Jen Moore, MaineHealth ACO President |
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ACO Distributes Largest Earnings Ever
The settlement of 2020 value-based contracts has recently been approved by the ACO’s Board of Directors. ACO President, Jen Moore, was pleased to report record earnings of $26,328,279, a 63% increase over 2019 earnings.
The significant increase in value-based earnings is attributable to increased shared savings. Shared savings are achieved when MHACO participants keep the cost of care below a budgeted target while continuing to deliver high-quality care.
In 2020, shared savings was driven by strong performances in quality, cost and utilization, and the accurate documentation of care.
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In Practice: Commentary by Rob Chamberlin |
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Parsing Signal from Noise
I’m working with my patient L on decreasing his blood pressure. He is coming in for nurse visits to recheck his blood pressure and we are titrating up his medications. I’m giving him twice as much focus as other patients in similar situations, even though I know there’s really no need to. I respond as soon as I see the nurse’s message about his current blood pressure. I think twice as long about what the best and safest next step is. And, most significantly, I review his labs three or four times to make sure that everything looks ok. His labs are most important to me because it was a lab result I overlooked two years ago that led to four weeks in which I was quite certain that an error I made was going to lead to his death.
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Rob Chamberlin, MD, MBA, is the MaineHealth ACO's Chief Medical Officer |
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Need to Know: Important Updates |
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Reminder to Practices: Update Your Demographics
Effective 01/01/2022, the Consolidated Appropriations act of 2021, Section 116 Protecting patients and improving the accuracy of provider directory information implemented a change from 120 days to 90 days for verification of accurate and updated provider changes to health plan directories. If the information is not accurate they will need to remove the provider from their directory.
Health plans will be asking your practice to update demographics should they find any inaccuracies. You will need to correct any discrepancies or your provider may be removed from the health plans directory.
Health plans have their policies on their websites or in their monthly newsletters (found on their websites).
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Remember to Update Provider Demographics in PECOS
Happy New Year to our ACO participants. Medicare’s Provider Enrollment, Chain and Ownership System (PECOS) must be kept up-to-date for your practice to receive appropriate reimbursement from Medicare. If you have a new provider, you must add them to your practice in PECOS or they will not be associated with the ACO in the Medicare Shared Savings Program (MSSP). If you had a provider term from your practice, you must update PECOS and remove them from the practice.
Providers are eligible for merit-based incentive payments (MIPS) based on the performance of all participants in the MaineHealth ACO. When the ACO is successful in the MIPS program, our participants receive an additional payment that is above the Medicare Physician Fee-Schedule. This is rewarded based on the tax id number and your practice must be set up properly in PECOS to be recognized and receive that incentive bonus. Medicare does not allow retroactive changes so timely updates are critical.
In addition to the reimbursement impact, this is a contractual requirement in your Medicare Shared Savings Contract with us to update your enrollment information using PECOS, which includes additions and deletions of providers billing under your tax identification number.
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The Aunt Bertha Platform is now 'findhelp'
MaineHealth’s community resources directory, powered by the Aunt Bertha platform, has recently changed its name to ‘findhelp.’ Care team members, patients, and community members can search the findhelp directory for free or reduced-cost services like medical care, food, housing and more.
Clinical care team members who refer to findhelp in Epic or access it from the intranet will continue to use the same login info (single sign-on landing page) as they used with Aunt Bertha. Findhelp can be accessed on the intranet under “Employee Tools,” and the findhelp Epic button will also open the platform right in the medical record. If you have questions about accessing findhelp, please contact the IS helpdesk at 662-6400.
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February BACON Podcast: ACO Organizational Update
In this month’s episode, the ACO’s chief operating officer, Shannon Banks, provides an update on performance results and a new data reporting tool. Also, Ansar Hassan, MD, introduces the Maine Medical Center’s Mitral Center of Excellence.
BACON is the MaineHealth ACO’s short monthly news and information podcast, hosted by Mike Clark, MD and Julie Grosvenor, MD. Find it on your podcast app by searching for “mainehealth.” Not a podcast listener? Transcripts, audio and bonus content can be found on our website. |
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Anthem MaineHealth Membership Passes 17,000
Anthem MaineHealth (AMH Health) has enrolled over 17,000 members into its Medicare Advantage plans, making it one of the fastest-growing Medicare Advantage plans in Maine. January 2022 marked the third year since the joint partnership began offering Medicare Advantage plans to eligible Mainers. AMH Health started marketing its plans in 2019 for an effective date of 2020.
AMH Health offers a competitive suite of Medicare Advantage plans throughout all of Maine including two HMOs, an HMO-POS, a PPO and a D-SNP. Certain AMH Health plan offerings feature “Essential Extras,” which allow members to choose from a list of benefits designed to help address social determinants of health (SDOH.) These benefits include services like transportation, meal plans and a flex card for discounts on vision, dental and hearing-related services. The ability to select from a list of benefit options is a feature which helps to set AMH Health plan apart from other Medicare Advantage plans in Maine.
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Help The Gender Clinic by Completing Their Short Survey
The Gender Clinic, a program of the Barbara Bush Children’s Hospital, is spearheading a needs assessment about health care providers in Maine. They are learning about health care provider/care team member experience, comfort level, and education surrounding the collection of patient Sexual Orientation and Gender Identity (SOGI) information, and need your help!
Please help them by completing this short survey (about 5 min long). The Gender Clinic will be holding focus groups for those who are interested in learning more about SOGI information collection and LGBTQ+ health care needs in Maine. Participants will be entered into a drawing to win a gift card.
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Upcoming Project ECHO® Sessions Link PCPs and Specialists
Project ECHO® is an interactive learning opportunity that uses video conferencing to connect a community of providers with common interests. Connect with other primary care providers and specialists on a monthly basis to discuss cases and share best practices for delivering care. CME/CEs are awarded for participation and it is FREE. MaineHealth-sponsored Project ECHO sessions currently cover more than two dozen topics.
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MMC’s Preventive Medicine Enhancement for Maine Program continues to host a ProjectECHO that focuses on the hurdles immigrants face when trying to access health care.
These sessions are held every second Tuesday of the month from 12:00-1:00 p.m.
- Co-produced with members of the immigrant community
- Includes resources that can help PCP practices save time and effort
- Includes information on how Community Health Workers can help reduce PCP burden
- There will be time for questions and answers
This ECHO is open to all members of health care teams, public health professionals and community health workers.
ProjectECHO Overcoming Barriers to Immigrant Healthcare is a coproduced series brought to you by a collaboration between the MMC Preventive Medicine Enhancement for Maine Program (PREVME) and Community Based Organizations.
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Upcoming Medical Assistant and Care Management Trainings
MaineHealth offers MA Foundational Training, MA Advanced Training for Medical Assistants, and Care Management Training. MAs, RNs, LPNs, Social Workers, and other clinical support staff are an integral part of the healthcare team and essential to the success of our primary care system. MaineHealth is committed to providing clinical staff with training to help prepare them for success in the practice setting.
Rooms are booked at 110 Free Street in the event that we can be in person; for the time being, the training is via zoom.
Foundational: two-day session dates, next session offered March 2-3, 2022. Register
Advanced: one-day session dates, next session offered February 16, 2022.
CM Training dates, next session offered May 2022. Register
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Maine Academy for Geriatrics Interprofessional Continuing Education (MAGIC) Course - Applications Are Open
Learn more about caring for older adults. The MAGIC Course is an 18-month program for physicians, physician assistants and nurse practitioners. View the flyer for additional information, and please submit your application by Monday, February 14.
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OptumHealth Educational Opportunities
February 17, 2022, 3–4 p.m. ET and February 23, 2022, 4–5 p.m. ET
This live webcast will be held twice. Each webcast will present the same material.
Please join us as Dr. Margaret-Mary Wilson and Dr. Michelle Garrido discuss how to communicate respectfully and sensitively with LGBTQ+ people, how patient-provider interactions can be more supportive of the individual’s needs, how to take a full history and perform an inclusive and affirming physical exam, and how health information can be thoughtfully documented to provide accurate information regarding health issues, screening recommendations and risk prevention.
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New Medical Education Intranet Site — Open to All
The Department of Medical Education has a new dedicated Intranet site: home.mainehealth.org/medicaleducation. This one-stop resource will offer current and potential faculty information about Grand Rounds, Simulation, Medical Students, Residents and Fellows, Library Services, Continuing Education, MITE and Faculty Development.
As part of MaineHealth’s commitment to improving health care delivery and patient outcomes, we are facilitating accessibility to Grand Rounds for all care team members with a new MMC/MH Program Grand Rounds page home.mainehealth.org/grandrounds. The page provides easy access to information and registration. Bookmark the site!
MMC Program Grand Rounds offers opportunities for learning and delivering continued education planned by the health care team for the health care team. Meetings are open to all and offered through Zoom webinars. Non-MH members can access Grand Rounds information by clicking here.
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COVID-19 Payer Policies and Information
View our website under Provider Resources for payer information including coding, waivers for member cost shares on diagnostic testing and telemedicine visits, opening crisis response lines and expanding 24/7 access to nurse medical lines. Payers are taking action and issuing information at a rapid pace.
Aetna Updates
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Aetna is moving to paperless processes, you will want to move to paperless EOBs and Direct Deposits. Visit Aetna OfficeLink Updates™ and go to page 9 to learn more.
Anthem Updates
Harvard Pilgrim Updates
United HealthCare Updates
Payer Newsletters
Subscribe to payer newsletters to receive notice of preauthorization changes, policy updates, tool roll-outs and other information that may impact your practice.
Aetna
Anthem Network Update
CIGNA Network News
Community Health Options
Harvard Pilgrim Network Matters
Martin's Point
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