How to get paid on time!

A wellness rockstar has joined our team

News You Can Use and Important Updates
August 2016
Strengthening partnerships, growing a wellness network, and welcoming a new member to our team. These updates and more in your August Network Newsletter!
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The Benefits of Building a Network of Wellness

Supporting your patients on a path to wellness is getting easier. We want to let you know about an exciting network we are eager to grow and share with our EMHS Health Plan members. Imagine a one stop shop that would connect you to different wellness services in your area. We're talking everything from gyms and personal trainers to yoga and massage. The best part, these would be credentialed wellness providers, by Beacon Health, and offer a discount to EMHS Health Plan members. Talk about a win win!
 
We want to help you best support your patients wellness goals and we think we're off to a good start. Please visit our website BeaconHealth.ME to check out all the providers currently participating.
 
If you know of some not on the list, please have them contact us or you can recommend them to Beacon Health on our web page, so we can continue to build our robust statewide network.
 
For more information, please contact Janelle Davis at jjdavis@emhs.org.
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CORRECTION: Use Beacon Health forms for Geisinger provider information changes!

In July, Geisinger Health Plan (GHP) sent out a letter to all Maine providers asking that they utilize the GHP website to add, change, or term providers for the GHP / EMHS Employee Plan network. THIS IS INCORRECT!
 
All Maine providers contracted through Beacon Health (hospitals, doctors, ambulatory surgery centers, and some others) should use Beacon Health forms to perform credentialing functions for Maine and the EMHS Health Plan.
 
Beacon Health forms are available on our website at www.BeaconHealth.me, or by calling Beacon Health at (207) 973-9798.
 
We apologize for any confusion this inadvertent announcement may have caused!  

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Credentialing Tip

Speed up your provider credentialing application to Beacon Health / Geisinger (or any health plan) by making sure you address the following:
  • Include Effective Date of starts, changes, and terminations on any notices to Beacon Health
  • Attach and/or upload CAQH all required documents, and make sure they are current!

Get Paid Earlier! Remember Beacon Health adopted the state policy that a provider's payment effective date is set as the date that a completed packet of application materials is made available to Beacon Health. The sooner you get us all required information - the sooner your provider gets paid!

 

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Acronyms of the Month
Decode the  healthcare acronyms below... the answers are at the end of the newsletter
  • CQM         _______________________________________________________
  • COB          _______________________________________________________
  • EMTALA   _______________________________________________________
  • GPWW      _______________________________________________________
  • PCORI      _______________________________________________________

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EMHS Medical Plan Switches to Magellan
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As of July 1, 2016,The EMHS employee medical plan is now using Magellan Healthcare for their behavioral health benefit management. The switch in "carve out" companies in mid-year was made to provide better overall customer service experience for Plan members'  behavioral health needs.

A "grace period" is in place to allow for providers to continue seeing EMHS Plan members who are in treatment while they apply to be in the Magellan network.

Magellan has a significant profile in Maine having served the state for many years, and recruitment of additional providers across Maine is well underway. Providers not current with Magellan have probably already received an outreach letter from the company and those who may want to join or rejoin the Magellan network should go to their website and follow the instructions.

From the header across the top you would choose:
  1. Provider Network
  2. Join the Network
  3. Select the right option

                 I am an individual / solo practitioner OR   

                 I am representing a group practice


 

     4.  Complete the required fields

 Make sure to click "Submit"

 

Once the information has been completed, a Magellan representative will contact you.

 
Beacon Health and Martin's Point Health Care Partner to Bring Good Health to Maine Communities

It's been three months since Beacon Health and Martin's Point Health Care announced a collaborative agreement to help approximately 9,000 of Maine's Medicare beneficiaries receive more consistent, effective, and affordable healthcare across the state. Under their new "population health agreement," the two entities are working together to maintain and improve the health of Martin's Point Generations Advantage Medicare plan members by focusing on preventive healthcare and chronic illness management.
 
This agreement brings together two Maine organizations that are nationally renowned for quality. Beacon Health, a provider-led Accountable Care Organization (ACO) and member of EMHS specializing in population health, was ranked second highest in quality out of 19 Medicare Pioneer ACOs nationwide. As Maine's leading provider of Medicare Advantage health plans, Martin's Point offers Generations Advantage, the only plan in Maine (and one of only 12 plans nationwide) to earn Medicare's highest quality rating of 5 Stars for 2016.
 
Under the agreement, Martin's Point Generations Advantage plan members with Beacon Health primary care providers (PCPs) have access to the services of Beacon Health's Nurse Care Coordination program. The program links members with chronic conditions with a care team consisting of nurse care and transition-of-care coordinators, health coaches, and social workers. The Beacon Health care teams will support all aspects of a Martin's Point Generations Advantage plan member's care coordination, closely monitoring the member between visits, ensuring receipt of necessary follow-up care, and emphasizing the importance of yearly visits and preventive care.
 
This level of comprehensive care for members managing chronic conditions has been shown to help keep them healthier, improve quality of life, and reduce overall healthcare costs. Key to this work is making sure members see their PCP at least once each year so health conditions can be identified, documented, and treated.

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Central Maine Healthcare Joins Beacon Health for a Healthier Maine

We are excited to share the news of a new partnership between Beacon Health, the population health member of EMHS (Eastern Maine Healthcare Systems), and Central Maine Healthcare. This new collaboration includes a statewide network of primary care providers, nurses, and quality experts all working together to personalize and make care delivery consistent across the cities and towns of our rural state.
 
Beacon Health and Central Maine Healthcare are currently partnering with Martin's Point, a Maine based insurance company, in a population health agreement for Medicare Advantage beneficiaries. In addition to their pledge to improve the patient experience, the two ACOs have also agreed to share financial risk with Martin's Point Insurance Company in a unique and innovative arrangement for all involved.
 
The success of the new cooperative model won't be known for many months, however in the meantime, all partners are committed to eliminating barriers to communication, increasing the coordination of care, and putting patients first. Central Maine Healthcare, Mount Desert Island Hospital, and all EMHS members are strategically and financially linked together to move this transformation forward in a lasting and meaningful way.  

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Rural Hospitals Join EMHS Strategic Network

EMHS recently signed strategic network participant agreements with Northern Maine Medical Center in Fort Kent and Down East Community Hospital in Machias. Currently, both organizations are partners in population health with Beacon Health.
 
The agreements, each for a minimum of three years, are intended to strengthen the relationships between EMHS and each hospital and advance the delivery of hospital specific, high quality, cost-effective integrated health delivery services. The Strategic Network is a new offering from EMHS and separate from a full membership affiliation agreement. Participants in the EMHS Strategic Network are independent hospitals that choose to align operationally and strategically with EMHS for access to a broad range of clinical and infrastructure services and expertise that help streamline operations, improve quality and/or anticipate change based on current and national trends.
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Andy VanEss, Walks the Talk!

If you were to look at Andy VanEss you might think, "this guy's got it made!" He'll be the first to tell you though that it's a daily commitment to being healthy, happy, and motivated that makes the kind of wellness leader that encourages and supports all those around him.
 
Andy's path to becoming the new Wellness Program manager at Beacon Health makes him the perfect person for the job. When he started at Husson University it was in their nursing program, but he realized he was better suited for healthcare administration. "I like the diversity and opportunities the field offers." He threw himself into his studies and also earned a master's in Business Administration as well. This experience taught him the value of life balance.
 
"When I graduated, I was out of shape, unhealthy, overweight, and needed to get back on track." Andy's intense focus on school work had him lose touch with the very thing he was studying-health! "I took all that I had been learning and incorporated it into my life, and through small changes and forming new habits, I was able to regain my healthy lifestyle and drop 112 pounds!"
 
Andy enjoyed his time at Healthy Maine Partnerships where he supported community health promotion for Mayo Regional Hospital, but when he saw the hands-on role of building a program with Beacon Health, he couldn't resist applying for the position. "The team that is here already is well rounded and passionate about this work. I want to be a part of the real difference they are making every day."
 
Andy understands the daily struggle of staying on course and living life at your healthiest. It's one of the reasons why he is tailor made for his new role at Beacon Health. "I want to be more integral in designing and promoting practical wellness strategies that can fit people in all walks of life."
 
Beacon Health is fortunate to have an open-minded, diversified, and passionate team member. Please welcome Andy!
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Acronyms of the Month
Decode the  healthcare acronyms below... the answers are at the end of the newsletter
 
  • CQM - Clinical Quality Measure: Created by CMS, clinical quality measures help measure and track the quality of healthcare services provided by hospitals and providers. CQMs measure various aspects of patient care including: health outcomes, clinical processes, patient safety, efficient use of resources, care coordination, patient engagement, population and public health, and clinical guidelines. Providers are required to report CQMs to CMS as part of quality improvement and reimbursement programs.
  •  COB - Coordination of Benefits: Agreement between health plans and insurers to make certain that the same services are not paid for more than once.
  •  EMTALA - Emergency Medical Treatment and Labor Act: Known as the patient anti-dumping statue, this federal law imposes specific obligations on Medicare-participating hospitals and critical access hospitals that offer emergency services. It sets forth requirements for medical screening exams for medical conditions, stabilizing treatment, and appropriate transfer, and prohibits delays in service to inquire about a patient's payment method or insurance status. It specifically addresses the hospital's obligations with respect to specialty physician availability in the emergency department.
  •  GPWW- Group Practice without Walls: A group practice in which the provider members come together legally but continue to practice autonomously in private offices scattered throughout the service area.
  •  PCORI - Patient Centered Outcomes Research Institute: Established by legislation under the Affordable Care Act, the PCORI is an independent, non-profit organization overseen by a board of governors made up of directors from AHRQ (Agency for Healthcare Research and Quality) and NIH (National Institutes of Health) along with 17 other appointed members, including three from the patient / consumer community. PCORI is charged with identifying research priorities based on certain factors and authorized to commission a wide variety of different types of comparative effectiveness research studies with respect to the relative health outcomes, clinical effectiveness, and appropriateness of medical treatments and services.

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Steve Ryan | Beacon Health | 207-973-9793 | sryan@emhs.org | BeaconHealth.ME
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