Fwd: Follow Up: UCHealth Clinical Review Liaison

[Bridget Paris]

Here is my response to UCHealth.

Bridget Paris, SPHR, CCP, CBP Human Resources Director Larimer County Human Resources p: (970) 498-5976  e: par...@co.larimer.co.us

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---------- Forwarded message ---------
From: Bridget Paris <par...@co.larimer.co.us>
Date: Mon, Mar 4, 2024 at 7:45 AM
Subject: Re: Follow Up: UCHealth Clinical Review Liaison
To: Knipe, Patrick <Patric...@uchealth.org>
Cc: Jennifer Whitener <whit...@co.larimer.co.us>, Thompson, David (CFO) <David.T...@uchealth.org>, Unger, Kevin <Kevin...@uchealth.org>, Stone, Jennifer <Jennife...@uchealth.org>, Pfaffinger, Mark <pfaf...@co.larimer.co.us>, Lorenda Volker <vol...@co.larimer.co.us>

Thanks, Patrick.  We discussed this response with Jennifer Stone at our lunch last week.  I expected this response.

I remain unclear, how asking a provider (our ask to UCHealth) to ensure (a double check) that the patient receives the most effective and efficient services within their provider system, is a billing or privacy issue.  For me, it's quality/outcomes assurance.

With Jennifer S, we also discussed how we have a different relationship with Banner and how that relationship creates an opportunity for partnership and engagement.  For example, we reviewed our high claims, recognized the cancer situation, brainstormed the best experience for the patient, Larimer County, and Banner, and made it happen.  *NOTE:  We are not directly contracting with Banner; this strategy exists within our existing Aetna/Meritain relationship.

We'll continue to work directly with Jennifer S on unique high-claims in UCHealth, as our clinical team at Lockton recommends improving patient care and experience, or as we received concerns from our employees.  

I'll share this response with Commissioner Kefalas, and we'll keep working on our strategy for supporting employees in complex and high-cost claims at UCHealth ~ independently.

We greatly appreciate the opportunity to have Jennifer S assigned to supporting Larimer County, she is great to work with, and she can support us with the employee specific situations.

Bridget Paris, SPHR, CCP, CBP Human Resources Director Larimer County Human Resources p: (970) 498-5976  e: par...@co.larimer.co.us

Interested in Professional Coaching?

Schedule a Coaching session with me.

On Thu, Feb 29, 2024 at 9:23 AM Knipe, Patrick <Patric...@uchealth.org> wrote:

Good morning, Jennifer.

 

First and foremost, I want to extend my sincere apologies for the delay in our response to your recent request for UCHealth to appoint a clinical expert to review large claimant data on a quarterly basis. We needed time to thoroughly review your request with our legal department and to gather comprehensive feedback.

 

After a detailed internal review, we must respectfully decline the proposal to conduct quarterly clinical reviews of patient cases in direct collaboration with the Larimer County Human Resources Department and/or Lockton associates.

 

Our commitment to maintaining the privacy and confidentiality of our patients’ information is paramount. In accordance with our agreements with Aetna, all clinical reviews and claims assessments for members who access UCHealth services are to be conducted strictly following Aetna’s provider manual, policies, and procedures. This policy is consistent across all our managed care network contracts. Furthermore, any issues related to utilization management are managed in accordance with Aetna’s Utilization Management (U/M) policies and procedures, as well as the quality review procedures outlined in the value-based agreements we participate in with Aetna. This also extends to the activities of Aetna’s Third-Party Administrator (TPA), Meritain.

 

Additionally, and in line with the Health Insurance Portability and Accountability Act (HIPAA) regulations, UCHealth is authorized to disclose Protected Health Information (PHI) to another covered entity, such as a health plan subject to HIPAA, or a healthcare provider for the payment activities of the entity receiving the information. However, our authorization does not extend to disclosing PHI to any entity other than the contracted network carrier (Aetna), or the health plans TPA, without an applicable exception under HIPAA. Payment activities, as defined, include a broad range of actions such as reimbursement, determination of eligibility for coverage, billing, claims management, collection activities, and the review of services for medical necessity, coverage under the plan, appropriateness of care, or justification of charges.

 

We understand the importance of managing healthcare costs and are committed to working within the established frameworks to ensure both effective patient care and adherence to regulatory requirements. We appreciate your understanding and are more than willing to discuss alternative ways to support your goals through collaboration with Aetna within the confines of our agreements and regulations.

 

We look forward to continuing our collaboration to provide high-quality healthcare services.

 

Warm regards,

 

Patrick Knipe
Vice President, Payer Strategy & Managed Care Contracting

7901 E Lowry Blvd, Suite 350, Denver, CO 80230

Cell (973) 769-7248

Email  Patric...@uchealth.org

 

 

 

From: Jennifer Whitener <whit...@co.larimer.co.us>
Sent: Friday, February 9, 2024 3:36 PM
To: Knipe, Patrick <Patric...@uchealth.org>
Cc: Thompson, David (CFO) <David.T...@uchealth.org>; Unger, Kevin <Kevin...@uchealth.org>; Stone, Jennifer <Jennife...@uchealth.org>; Bridget Paris <par...@co.larimer.co.us>
Subject: Re: Follow Up: UCHealth Clinical Review Liaison

 

USE CAUTION: External Message

Thank you for the update Patrick, we appreciate it.  Have a nice weekend.

 

Regards,

Jennifer

Jennifer Whitener, CEBS Benefits Manager Larimer County Human Resources  p: (970) 498-5983   e: whit...@co.larimer.co.us

 

 

 

On Fri, Feb 9, 2024 at 3:34 PM Knipe, Patrick <Patric...@uchealth.org> wrote:

Hi Jennifer,

 

Your request for quarterly review with a clinical representative has been under review by our Compliance and Legal departments, we need their input before we can provide you with an adequate response. David Thompson has been following up regularly with the internal stakeholders to close the loop, we should have a response shortly. Several of us are tracking, and Jennifer Stone has this on her radar daily. We’ll keep you updated and hope to have the answer ASAP.

 

Thank you,

 

Patrick Knipe
Vice President, Payer Strategy & Managed Care Contracting

7901 E Lowry Blvd, Suite 350, Denver, CO 80230

Cell (973) 769-7248

Email  Patric...@uchealth.org

 

 

 

From: Jennifer Whitener <whit...@co.larimer.co.us>
Sent: Tuesday, February 6, 2024 10:17 AM
To: Thompson, David (CFO) <David.T...@uchealth.org>
Cc: Knipe, Patrick <Patric...@uchealth.org>; Unger, Kevin <Kevin...@uchealth.org>; Stone, Jennifer <Jennife...@uchealth.org>; Bridget Paris <par...@co.larimer.co.us>
Subject: Re: Follow Up: UCHealth Clinical Review Liaison

 

USE CAUTION: External Message

Good Morning,

 

Just wanted to follow up on the status of this to see if the UCHealth team had any updates?

 

Thank you,

Jennifer

Jennifer Whitener, CEBS Benefits Manager Larimer County Human Resources  p: (970) 498-5983   e: whit...@co.larimer.co.us

 

 

 

On Mon, Jan 29, 2024 at 12:15 PM Jennifer Whitener <whit...@co.larimer.co.us> wrote:

Thank you David, and I appreciate your quick response.

 

Yes, Meritain offers standard case management as part of their core service, and our benefits consultant (Lockton Companies Denver) also performs regular clinical reviews that are even more in-depth than medical third party administrators.  But, our hope is to bring the provider-side (UCHealth) together with Lockton and our team so that we're reviewing these cases holistically together going forward. 

 

Regards,

Jennifer

Jennifer Whitener, CEBS Benefits Manager Larimer County Human Resources  p: (970) 498-5983   e: whit...@co.larimer.co.us

 

 

 

On Mon, Jan 29, 2024 at 12:11 PM Thompson, David (CFO) <David.T...@uchealth.org> wrote:

Hi Jennifer – we are still researching the aptness and mechanics of how this may work.  I will get back to you in the next day or two.  Question for you, does Aetna/Meritain provide any utilization case review for you?

 

David

 

From: Jennifer Whitener <whit...@co.larimer.co.us>
Sent: Monday, January 29, 2024 12:02 PM
To: Knipe, Patrick <Patric...@uchealth.org>; Thompson, David (CFO) <David.T...@uchealth.org>; Unger, Kevin <Kevin...@uchealth.org>; Stone, Jennifer <Jennife...@uchealth.org>
Cc: Bridget Paris <par...@co.larimer.co.us>
Subject: Follow Up: UCHealth Clinical Review Liaison

 

USE CAUTION: External Message

Good Afternoon,

 

I just wanted to follow up with this group since it's been over two weeks since we last spoke with regard to being assigned someone with clinical expertise who could review large claimant data on a quarterly basis.

 

Has there been any movement with this request?

 

Thank you,

Jennifer

Jennifer Whitener, CEBS Benefits Manager Larimer County Human Resources  p: (970) 498-5983   e: whit...@co.larimer.co.us