help to improve your practice’s quality performance. During well-person exams, it is extremely important to talk about what preventive services are recommended/due based on age and any risk factors that may be due to ethnicity and lifestyle. 

    Counsel and screen for the following at every wellness exam:

    • Diet and exercise
    • High blood pressure
    • Smoking cessation
    • Mental health disorders
    • Substance use disorders
    • HIV and other STI’s
    • Dental health
    • Other lifestyle or age-related concerns


    Review history and order screenings, as needed, for:

    • Colorectal cancer screenings (men aged 45 and over and at average risk may be eligible for Cologuard®).
    • Diabetes screening services for members who are overweight or obese
    • Cholesterol screenings for members at certain ages or have a higher risk for developing high cholesterol


    Review immunization history and schedule for upcoming or catch-up vaccines, recommended by age, including but not limited to: 

    • COVID-19
    • Annual flu shot
    • HPV (catch up to age 45)
    • Tdap/DTaP
    • Pneumococcal
    • Shingles 
  • Improving Rates of Preventive Dental Care for MMC Adult Members Ages 21-64 Years

    Program Overview


    Low-income adults suffer a disproportionate share of dental disease and are nearly 40% less likely to have a dental visit in the past 12 months, compared to those with higher incomes. Poor oral health can increase risks for chronic conditions such as diabetes, heart disease, and tooth decay—currently the most common chronic disease in the US. The NYS Department of Health (NYSDOH) recognizes the importance of annual dental visits and good oral health for the Medicaid Managed Care (MMC) population and is the foundation for the NYS PIP Improving Rates of Preventive Dental Care for MMC Adult Members Ages 21-64 Years. To help improve preventive dental care rates among this population, the PIP will focus on three areas:

    1. Annual dental visits (ADV)
    2. Emergency department for non-traumatic dental conditions (NTDC-ED)
    3. Social determinants of health (SDOH)


    MVP identified that in 2019, only 25% of MMC adult members completed an ADV and there were more than 1,700 member visits for NTDC-ED. Between 2019 and 2021, MVP MMC adult membership increased over 60%. However, partial 2021 data indicate similar trends for NTDC-ED and a downward trend for ADV. 


    According to the CDC, in the US, nearly twice as many Black and Mexican American adults have untreated cavities compared to White adults. The CDC also reports that about 40% of adults with low-income or no private health insurance have untreated cavities.

    Dental Care is Primary Care

    Primary care teams can help members understand the importance of oral health in the context of their overall health and reinforce the importance of annual dental visits and preventive care. Additionally, primary care providers and their teams can leverage their skills, resources, and tools to intervene in the oral disease process:

    • Ask about the member’s oral health, risk factors, and symptoms of oral disease.
    • Look for signs that indicate oral health risk or active oral disease.
    • Identify SDOH or local/regional barriers to dental care.
    • Decide on the most appropriate response.
    • Offer preventive interventions, referral for treatment, and/or self-care practices.
    • To align with goals for the NYS PIP, MVP has partnered with Healthplex, facilities, providers, and community partners to reduce NTDC-ED, increase ADVs, and improve member experience, access to appropriate care, and overall member health.
  • Spotlight on Medication Adherence

    Published April 2022


    Medication adherence is a critical aspect for managing chronic conditions such as diabetes and hypertension. Despite its importance, medication nonadherence continues to be a serious problem and a leading driver of poor health outcomes.

    Strategies for Improving Medication Adherence:

    • Ensure open and ongoing communication between you and your patient, with the goal of achieving optimal health outcomes. For example, when ordering the initial prescription, educate the Member on the benefits and potential side effects.
    • Leverage all visits, including annual wellness and sick visits to conduct medication reconciliation. Patients fail to take their medications about 50% of the time. Medication reconciliation creates an opportunity to discuss adherence, stress the risk factors associated with non-adherence, and help improve compliance with instructions.
    • Assess if the Member is eligible for a longer-term supply of their medication. Not only does it mean fewer trips to the pharmacy and possible cost-savings for the Member, but studies have also shown that adherence is 20% higher when the individual has a 90-day supply versus a 30-day.


    There are countless reasons for medication nonadherence, and no easy solutions. The best approach for improving adherence is by working collaboratively with the Member and their pharmacists, specialists, and entire health care team.

  • MVP Supports the Following Services to Help Improve Medication Adherence With Your Patients

    Published April 2022


    CVS® Caremark Mail Service Pharmacy

    MVP Members who have prescription drug coverage may be able order up to a 90-day supply of their maintenance medications through this program. To find out if a medication is available from CVS Caremark Mail Service Pharmacy, view MVP Formularies, and the select the appropriate formulary; if a drug or drug class has an asterisk (*) next to it, that drug or all drugs in that class are available through mail service program.


    SimpleDose™ from CVS Pharmacy®

    SimpleDose is a convenient and simple medication management solution for your patients taking multiple medications. Eligible medications are presorted into easy-to-open packets based on dose, date, and time. There is no additional cost to enroll. Free nationwide delivery to the Member’s home or any CVS Pharmacy location is included. SimpleDose™ can only be filled for 30-day supplies. If you have a Member who would like to learn move, visit or call 1-800-753-0596.

  • Medication Therapy Management Program

    Published April 2022


    Eligible MVP Medicare Advantage Members can speak with an MVP pharmacist privately over the phone to review their medications for safety and check if lower-cost alternatives are available. The Medication Therapy Management Program (MTMP) also helps to ensure that Members understand why they have been prescribed a medication and the importance of taking it exactly as prescribed. To find out if a Member is eligible for MTMP, call MVP at 1-866-942-7754, Monday–Friday, 8:30 am–5 pm Eastern Time.

  • A Woman’s Health Journey
    Published April 2022


    Whether it’s keeping up with routine screenings or needing specialized diagnosis and treatment, women face complex health decisions at every stage in life.


    Establishing a strong foundation during early childhood and adolescence will make it easier to help them manage changes, both physical and behavioral, as they grow into adulthood.

    • Starting at birth, girls should see their pediatrician or PCP for routine well-child visits
    • It’s important that girls select a gynecologist and start annual well-woman exams once in their teens.
    • HPV is the leading cause of cervical cancer. Adolescent girls should get the HPV vaccine series completed between nine and 13 years old


    Teens andYoung Adult

    • Working with younger female patients to develop and maintain healthy habits may help them stay physically and mentally fit as they get older. Implement office procedures to ensure your female patients keep regular checkups, health screenings, and immunizations.
    • One in four young female adults will be diagnosed with an STD. Women who are 16–24 years old and sexually active should have at least one test for chlamydia each year.
    • Cervical cancer can be found with regular pap tests. Women should be screened for cervical cancer every three years starting at age 21
    • Women in reproductive years are recommended to seek contraception and family planning counseling.


    Mature Adult

    Promoting self-care becomes especially important during this phase of a woman’s life. Along with the demands of everyday responsibilities, women are going through changes that can raise their risk of high blood pressure, heart disease, and diabetes.

    • Use annual well-care or well-woman visits to discuss stress, depression, anxiety, or other mental health issues.
    • Begin scheduling breast and colorectal cancer screenings at age 40 and 45, respectively, unless risk factors indicate for earlier screenings.
    • One in four women die from heart disease—talk about health screenings that are age or lifestyle appropriate such as blood pressure readings and hemoglobin A1C testing to help prevent or manage chronic care conditions.


    Older Adult

    In addition to chronic conditions like heart disease and diabetes, this is the time to speak with your female patients about good bone health.

    • One in two women will have an osteoporosis-related bone break; 33% of women will be diagnosed with osteoporosis by age 75.
    • 46% of older women take five or more prescription drugs. Make sure you know all their medications, and if they’re causing side effects.
    • Work with your older patients on a fall prevention plan including appropriate exercises for balance and strength and hearing and vision checks
    • Starting at age 65, women should complete an osteoporosis screening every two years.


    From early childhood to older adulthood, the provider-patient relationship that fosters open-communication and coordination of care increases the likelihood that women will be more involved in their health care, improving overall health outcomes.

  • Back on Track with Annual Wellness Visits (AWV)

    Published April 2022


    The world may have changed due to the pandemic, but the importance of annual wellness visits has not. Even prior to COVID-19 people may have justified not seeing their PCP annually with reasons like “I never get sick” or “I don’t have any risk factors”. However, in today’s times, it’s vital that Members recognize that preventive care, including annual wellness visits, is an investment in their health.


    Routine annual visits, regardless of the Member’s state of health, allow the PCP to build a comprehensive picture of the Member’s health risks, goals, and barriers. Implementing an integrated approach with your patients that includes physical, behavioral, and social factors encourages Members to be active players in their health care and empowers them to make well-informed decisions appropriate for their own health journey.

    Annual visits also provide a good opportunity to remind your patients of any other services they may need, such as:

    • Are they due for a colorectal cancer screening (COL) and would they be a candidate for home screening such as Cologuard®?
    • Are they due for breast cancer screening (BCS) or a bone mineral density test and can you get that appointment set up before the visit is over to ensure better compliance?
    • Remind them if they need a HbA1c lab testing, kidney health evaluation, or retinal screening.
    • Review immunizations they may be due for; identify any that can be given during the wellness visit to ensure better compliance.
    • Would they benefit from support services or referrals for healthy living such as weight management, behavioral health treatment, or tobacco cessation?


    Continue to utilize telehealth services when appropriate and make sure that Members keep upcoming appointments with outreach calls or letter reminders. Specify what they need to do or have available at the time of the visit, such as medications, list of other health care providers, blood pressure readings, etc.


    While the last two years have been challenging for everyone it is still crucial that plans and Providers work together now to educate, facilitate, and remind Members why annual wellness visits and preventive care are necessary.

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