Provider Network Newsletter
In This Issue
Pharmacy Tools
Quick and Easy DME
UPDATE Prior Auth
CCT - Extention of PCPs
Meet Steve Ryan
Acronyms of the Month
Quick Links
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Issue: Number 5January 2016
  
 

For the past five years, Beacon Health has partnered with healthcare organizations across Maine to transform health delivery. It's been an exhilarating time as providers, care teams, and communities have come together to make sure people in the Beacon Health network have the care they want and need to live their healthiest lives possible.
 
"When you focus on relationships with your patients and have the tools available to ensure they are getting preventive care, follow-up care, chronic condition care, and easy access to care teams, then you are really providing customized care to fit individual needs," shares Frank Bragg, MD, Beacon Health performance improvement chair, and physician at EMMC Internal Medicine. Dr. Bragg is one of nearly 600 Beacon Health Network primary care providers statewide working to build a health delivery system that is not only efficient but is of the highest quality and consistent no matter where a patient receives care.
 
The hallmark of Beacon Health's transformative journey is the network is expertly driven by our providers. This expertise is critical to building a high value integrated network that is attractive to employers, commercial payers, Medicare, and MaineCare. With well-coordinated teamwork, the patient is always at the center of our care teams.
 
Adrienne Roy, a Beacon Health patient at Inland Family Care in Waterville knows first-hand what patient-centered care means. "I have COPD and diabetes, which can be overwhelming at times. That's why having a nurse care coordinator available by phone or in the office has been a huge relief to me. She sets up a community care team to come into my home for added support. My life is a lot easier and better with my care team."
 
Data Analytics
To ensure Mainers have access to care close to home for generations to come, Beacon Health is providing a platform of expertise, leadership, and innovation to deliver the right care at the right time to each patient every day. Our 75 nurse care coordinators touch the lives of 1,125 patients every day. With solid data analytics, care teams can reach out to patients who need extra support or preventive care. And, with providers who have joined forces, we are transitioning to a model sustained by quality of life, patient experience, outcomes, and lower cost.
 
"The Beacon Health Network is offering something that's never been done before in Maine and it's very attractive to employers because they know if someone on their health plan gets care from northern, southern, eastern, or western Maine it will be consistent and of the highest quality," explains Mike Donahue, MBA, CEO of Beacon Health.  
 
Network Highlights
  • One of 21 Medicare Next Generation Accountable Care Organizations (ACOs)
  • One of 100 new Medicare Shared Savings Program ACOs, focusing on rural healthcare
  • Commercial contracts for more than 80,000 patients including State Employees and EMHS employees and dependents on the system's medical plan
  • Ranked second nationally in quality among 19 Medicare Pioneer ACOs -also exceeded the ninetieth percentile in 11 of 33 quality measures
  • NCQA accredited care coordination program decreased hospital admissions for COPD, heart failure, asthma, and COPD patients
  • Reduced overall cost of care for State Employee's covered by Beacon population by 9%
  • Reduced unnecessary hospital admissions and readmission for EMHS medical plan

Acronyms of the Month

Because they're just a part of healthcare!

 

 Can you decode the healthcare acronyms below?

  • ELSI            _________________________________
  • HCFAC       ________________________________
  • MBWA        _________________________________
  • MSSP           _________________________________
  • NPI               _________________________________

  Find the answers at the end of the newsletter.

  
Population Health Tools in Pharmacy
  
 
Miller Drug is a four store pharmacy located in Bangor and Brewer, Maine. Primary services include traditional prescription filling, mail-order on request, delivery, and nursing home medication programs.
  
 
In addition to these core services, they have also started many new programs in 2015, offering their customers even more support. One program is a comprehensive smoking cessation program... Although it can be extraordinarily difficult to quit, it is the best way someone can improve their health. This is why Miller Drug sees this program as being such an important service to provide.
 
Miller Drug's approach is unique and not available in many communities in Maine aside from the Maine Tobacco Helpline. The pharmacy, in conjunction with Beacon Health, hired a fulltime clinical pharmacist to start a complete smoking cessation program. As a certified tobacco cessation specialist, Bob Cattan, RPh, from Miller Drug, offers individual consults, group visits, smoking cessation medication management, and follow-up care. Bob assesses a patient's nicotine dependence and develops an individualized care plan with at least weekly follow-up. In the first two groups of patients, 17 came to at least one tobacco cessation class. Twenty-nine percent of these patients have fully quit and five more patients are still engaged in the program.
 
Bob has also started a 100 percent free blood glucose meter and test strip program. Using Glococard meters and test strips, a patient may upload their blood glucose data onto a secure website free of charge. The data provided can help patients make more informed decisions regarding their blood glucose management.
 
Looking to 2016, Miller Drug is in the final phases of the accreditation process to become only the third Utilization Review Accreditation Commission (URAC) accredited specialty pharmacy in Maine. The accreditation will allow patients to get specialty medications closer to home without driving hours. Certified specialty pharmacies have high quality programs, which provide personalized and expert clinical services to patients on specialty medications.
 
Further goals of 2016 include better integration with Beacon Health, enhanced medication adherence tracking and intervention, and integration of immunization data into HealthInfoNet and/or electronic medical records.
 
For more information regarding these fantastic new programs, reach out to Will Seavey, RPh, pharmacy manager, at wseavey@emhs.org or Robert Cattan, RPh, pharmacist, at rcattan@emhs.org.
  
An Easier and Quicker Way to Get Your Patients the Durable Medical Equipment (DME) They Need!
Introducing: Preferred Providers to Support Network
  
Busy practices need all the support services they can get! Beacon Health, with Geisinger and the EMHS Employee Medical Plan, has identified two Durable Medical Equipment (DME) provider organizations across Maine who are committing to stepping up their responsiveness and support for practices in 2016.
  
Coastal Med Tech is a locally owned company that has six locations across Maine and specializes in oxygen, sleep apnea, and heavier equipment (beds, wheelchairs, etc.). Available 24 hours a day by calling one of their sites or by visiting www.coastalmedtech.com and clicking the "Contact Us" button. Patients can also visit the site to identify products that would assist with their needs. Chief operation officer, John Thayer, says after-hours emergencies and services are handled as soon as possible; mail order is also available.
  
Edgepark Medical Supplies is a national organization that touts their free one to two day delivery times to 99 percent of the population. Orders can be placed by phone, fax, EDI, or at www.Edgepark.com. Their extensive product availability makes them a good Preferred Partner for Beacon Health, and they have committed to working closely with us to assure responsive and timely services to our network.  
  
Please feel free to contact Steve Ryan at Beacon Health (StephenRyan@emhs.org) for more information, or if you have suggestions about how these preferred DME providers could better serve your practice.
GEISINGER ANNOUNCES UPDATES TO PRIOR AUTH LIST
  
Geisinger Health Plan, administrator for the EMHS Employee Medical Plan, has announced that they have updated the Prior Authorization lists and supporting documents on their website.
  
To access the updates, go to: www.thehealthplan.com and click on the Health Care Providers tab, then GHP Clinical Policies, and What's New - Medical. A full listing of GHP Medical Policies is also available there.
  
GHP Maine Operations Manager Pam Hageny reminds providers and staff that there are new procedures included in the update for prior-authorization and that they should go to the website to assure they have the most recent information. Pam may be reached at pehageny@thehealthplan.com or (570) 490-7863.
Beacon Health Community Care Team (CCT)
Brings Primary Care into the Home
  
Community Care Teams were created across Maine in response to incentives and program opportunities within the National Committee for Quality Assurance's (NCQA) Patient-Centered Medical Home pilot. In a very short time, they've grown to be important members of the care teams allowing providers to get a 360 view of their patients.
  
 "We are proud of what our program can do for these patients," shares Ralph McPherson, LCSW, Beacon Health team lead in Aroostook County. This didn't happen overnight, when the CCTs were formed practices weren't really sure what they were and how to best use the program. "Now practices seek us out to support specific patients so we can surround them with services so they cannot only meet their healthcare needs, but their basic needs. The practices seem to truly value what the CCT has to offer their patients."
  
Ralph is especially proud of the Hospital to Home program, which provides follow-up visits to recently discharged patients. "We help arrange post-discharge care and assist with medication questions." These added measures have helped many patients avoid medication complications, gaps in care, or even hospital readmission.
  
What Makes the CCT Program Unique?
An obvious comparable service might be home health services, but according to Ralph, "the only way we are the same is that we go through the client's front door." CCTs are not restricted by the many regulations enforced on home health agencies, including a prescribed list of services that can be rendered (and reimbursed) or the requirement that a client be home-bound. Also, because they are integrated with the primary care practices, CCT can often begin services very quickly, with less authorization and referral paperwork.
  
However, community care teams do not take the place of home health services. Often times, once CCTs make a connection with patients and find out what their specific needs and requirements are, they facilitate referrals to home health agencies to help bridge gaps in care.
  
In many ways, CCT is an extension of the primary care practice. They help patients follow through with their provider's recommendations, assist in setting up appointments, spend the time with clients to process and understand the last visit or test results, offer support to help avoid emergency department visits or readmissions, and sort through the often confusing array of medications that a client may have collected from multiple care sources. All this at no extra cost to patients!
  
  This level of care is an investment in time, some visits last up to 90 minutes, but the relationships that are made are essential to supporting patients living their fullest life. "The most important aspect of our jobs is to be sure that we identify any urgent concerns and any barriers to care, including self-care," shares Alison Ashley, LCSW, Beacon Health CCT central region.
  
Community care teams are a good combination of medical and mental health approaches. "The program allows staff to address the psycho-social needs of the client, which can be especially important for clients with anxiety or other disorders that prevent them from getting out of their homes and seeking appropriate care," explains Ralph.
  
WHAT'S NEXT
Beacon Health CCT program manager Jaime Rogers says, "We have an uncanny ability to do wild and crazy things to address a client's need." She shared a recent success where a team member found a spanish-speaking pharmacist near a Latino client's home who cleared up the client's confusion about his diabetes medications and instantly improved the client's blood sugar levels, and therefore his ability to function during his day.  
  
"We are really offering a wonderful service," smiles Jaime, who feels that the program should be available to all of a practice's patients, not just those on the list from the health plan (or their occasional "exception"). "Practices and PCPs shouldn't have to make these distinctions about who can receive the help they need to get and stay healthy!"  
Meet Steve Ryan
  
Stephen Ryan is director of Network Management at Beacon Health and is responsible for supporting our multiple provider networks. 
He was previously president and CEO of Maine Network for Health, a provider-owned organization specializing in healthcare business support services including payment contracts, business office functions, and quality improvement assistance.
Steve holds a master's degree in Health Care Administration from Simmons College in Boston and is active with various statewide healthcare-related boards and committees.
 He lives in Belfast with his wife and the younger two of their three children, and volunteers in his hometown by serving on the board of Friends of Midcoast Maine, serving on the city's planning board, and assisting with the annual Maine Celtic Celebration.
Answers to ACRONYMS OF THE MONTH
    • ELSI - Ethical, Legal, and Social Implications Program; A component of the Human Genome Project, currently studies the ethical, legal, and social issues surrounding the availability of genetic information. It researches the use of genetic information on privacy and confidentiality; psychological impact and stigmatization, reproductive issues, clinical issues, conceptual and philosophical issues, health and environmental issues, and commercialization of products.
    • HCFAC - Health Care Fraud and Abuse Control; A program established by the Health Insurance Portability and Accountability Act of 1996 that funds efforts to coordinate, federal, state and local law enforcement efforts to prevent healthcare fraud and abuse.
    • MBWA - Management By Walking Around; An approach by which a member of a hospital or practice management team regularly walks through offices, lab areas, patient rooms, and so forth, to talk to employees, patients, and families to find out about any issues or problems and receive feedback.
    • MSSP - Medicare Shared Savings Program; A program established by CMS that allows healthcare providers to join together in accountable care organizations (ACOs) to integrate and coordinate services in return for a share of any savings to the Medicare program. Medicare Shared Savings Program ACOs will be rewarded for lowering growth in Medicare costs while meeting performance standards on quality of care and putting patients first.
    • NPI - National Provider Identifier; A 10 digit, numeric identifier issued to healthcare providers by the Centers for Medicare and Medicaid Services and used for administrative and financial transactions adopted under the Health Insurance Portability and Accountability Act (HIPPA).