Right Care. Right Time. Right Place.

February 12

A Decade of Data and a Clear Story of Improvement 

When the MHACO Quality Heat Map was introduced in 2015, its goal was simple: focus on the measures that make the biggest difference for patients and practices. Over time, some measures have changed, but the story the data tell has stayed consistent: tracking performance, reviewing it regularly, and acting as a team drives improvement.


The performance trend guide brings these patterns into clearer focus, illustrating how steady, year-over-year gains translate into meaningful improvements in care delivery and patient outcomes. It also shows how MHACO performance compares with national benchmarks, including HEDIS and CMS Star ratings. Notably, colorectal cancer screening and diabetes kidney health evaluation exceed HEDIS 90th percentile and CMS 4-Star benchmarks. In addition, five other measures surpass HEDIS 90th percentile, with two more exceeding HEDIS 75th percentile.

Take FY25 as an example. At the start of the year, just two of 10 measures were on target. By year-end, six had reached target, and eight showed improvements of more than one percentage point. These results didn’t happen by chance, they reflect continuous monitoring and intentional, team-based action, exactly what the Heat Map was designed to encourage.


Looking at multiple years makes the impact even clearer. Colorectal cancer screening climbed from 58% in January FY15 to 77% by January 2026; diabetes eye exams rose from 52% to 65%, hypertension blood pressure control from 65% to 77%. Newer measures, like diabetes kidney health evaluations, jumped from 48% in January 2022 to 69% by January 2026. Incremental gains, sustained over time, add up to meaningful improvements in care delivery.



By focusing on just 10 critical measures out of more than 100 across 15 value-based contracts, the Heat Map helps our medical practices prioritize work that truly matters, improving patient outcomes, strengthening contract performance, and maximizing performance-based incentives.

Announcements & Reminders

Curbside Consult: Episode 10 - Child Psychiatry with Melissa Bowker-Kinley, MD

MaineHealth Behavioral Health child psychiatrist Dr. Melissa Bowker-Kinley joins Heather and Mike with tips on supporting pediatric patients with common conditions including anxiety and ADHD. They also discuss current therapeutic approaches, navigating behavioral health referrals and the importance of family involvement in treatment.


Curbside Consult is a podcast from the MaineHealth ACO that brings together specialists and primary care physicians to discuss clinical topics, referral management and coordination of care. Each month, family physician hosts Dr. Mike Clark and Dr. Heather Ward welcome a new specialist to share their unique insights.  

 

Listen to Curbside Consult on your favorite podcast app, on the MaineHealth intranet home page or at the Curbside Consult website. To stay in touch with the show, follow the MaineHealth ACO on LinkedIn. 


Suggest a specialty that you'd like to hear from!

Reminder: Supplemental Data Requests

Supplemental data captures care not reflected in claims or structured EHR data, helping ensure accurate quality reporting, close care gaps, support compliance and improve contract performance.


Over the next few months, you may be contacted by a MHACO care team member for documentation to address quality gaps. Please respond promptly to support contract deadlines. Thank you.

Resources & Education

Join Us for an Upcoming Office Manager Forum

Are you an office manager, practice manager, or member of the billing team for one of our participating providers? If so, we welcome you to join us for our Office Manager Forums!

 

You may view the new 2026 schedule here.

 

The Office Manager Forum is an opportunity for you to hear monthly directly from a featured health plan representative on important policy, process updates and administrative tips, tools, and resources. You will also hear from the MaineHealth ACO on the latest news, learning opportunities, and how to make the most out of the agreements that are in place with the featured health plan.

 

This meeting provides an opportunity to submit generic questions ahead of time. Interested? Request more information.

 

Please note, this opportunity is a benefit of participation in the MaineHealth Accountable Care Organization. Provider specific questions should be addressed directly with the health plan separate from these meetings. Schedule is subject to change. Watch for an email invitation for each monthly forum. If you are not receiving the invites, please fill out our Interest form.

Let's Go! Move More Challenge

MaineHealth Let’s Go! and the Portland Sea Dogs are teaming up again for the Let’s Go! Move More Challenge. In celebration of Let’s Go's! 20th birthday, kids who move 20+ days for one hour or more can earn a free ticket to a Portland Sea Dogs game during the 2026 season. The goal is to motivate families to move more while highlighting the benefits of physical activity for one hour+ every day. Movement positively impacts our minds and bodies and is an important part of learning about lifelong healthy habits. 


Participation is easy! We encourage you to share this challenge with your patients and families. Participants can learn more at the Let’s Go! website, where they'll find information on how to complete the challenge and claim their ticket online! 


For more information, contact letsgomovemore@mainehealth.org.  

 

Payer News

HEDIS Reminder


It is that time of year for payers to request medical record for HEDIS audits. Friendly reminder that this is a requirement for you to comply with the payers when they are requesting medical records for HEDIS.


Thank you, in advance, for your assistance as the payers reach out to you. 

The federal spending package signed on February 3, 2026, includes a two-year extension of Medicare telehealth flexibilities, supporting continued access to telehealth and virtual care for our patients.


Key Points:

  • Telehealth from home is extended through December 31, 2027.
  • Outpatient therapy services (PT, OT, SLP, audiology) remain eligible via telehealth through December 31, 2027. 
  • Behavioral health telehealth may continue without in‑person visit requirements through January 1, 2028.
  • Read the guide to navigating pre-service clinical appeals.
  • Effective for dates of service beginning April 1, 2026, for our Harvard Pilgrim Health Care Commercial members, Point32Health will require prior authorization for elective inpatient medical admissions, including elective oncology admissions for the administration of chemotherapy drugs, and will apply level of care reviews. Learn more. 
  • Referral reminders.  

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. 


Find payer website resources


Aetna

Frequency: quarterly (March, June, September, December)

View online and subscribe

 

Anthem Network Update

Frequency: monthly

View online

 

Centers for Medicare and Medicaid Services (CMS)

Frequency: weekly

View online OR Subscribe for Medicare Learning Network (MLNconnects)

 

CIGNA Network News

Frequency: quarterly (January, April, July, October)

View online and subscribe

 

Community Health Options

Frequency: periodic updates

View online and Subscribe

 

Harvard Pilgrim Network Matters:

Frequency: monthly

View current or archived newsletters and subscribe

 

Humana

Frequency: Bi-Monthly

View online

 

Martin's Point

Frequency: Quarterly (typically Jan, April, July, October)

View online

 

United Health Care

Frequency: Monthly

View online OR Subscribe

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