Provider Network Newsletter
In This Issue
Going Back to His Roots!
Credentialing Changes
Farewell, Alyssa
Acronyms of the Month
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Issue: Number 6April 2016

Happy Spring! We've got spring fever popping up all over the Beacon Health Network - sure hope the temperatures start reflecting the change in season.
If there are topics you'd be interested in learning about in our newsletter please let us know.
As always we are here to support you in delivering the highest quality patient care.
Acronyms of the Month
Test your knowledge and
 decode the healthcare acronyms
  • ASC            _________________________________
  • DGME         ________________________________
  • HCC            _________________________________
  • IRB              _________________________________
  • HCQIA        _________________________________
  • NPDB          _________________________________
  Find the answers at the end of the newsletter.
Doctor Margolskee is Going Back to His Roots!
It's been a long and winding road for Howard Margolskee, MD, at Sebasticook Valley Health (SVH) in Pittsfield. Recently, he announced that he's heading back to his true love, supporting patients at SVH Family Care. Dr. Margolskee is transitioning from his current role as lead primary care physician to return to more direct patient care.
Leading and guiding providers in the three family care practices of SVH gave Dr. Margolskee a new perspective on the importance of team work and supporting both patients' physical and mental/behavioral care, as well as their socioeconomic needs. "Quality metrics don't tell the whole story about why patients and their care teams aren't achieving shared goals. If we are going to truly care for populations and provide the highest quality care, we have to think about the whole person-it's the only way we are going to move our quality numbers to the next level," says Dr. Margolskee.
One strategy to get care teams all rowing in the same direction is the implementation of daily huddles. He continues, "It's done two things, one it makes sure all members of the team know about challenging cases and it promotes collaboration among all providers in the practice."
A second strategy is team meetings, which have identified success stories in why some workflows are working better and how to share those wins with colleagues. "All providers develop habits over time and our teams reflect our style," he shares. "What we're learning is we can still have our style of delivering care, but in order for all our patients to receive the same high quality, we have to have some degree of standardization in our workflow. I don't see a time when we won't focus on team effectiveness and we now have the data to support our work."
Being able to say care is consistent across our primary care practices is becoming more important and our providers are realizing this can free them up to tailor their care to meet the individual needs of their patients. Access to data is influencing this change in practice.
"Teams are not only collecting data through our EMRs but they understand it - it's driving our transformation to value based care and keeping our patients their healthiest," says Dr. Margolskee. "Paper charts and photocopied articles are no longer the way to excel at patient care. Beacon Health is doing a great job building a team that is not only helping primary care teams survive, but thrive in the next age of healthcare."
Going from provider to patient was a humbling experience for Dr. Margolskee and it has changed his perspective on the importance of caregivers. "I firmly believe that some of the reasons I am still here are my wife and family advocating for one care approach or another. Caregivers are as important as any medication that I can prescribe."
He continues, "Everyone a patient encounters on their health journey needs to think of themselves as a member of their care team and that we all have expertise and one goal, to support each patient every day."
Dr. Margolskee believes the importance Beacon Health is playing in this transformation is helping practices develop and build skills and effectiveness. "Beacon is giving us actionable data so we can provide the right care, at the right time, in the right place with our patients-it's a game changer!"
Credentialing Changes Needed Within 30-Days
Beacon Health has recently been asked to process some Change In Practice notices that were from October 2015, last summer, and even 2014!
Practices must submit Changes in Practice-including terminations-in a timely manner so that claims are processed correctly. A practice's termination affects the claims submission and payment for the location that provider goes to, so please be courteous and efficient. (You would not want to be on the receiving end of a slow "change" process, right?)
Send all Change In Practice and new provider Provider Data Forms to Karen at Your processing will be slowed down if you send it to the wrong entry point. Also, don't forget to update CAQH, PECOS and other key records!
Beacon Health needs all change forms within 30 days of the effective date of the change. Your revenues, other practices, and Beacon Health depend on it.
Farewell and Thank You, Alyssa...
It is with regret that we share with you that Alyssa Hanson will be leaving Beacon Health as our Wellness Program manager.

Alyssa has been instrumental in developing our wellness program and bringing it to new heights accessible across the state to support EMHS employees improving their quality of life.
With Alyssa's commitment to wellness, Beacon Health was able to launch a system wide program without missing a beat.

She's given us a strong foundation and developed a team of aspiring wellness coordinators!Alyssa is leaving us to continue her wellness journey in pursuit of a degree as a nurse practitioner.
The Wellness plays an increasingly more important role in population health. The team's primary responsibility is to provide a range of wellness services to EMHS Medical Plan eligible employees and dependents: coaching, educational and health improvement programs, and biometric screening. The team also partners with EMHS Benefits when designing and implementing employee incentives around system offered wellness programs.
"Speaking of that, EMHS employee engagement in their health is at a very good level right now," shares Alyssa. "Beacon Health administered nearly 8,500 biometric screenings in 2015, out of approximately 10,000 eligible, and four wellness coordinators supported more than 1,000 employees statewide with approximately 4,100 hours of coaching."
In addition, the home-grown Beacon Weight Solutions program is a fabulous success, with strong participation and high client satisfaction. Diabetes prevention and stress reduction programs are in development for next year. Not to mention how much fun folks are having with Virgin Pulse. The new online program is making a healthy lifestyle easier and less intimidating for the average employee.
Wellness programs really can benefit anyone, regardless of their current health. As we start moving more toward population health and addressing the needs of communities, having tools to engage and support patients living their healthiest is becoming more vital. Alyssa is passionately researching ways to support clients no matter their risk. "The challenge is to identify who needs assistance and how we can help. Currently, we are digging through the risk score data of our populations and beginning to devise interventions for people in the rising risk segment - specifically those who are not struggling with chronic conditions yet, but who are showing some early signs."
Modeling healthy behaviors is not second nature to Alyssa. It was a behavior she learned over time that she grew to value. She explains, "It's hard to develop these habits later in life, but I see how it makes a tremendous difference not just for myself, but for others."
We wish Alyssa all the best as she advances her career, and thank her for all that she has done for Beacon Health and our statewide membership!

Answers to
  • ASC - Ambulatory Surgical Center: Outpatient center that provides surgical procedures that do not require an overnight stay.

  • DGME - Direct Graduate Medical Education payments: The payments hospitals receive from Medicare/Medicaid based on the amount of medical school graduates being trained.

  • HCC - Hierarchical Condition Category Coding: Medicare has classified thousands of the ICD diagnosis codes in HCCs or categories designating chronic conditions that end up costing them more money over the long run, such as diabetes, kidney failure, old MI, etc. When patients are assigned these ICD codes, Medicare sees those beneficiaries as being more severely ill than the "average" Medicare beneficiary. For certain Medicare members, this could result in higher reimbursement.

  • IRB - Institutional Review Board: An independent body constituted of medical/scientific professionals and non-medical/non-scientific members, whose responsibility it is to ensure the protection of the rights, safety, and well-being of human subjects involved in a trial and to provide public assurance of that protection by, among other things, reviewing and approving/providing favorable opinion on the trial protocol, the suitability of the investigator(s), facilities, and the methods and material to be used in obtaining and documenting informed consent of the trial subjects.

  • HCQIA - Health Care Quality Improvement Act: Passed by Congress in 1986, this legislation provides healthcare organizations and their peer review bodies immunity from monetary damages as a result of "adverse professional review actions" that relate to the competence or professional conduct of an affected physician or dentist. The act has established standards for due process when restricting or terminating a physician's privileges. It does not prevent other types of legal action (e.g. injunctions or restraining orders) and it does not convey protection of peer review documents from discovery in legal proceedings. HCQIA also created the National Practitioner Data Bank (NPDB), a system for reporting physicians whose competency has been judged inadequate.

  • NPDB - National Practitioner Data Bank: Established by HCQIA, this data bank serves as a clearinghouse of information for healthcare organizations throughout the nation. It has a number of reporting requirements that must be followed by healthcare entities that perform peer review.  Healthcare bodies that do not make required reports to the NPDB forfeit the peer review immunities they would otherwise be entitled to under HCQIA.