Monthly eNews

June 12

Care in Concert: MHACO Symposium Energizes Value-Based Care Movement

Last month, more than 200 health care leaders from across our network and partner organizations gathered for our second-annual Value-Based Care Symposium—a day focused on the future of care delivery and the work already underway to shape it.


The event opened by engaging attendees in a brief music-making exercise that introduced the theme: Care in Concert. Value-based care, like an orchestra, relies on alignment and collaboration to create something greater than the sum of its parts. In contrast, traditional fee-for-service models often encourage solo performances, where individual efforts aren’t always in sync. The result can be a cacophony instead of a symphony.  


“Our goal was to spark ideas, share innovations, and strengthen the community of people doing this critical work,” said MHACO President Jen Moore. “This event was a celebration of what’s already happening—and a call to action for what’s next.”


Continue reading.


Keynote Recording & Presentation


Breakout Presentations

Resources

Curbside Consult: Episode 2 - Pediatric Endocrinology with Dr. Mike Dedekian

In this month’s Curbside Consult podcast from the MaineHealth ACO, pediatric endocrinologist Mike Dedekian discusses exciting hot-off-the-press innovations in type 1 diabetes treatment, including the use of monoclonal antibodies to delay onset. The conversation also covers the importance of recognizing symptoms of type 1 diabetes in children and the ongoing challenges of childhood obesity and hyperlipidemia. 

 

Curbside Consult 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 physician 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. 

Pharmacy Update: Supporting Patients During GLP-1 Receptor Agonist Drug Formulary Changes 

Due to insurance formulary changes of weight management medications, many patients on GLP 1 Receptor Agonists (RAs) or GLP-1/GIP RAs will need to be changed to alternative therapies. Here are some tips for supporting patients during this formulary change. 

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 2025 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.

Commentary

Interview with Tom Johnson, MD, MaineHealth Primary Care - Family and Internal Medicine - Norway


Kendra: Can you share a little about yourself?


Tom: I am a family medicine physician and have been practicing in Norway for the last 10 years.


Kendra: A key goal of value-based care is providing the right care at the right time and at the right place for each individual patient. How do you see your work contributing to this goal?


Tom: I think that primary care is the foundation of our medical system. I've always seen value-based care as an important endeavor for primary care because, if we think of value as quality over cost, those are two things that lie at the heart of what primary care providers do. We strive to provide higher quality care to patients at a lower cost.


So, in many ways, value is something we're already thinking about on a daily basis. Formalizing value-based care through contracts and being mindful of it in our day-to-day work will only increase recognition of the role and importance of primary care.


Continue reading.

Payer News

  • View the coding billing updates and specialty medication coverage updates as of July 1, 2025. 
  • Learn more about Wellness Visit updates for members enrolled in an ACA Plan, additional drug codes added to medical claims and Education and Training that are available.
  • Medicare preferred continuous glucose monitors: Starting June 1, 2025, the list of preferred continuous glucose monitors (CGM) for most Medicare plans will be expanded. Members will now have two options: Freestyle Libre or Dexcom. Members must obtain the CGM system from a retail or mail‑order pharmacy that participates in serving Medicare, not a durable medical equipment (DME) facility. Learn more.
  • Medication additions to Site of Care Program.
  • Please review the July 1, 2025, changes to non-preferred medications and formulary exclusions in the May 2025 Provider Bulletin.
  • HPHConnect Provider portal updates: Learn how they will be launching updates in May to the portal. 
  • View the new requirements for all specialty care and other referral FAQ’s. 

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

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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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