News You Can Use and Important Updates
July 2017
 Beacon Health Expands Health Plan Opportunities:
An Announcement from EMHS President and CEO Michelle Hood and
Beacon Health President, Sr. VP EMHS Michael Donahue...
 
We have reached an important milestone that will benefit employees throughout the system.  For the past five years, we've been laser-focused on transforming EMHS into an integrated health system. Many of you have put in long hours to help build what is now a strong foundation that can more effectively and efficiently support care delivery across all points of care.
 
What this means 
Beginning January 1, 2018, EMHS is putting the administration of the EMHS Employee Medical Plan into the capable hands of Beacon Direct, a service line of Beacon Health. You may recall that in 2012, EMHS gave life to Beacon Health as the vehicle that would prepare the system for a value-based payment model. As the population health member of our system, Beacon Health quickly became a change leader by working directly with frontline providers and staff in all of our primary care practices. In a relatively short period time, Beacon Health has helped bring about consistent high quality, proactive, and personalized care to more than 100,000 people aligned to its accountable care organization. This includes the nearly 18,000 EMHS employees, spouses and domestic partners, and dependents on our health plan. Beacon Health has worked alongside our current plan administrator, Geisinger, taking on bits and pieces of the administrative work in order to develop and grow skills in this area.
 
At the end of the year, we say goodbye to Geisinger and turn the third party administrator (TPA) duties over to Beacon Direct.  As with any third party administrator that EMHS would employ, there is a strict firewall between Human Resources and Beacon Health to ensure that employee health information remains private.
 
Why an administrator is needed
The EMHS Health Plan is "self-funded." That simply means that EMHS assumes the financial risk for providing health benefits to its work force and their dependents. So in some ways, you are your own health plan! The third party administrator provides the administrative and functional components of the medical plan (claims processing, care management, etc.), but it does not provide the insurance. EMHS uses system dollars (your bi-weekly premiums and your employer's portion of those premiums) to pay for the healthcare benefits of the plan-meaning all claims incurred by the plan are paid collectively by all of us. A self-funded plan allows EMHS the flexibility to design efficient and effective programs that meet the unique needs of our employee population, such as the wellness programs offered by Beacon Health. These programs have touched thousands of EMHS lives since becoming a benefit of the plan in 2013.
 
We are very pleased to be able to offer Beacon Direct.  More news and details to come.
 
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Beacon Health Expanding Network for 2018

Beacon Health is expanding its knowledge, leadership, and expertise in order to best support the care of our more than 100,000 people aligned to our participating accountable care providers and organizations. Did you also know Beacon Health is the organization that contracts and credentials providers and hospitals for the EMHS Medical Plan's more than17,000 members across Maine from York to Aroostook Counties?
  
Currently Beacon Health contracts, credentials, and supports a provider network of more than 4,000 professionals and more than 30 hospitals, home health agencies, skilled nursing facilities, and other provider types for the EMHS Plan.
  
To broaden our services to the EMHS Plan, Beacon Health is expanding our provider network beginning January 1, 2018, and will now be contracting with behavioral health providers, chiropractors, physical therapists, skilled nursing facilities and a full range of healthcare services to support the EMHS Plan's members' needs.
  
By returning arrangements for these services to local control, Beacon Health is going to be able to work more closely with Maine providers on members' care, quality, cost, and administrative efficiency issues. One important difference will be that the EMHS Plan and Beacon Health are removing the behavioral health "carve-out" company typically utilized by employers, and are re-integrating behavioral health care into our complete benefit package.
  
  
If you have any questions, please do not hesitate to contact us:
BeaconNetMan@emhs.org or 207- 973-9799.
  
 
Acronyms of the Month
Decode the  healthcare acronyms below... the answers are at the end of the newsletter
  • CO-OP    ______________________________________________________
  • EPSDT    ______________________________________________________
  • EOB        ______________________________________________________
  • HCERA   _______________________________________________________
  • IHI           _______________________________________________________

 

 

Please Welcome Sarah Paida!

We are pleased to welcome Beacon Health's new credentialing specialist, Sarah Paida.
She's hit the ground running and we are so thankful for her expertise and added support to our network team and the benefit she'll be to all of us. Sarah's areas of focus are credentialing, provider support, ACO reporting, and network data integrity management.
 
Her previous experiences make her the right person for our ever expanding network responsibilities. Sarah comes to us from Maine Coast Memorial Hospital where she spent the past six years as the medical staff coordinator with responsibilities that included managing credentialing and re-credentialing of the medical staff and on-boarding new medical staff. Prior to this she spent four years as a credentialing assistant at Maine Coast Memorial Hospital.
 
Sarah is a Certified Provider Credentialing Specialist and is a member of both the Maine Association of Medical Staff Services and the National Association of Medical Staff Services. She lives on Verona Island with her husband Scott and their calico cat. When she's not working, you can find her spending time with her husband and her friends, spoiling her cat, or enjoying the outdoors on foot or in a kayak.
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Wellness Tip for July - Get UP and Get Moving!
  
I hope you are enjoying your summer! Since we can't take every nice day off, how about some office wellness tips? It's important to take some breaks from sitting or standing in front of your computer.

Have you thought about bringing sneakers into work so you could go for a quick 15 minute walk outside, maybe invite a coworker too? The change of scenery and boost of endorphins could help you gain new focus and give you the boost of energy to make the rest of your day more productive. If you don't have time for that, simply standing and stretching is a good way to get your blood flowing too.

These simple steps could be a game changer - why not give it a try - you can't underestimate the power of fresh air, sunshine, and movement.

Looking to do more and explore more in our great state this summer, we've included links to some fun and free events taking place in every corner of Maine.

So stretch your legs, walk around, take in some music, or what may interest you! Enjoy, have fun, and be safe!


 

Waterville Area Events


 

Downeast Area Events


 

Statewide Events


 

Events by Region and Month


 

 

Acronyms of the Month:
Answers...
  • CO_OP - Consumer Operated and Oriented Plan: A program created by the Affordable Care Act that allows for the development of qualified non-profit health plans selling essential health plan benefit plans through state exchanges.
  •  EPSDT - Early and Periodic Screening, Diagnosis, and Treatment: A federal requirement that state Medicaid programs cover a comprehensive set of preventive services and early assessment of health needs of Medicaid-eligible children. Any medically necessary treatment that results from the provision of EPSDT - mandated services must also be covered, even if that service is not typically covered by the Medicaid program.
  • EOB -  Explanation of Benefits: A statement to a member or a covered insured explaining how and why a claim was or was not paid.
  • HCERA - Health Care and Education Reconciliation Act of 2010: This legislation, signed into effect on March 30, 2010, combines revised portions of the Affordable Care Act with the Student Aid and Fiscal Responsibility Act (SAFRA) which amends the Higher Education Act (HEA) of 1965.
  • IHI - Institute for Health Improvement:  A not-for-profit organization focusing on the improvement of healthcare throughout the world. Founded in 1991 and based in Cambridge, Massachusetts, IHI was the force behind the 100,000 Lives and 5 Million Lives Campaigns. IHI's goal is to help accelerate change in healthcare by cultivating promising concepts for improving care and turning those ideas into action.
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