Steps to be GREAT!

Epic High-Five

News You Can Use and Important Updates
November 2016
Beacon Health 2017, open enrollment is closed, now what? Resources to strengthen your patient engagement, and can we get an epic high five! These updates and more in your November Network Newsletter!

Dr. Miller
Beacon Health Full Steam Ahead...

A new President and Congress does not necessarily signal doom and gloom for Beacon Health programs and stellar performance. One reason for that is that Democrats and Republicans alike agree that as a nation we need to better manage the cost of care. Now the hard work begins on finding common ground to a sustainable healthcare future.
We know that healthcare is at the top of President-elect Donald Trump's to-do list for his first 100 days in office. Surely you heard his strong messaging regarding the Affordable Care Act (ACA) during the very long campaign. "Repeal and replace the ACA" was his consistent theme. Many are wondering how, or if the election results will affect Beacon Health and our initiatives to transform care delivery throughout EMHS and our partner organizations. At this time we simply don't know what a Trump presidency plus a Republican-controlled Congress will mean for the ACA and healthcare overall. However, in the past few days we've heard evidence that dismantling the ACA in its entirety won't happen - President-elect Trump told the Wall Street Journal he might preserve the popular prohibition against insurers denying coverage because of preexisting conditions and allowing young people to stay on their parents' insurance to age 26. There also seems to be some unease among House members, who run for re-election every two years, to live with the potential consequences of a sweeping repeal of the ACA.
With all that it seems clear meeting the Triple Aim and transforming the Medicare payment system to one that is value-based will continue. The path we are on may change (and face it, we are all about change), but our goal to improve patient care and lower costs will not go away.
Efforts to drive innovation (e.g., Next Generation ACO, MSSP, MACRA etc.) will very likely continue. In fact, we may see additional flexibility and opportunities to try common sense approaches to improve care, such as post discharge home visits.
Much of the criticism around the ACA has been focused on the public exchange and although that does affect our provider partners, the exchange has little direct impact on current Beacon Health initiatives.  
We also expect there will be continued strong support for programs where we are most invested - Medicare Advantage, Medicare Next Generation ACO, and the Medicare Shared Savings Program.
Commercial payers and their desire to implement population health programs will likely be unaffected by changes to the ACA.
Overall, we need to continue to deliver solutions for improving personalized population health - better quality of life for our patients and employees, better quality outcomes, and lower costs.
Our path may change or have some new twists and turns but the incentives to achieve that goal is not going to go away. We expect it will only increase.
EMHS Plan Open Enrollment!

It's that time of year! Open Enrollment just wrapped up for 17,500 plus members of the EMHS Employee Medical Plan across Maine. Practices should take a few easy steps to assure that your practice's information is correct with Beacon Health, which manages the Plan's Maine network.
  1. Check your practice's set-up and locations using the Provider Search under Contracted Provider Network at www.BeaconHealth.ME. Are all your providers listed and at the right address? Is your InSystem or InNetwork benefit tier correct?
  2. Notify Beacon Health of new providers or providers not listed using theProvider Data form.
  3. Add locations or update other provider information by using the Change in Practice form.
Questions? Please contact Karen Eldridge of Beacon Health at or 207.973.9799.


Acronyms of the Month
Decode the  healthcare acronyms below... the answers are at the end of the newsletter
  • CON          ______________________________________________________
  • CCR          ______________________________________________________
  • EOC          ______________________________________________________
  • FSS           ______________________________________________________
  • HFAP       _______________________________________________________
  • PCIP        _______________________________________________________




Looking to Improve Your Patient Engagement?
Here's a GREAT Resource! 

When it comes to Experience there is no shortage to companies trying to sell us solutions. Between engagement and experience there are more than 200,000 vendors trying to make their mark. 
We have an option to help support Experience training and it won't cost you anything but time and commitment. 
Edward Elmhurt Health has 69 locations across Illinois. It is a progressive health system. They've done a great deal of work engaging their staff at all levels of care in patient experience - not just focusing on inpatient.
They've branded their approach GREAT.  Greet Relate Explain Ask Thank 
To be great requires dedication. It's ongoing training and mentoring programs. It's the why behind what we say and do that matters. GREAT improves patient and employee engagement and satisfaction.

Let's Have Fun!
Wellness Tip For Everyday 
Do you remember when you were a kid and you'd play a round of kickball or baseball? What did you do when you'd score or make a great play? You'd high five your buddies!
Did you know that simple action releases chemicals inside your body that make you feel better and actually improve your well-being?
By adding this one small action during your day can help release oxytocin (AKA "the trust hormone") and reduce the stress hormone cortisol.  
It's true... high fiving each other improves wellness! We are going to call this the EPIC HIGH FIVE! So when your co-worker does a great job or helps you out try giving them an EPIC HIGH FIVE!
Really... try giving a high five and not smiling. To add value to this awesome, fun idea, it is also less likely to spread germs when you high five instead of shaking hands.
Happy High Fives!!

Acronyms of the Month
Decode the  healthcare acronyms below... the answers are at the end of the newsletter
  • Certificate of Need CON:  Laws of certain states that require entities to seek prior approval from the state before expanding and / or offering new types of healthcare services.
  • Cost Coverage Ratio CCR: The standard for evaluating the appropriate rate and thus the success of a managed care contracting effort. The cost coverage ratio is calculated by dividing the net revenue from a specific health plan by the fully allocated expenses.
  • Evidence of Coverage EOC: A certificate, agreement, contracted or letter of entitlement of issued to a subscriber or enrollee establishing coverage to which the subscriber or enrollee is entitled.
  • Fee-For-Service FFS: A traditional method of reimbursement to healthcare providers in which an insurance company pays hospitals and doctors according to the fees on a preset schedule.
  • Healthcare Facilities Accreditation Program  HFAP: Founded by the American Osteopathic Association in 1945, HFAP has deeming authority from CMS to conduct accreditation surveys of acute care hospitals under the Medicare Conditions of Participation. The program is recognized alternative to accreditation by CMS or The Joint Commission.
  • Pre-Existing Condition Insurance Plan PCIP: A program that makes health coverage available to individuals who are US citizens or reside in the US legally, have been denied health insurance because of pre-existing condition, and have been uninsured for at least six months. This program provided coverage until 2014. Now, these individuals have access to affordable health insurance choices through an exchange, and can no longer be discriminated against based on pre-existing condition.