November 2017
Top Story 

2016 MSSP Contract Results Are In: 
Quality Score Jumps to 97.3%

CMS recently released the MaineHealth ACO's 2016 Medicare Shared Savings Program contract performance results. The results indicated a significant increase in the ACO's annual quality score, a sign that participants' efforts to improve quality are having an impact. The ACO achieved a score of 97.3 percent, up nearly four percent over the ACO's 2015 score, and well above the 2016 average for all ACOs nationally of 94 percent.

ACO In Action

Medicare Wellness Visits Made Easier:
New Guides and EMR Refinements for Providers & Practices

Since Medicare introduced wellness visits in 2011, many practices, systems and ACOs have come to accept them as useful for improving patient care. The visits are uniquely focused on prevention and offer patients and providers the time to collaboratively review health status, medications and factors effecting wellness. Patients leave the visit with a personalized preventative health plan and providers with a deeper understanding and updated documentation of their patients' conditions.   

The MaineHealth ACO's Value Oversight Committee has made these visits a priority, setting a 2018 goal of increasing the number of Medicare and Medicare Advantage wellness visits conducted by ACO participants. To support this goal, the Committee created a work group to develop tools and resources that make scheduling and conducting wellness visits easier for practices and providers.

Measure of the Month 

The Colorectal Cancer Screening Quality Measure: 
Tips and Resources for Meeting the Measure Goal

Colorectal cancer is the 3 rd leading cause of cancer death in the U.S. There are no signs or symptoms in the early stages, which is why screening for colorectal cancer is so important. The five-year survival rate is 90% if disease is caught in its earliest stages. While screening is very effective, it is still underutilized.  Providers and care teams have the opportunity to provide education to patients on the importance of screening for colorectal cancer, and to help them make informed choices about which test is best for them.

N eed To Know: Important Updates

ACA Open Enrollment Info for Patients

C onsumers may be more confused than ever this year due to repeal and replace efforts, but it is business as usual for ACA Open Enrollment, which continues through December 15. 
While the media have been good at announcing premium rates are going up, they have not been as good at communicating that the Premium Tax Credit will absorb the rate increase for people who get a subsidy (85% of Mainers).
At MaineHealth Access to Care Programs, Certified Application Counselors (CACs) on the CarePartners and MedAccess teams provide free in-person help educating and enrolling people in the plans. These patient info sheets include a list of local assistance available throughout the MaineHea l th system:

To help promote awareness of ACA Open Enrollment, download this flyer:
Email Kathy Pipkin, MaineHealth Access to Care Coverage Team program manager, for more information about Marketplace assistance and patient resources. 

More Accessible Office Manager Forums in 2018

The ACO has been facilitating 'office manager forums' in different area hospitals over the past few years. If you've attended these forums, you know that our goal is to bring together practice staff and health plan representatives to talk about health plan updates, policy changes, and administrative tips and resources to help streamline your daily work.

We collect feedback after each forum, and we've heard that you want more time with each health plan representative, and more detailed information.  We also heard that sometimes the information that is shared is better suited for other staff in the practice, but not everyone can attend these in-person events.

So, responding to your feedback. we've decided to try something new. Beginning in January, the forums will be presented monthly, and most of those will be virtual, using a webinar format. Each hour-long forum will feature just one health plan, so more in-depth information can be shared and discussed. We will retain an in-person format for two forums each year, to be held in May in October, with multiple health plans presenting. 

What's next?  If you've attended (and signed in at) an office manager forum in 2017, you have been added to the invitation list for the 2018 series.  If you have not attended but want to be added to the invitation list, click here.

Watch your email inbox in early December for an invitation to register for the January forum featuring Anthem.  Invitations will be sent out about three weeks before each of the events, so you can decide if you'd like to attend on a month-to-month basis. We hope you will join us!

Questions?  Contact us at

Arcadia bubble plot  of utilization costs and variation
Population Health Management Tool: Roll Out Update

More than 30 medical and operational leaders from ACO regions and independent practices were introduced to the new Arcadia population health management tool last month. These early adopters used Arcadia's claims-based performance tools to explore performance trends in ED utilization, readmissions and disease-specific admissions.  Over the coming months, these early adopters will provide the ACO with feedback on the tool and help inform continued roll out throughout regions.
At the earliest stage of implementation, Arcadia currently aggregates claims data from specific payers such as Aetna, MSSP and Martin's Point. Plans for future development of the tool include integration of additional payer lines (such as Anthem) and clinical data sources (such as Epic).
With just a number of claims sources aggregated, leaders have already been able to see how this tool can help identify potentially actionable trends and themes:
  • One system used the tool to understand hospital utilization trends for patients with COPD: in a few clicks, they identified patients who had had an Inpatient visit but no discharge follow up visit in the past year.
  • A number of early adopters used the tool to run lists of patients with highest ED utilization in the past year, including EDs outside of their system. They now have actionable lists of potential candidates for care management and other follow up.
  • One region considered which primary diagnoses drove non-emergent ED utilization over the course of a year, initially identifying the diagnoses with highest variation in costs. 
Stay tuned for news of continued roll out of this tool!

Audio Interview:  MaineHealth ACO president and CEO Dr. Betsy Johnson

Dr. Lisa Belisle, host of the Love Maine Radio program, recently spoke with Dr. Betsy Johnson on a range of topics including the difference between HMOs and ACOs, the current industry emphasis on social determinants of health, the importance of leadership in healthcare and the need to balance work and family. Hear the interview and read the transcript at the Love Maine Radio website.

Clinical Corner

Metformin - an Oldie in a World of Newbies

A diabetes treatment update from the MaineHealth Chronic Disease Team's  Elizabeth Nalli

There is no shortage of new and exciting drugs in the world of diabetes.   GLP-1 receptor agonists, SGLT2 inhibitors, new basal insulins . . . the list of recent pharmaceutical breakthroughs in the world of diabetes is extensive. So, I was surprised when I went to a diabetes conference this month and heard pharmacist Jessica Bates comment in a lecture that she "loves metformin" and repeatedly sang its praises. Her talk inspired me to discuss metformin this month.  
Fast Five: The Interview

Tom Pulling, MD 
MaineHealth ACO Physician Liaison Officer
Sports Medicine Physician, Franklin County Health Network

Each month, we ask an ACO stakeholder five quick questions about their work and life. This month, we catch up with Dr. Tom Pulling.

Be Heard at the MaineHealth ACO Listening Dinner in Farmington on December 7th

What part of your work is most important to you?  What gets in the way of achieving your goals? What does a good day look like at your practice? We'd like to know.
Farmington-area healthcare providers participating in the ACO are invited to join us at the Homestead for our second regional Listening Dinner.
The dinner is hosted by Dr. Tom Pulling, the MaineHealth ACO's physician liaison for the Franklin County region, and Dr. Betsy Johnson, MaineHealth ACO CEO.
There is no cost to attend, but space is limited. Please register today. 

Care Management Training - Free to MaineHealth ACO Participants & $100 for Non-participants

November 28th,  MaineHealth, 110 Free Street Portland
December 5th, 12th, 19th,  MaineHealth, 110 Free Street Portland

Click here for registration
Questions? Contact Beth Wilcox.

2018 Care Management & Medical Assistant Training 

Care Management Training
February 6th, 13th, 20th & 27th
April 3rd, 10th, 17th & 24th
June 5th, 12th, 19th & 26th
August 7th, 14th, 21st & 28th in Pen Bay 
October 2nd, 9th, 16th & 23rd 
November/December 27th, 4th, 11th & 18th 

Medical Assistant Foundational Training
January 10th & 11th
February 7th & 8th
March 7th & 8th in Pen Bay 
April 4th & 5th
May 2nd & 3rd
June 13th & 14th
August 1st & 2nd
September 12th & 13th
October 3rd & 4th
November 7th & 8th

Medical Assistant Advanced Training 
January 25th
February 15th 
March 22nd at Franklin Memorial 
April 25th
May 17th at Lincoln County
June 20th
August 15th
September 19th
October 17th
November 15th 

Stephen Andrew
Stephen Andrew
Motivational Interviewing Training 
Let's Go! is sponsoring Motivational Interviewing trainings with Stephen R. Andrew, a member of the International Motivational Interviewing Network of Trainers since 2003 who has more than 110 hours of Motivational Training experience.

Basic Training: Dec. 4 - 5, 110 Free St., $100 (includes lunch)

Refresher Training: Jan. 18, 110 Free st., $50 (includes lunch)

Please contact Gretchen Noonan with questions. (207) 661-3233

29th Annual IHI National Forum - Satellite Broadcast
Dec. 12 - 13, 2017
MaineHealth Conference Center
The future of health care quality depends on our vision, our commitment, and the steps we take now. Join us at the upcoming 29th Annual National Forum Broadcast and seize the moment! Guest speakers will include Derek Feeley, President & CEO, IHI; General Stanley McChrystal, Former US Commander; Donald Berwick, MD, MPP and many more!

Event information and registration 

Payer Newsletters Contain Valuable Information

Subscribe to payer newsletters to receive notice of preauthorization changes, policy updates, tool roll-outs and other information that may impact your practice. 

This month, Harvard Pilgrim's Network Matters newsletter announces that the plan will  cover digital breast tomosynthesis (DBT), commonly known as 3D mammography, for screening or diagnostic purposes in all states, beginning on January 1, 2018.

Frequency: Quarterly (March, June, September, December)
Anthem Network Update
Frequency: Every other month (February, April, June, August, October, December) 
CIGNA Network News
Frequency: quarterly (January, April, July, October)
Community Health Options
Sign up   for email list to receive periodic updates
Harvard Pilgrim Network Matters:
Frequency: monthly
Martin's Point
Frequency:  Quarterly, not a consistent month (basically Jan, April, July, October)