To ensure optimal health and wellness for every MetroPlus member assigned to our department through the provision of comprehensive care coordination, adherence engagement, health education and supportive services in a caring, nonjudgmental and empowering manner.
MEET THE METROPLUS HIV MEDICAL DIRECTOR
Dr. Ross G. Hewitt is a native New Yorker, born in Brooklyn and raised in the Bronx. He graduated from NYU medical school in 1983, right at the start of the AIDS epidemic, and spent time on the wards of Bellevue Hospital helping to care for some of the city’s first AIDS patients. He went to Buffalo, NY, where after graduating from internal medicine residency and infectious disease fellowship, he established the AIDS Designated Center at the Erie County Medical Center (Buffalo’s equivalent to Bellevue), where he led the program for 18 years. He was an ACTG sub-unit Principal Investigator, and helped study the first 15 antiretrovirals that came to market. After moving back to NYC in 2004, he worked for Heritage Health & Housing, North General Hospital and then the Institute for Family Health -- Family Health Center of Harlem, where his current clinical practice is still located.
When Dr. Ross G. Hewitt joined MetroPlus in June 2015, he was given a mandate to take a fresh look at the structure and function of the HIV Services department which manages the HIV Special Needs Plan (SNP), also known as Partnership In Care, and provides telephonic care coordination to members (enrollees) with HIV infection across all of the insurance plans the company offers, including Medicare and marketplace plans on the NYS Health Exchange. What emerged from a comprehensive and inclusive process was a new structure to support more people living with HIV in a more efficient way (see article on Health & Wellness Advisement elsewhere).
Another important role for him is interaction with facilities and providers that he takes very seriously. “It’s all about our relationship with HIV clinics and HIV providers throughout our network. We want to let them know that we are here to help. Our goal is to help our members achieve and maintain viral load suppression, ultimately improving their quality of life, which is the exact same goal as their primary care team. We consider ourselves an extension of that team.”
Dr. Hewitt is here to help providers resolve issues with pharmacy prior authorization requests, utilization submissions for personal care services (home health aides), medical equipment and any other process obstacles they may encounter. He welcomes your phone calls and emails, and will generally respond to your requests within 2 business days. HewittR@metroplus.org
HEALTH & WELLNESS ADVISEMENT
Every HIV+ MetroPlus member deserves the assignment of someone they can personally count on for assistance. That is the philosophy that guides the staff of HIV Services under its newly revised structure.
The needs of the individual with HIV have grown beyond traditional case management, which was the model the department was originally founded upon. People living with HIV need varying degrees of care coordination, health education, adherence counseling and access to supportive services. We now provide concierge-style service so their assigned Health & Wellness Advisor (HWA) can assist then in a large variety of ways, and if not, connect them to someone who can. We no longer call our staff “case managers” or “case management technicians” because we want to minimize confusion for the member who may already have a case manager at their clinic or community-based organization.
Our HWAs are organized into seven territories, based upon where the member receives their care (not where they live): Manhattan North, Manhattan South, Bronx North, Bronx South, Brooklyn North, Brooklyn South and Queens. As we expand into Staten Island, our Manhattan South team will cover there.
Our HWAs are here to identify and address gaps in medical and psychosocial supports that are identified through a comprehensive assessment that is done with each member. They can be particularly helpful to members who receive their care in private practices where case management support may not exist.
Our HWAs attempt to call each member on their roster. Providers, clinics, pharmacies and other vendors may be contacted by our HWAs to obtain a current phone number for the member. When we can’t reach the member after six attempts, we schedule a future time to try again. We thank you in advance for your cooperation.
We are here to help. Any member or provider may contact our department hotline (212-908-8877) for assistance during regular business hours.
METROPLUS COVERS PrEP
Access to Truvada, medical monitoring and necessary lab tests that are part of the standard of care to safely prescribe and monitor people for pre-exposure prophylaxis (PrEP) are a covered benefit of all MetroPlus insurance plans. There may be co-pays for Truvada, which is considered a brand name medication, for plans other than Medicaid Managed Care and the SNP. There may also be co-pays for the provider visit. Co-pays vary by insurance plan and often by level of income for many of the “exchange” plans. Members should be directed toward a participating laboratory.
GENYOYA, ODEFSEY AND DESCOVY FORMULARY STATUS
All three of these new antiretroviral medications have been added to the Medicaid formulary on an urgent basis as they have been released. They offer a significant advantage of less bone and renal toxicity of their counterparts Stribild, Complera and Truvada. However, for other plans at MetroPlus, particularly on the exchange, they may not yet have made it to the formulary, as additions generally occur every 90 days. These plans are designed to be lower cost by have tighter formularies so in some cases, these medications may require a prior authorization request. Descovy does not have an indication for use in PrEP at this point and off-label use may also require a prior authorization request. We are here to get our members the care they need. If problems arise with access to these medications, providers should contact Dr. Hewitt for assistance.
Benefits for Special Needs Program (SNP) Members
How will MetroPlus Partnership in Care Help Members
- HIV Specialist as their PCP
- Multiple appointments on the same day
- Designated Health and Wellness Advisor
- Flexibility in authorizations and referrals
- Incentive program
Benefits for the Providers
- Every SNP member has access to a Health and Wellness Advisor at MetroPlus and a medical case manager at the facility.
- If a facility does not have a medical case manager, MetroPlus Health and Wellness Advisory team will provide support, care coordination and complex case manager services to the member.
- The Case Managers at the facilities and the Health and Wellness Advisors at MetroPlus will coordinate efforts to help members get the following services:
- Housing Assistance
- Meals/Nutritional Counseling
- Education Programs
- Legal Services
- Day Care Services
- Pregnancy Services
- Parenting Education
Online Resources for HIV-related CME
Clinical Education Initiative
Clinical Care Options - HIV
- Member plan of care developed by the health and wellness advisor with the provider.
- Discharge planning in coordination with social worker and providers at the facility.
- Notification to provider of members admitted in hospital or with high ER utilization.
- Access to view reports from the MetroPlus claim base and the IPRO systems.
- Community relations support and activities designed for Health education, prevention risk reduction, and HIV testing and treatment adherence.
- Enhance revenue by billing Preventive medicine, individual counseling and case management activities.
- Educational sessions about getting access to the MetroPlus resources such as Web page, provider portal and MetroPlus report delivery system.
- Obtain flexibility with prior authorization for medications, special procedures and out of network referrals.
- Assistance with the credentialing process to become an HIV specialist.
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Continuing Medical Education (CME) Calendar
|June 2, 2016
||9 am - 12 pm
||*Routinizing Sexual Health in Primary Care
||NYC DOHMH Gotham Center, 42-09 28th Street, 3rd Floor, Long Island City, NY 11101
|June 15, 2016
||9 am - 12 pm
||*Routinizing Sexual Health in Primary Care
||Brooklyn Borough Hall, 209 Joralemon Street, Brooklyn, NY 11201
|June 20, 2016
||9 am - 5:45 pm
||NYS 2016 HIV Cure Symposium
||NYU Kimmel Center, 60 Washington Square South, New York, NY 10012
||Mt. Sinai Institute for Advanced Medicine
|June 24, 2016
||8:30 am - 4:45 pm
||2nd Annual NYS STD Conference
||The Lodge at Welch Allyn, 4355 State Street Road, Skanaeteles, NY 13152