October 2022 eNews

October 2022

MONTHLY NEWS

Top Story

New Heat Map Measure Examines Health Equity

A new MHACO Quality Heat Map Health Disparity Measure has been approved by the Value Oversight Committee (VOC) and will be introduced in November, reflecting October data that marks the beginning of the fiscal year. This new measure aligns with MaineHealth values, Diversity, Equity, and Inclusion strategic planning, and industry trends that examine how social inequities impact an individual’s health in numerous critical ways. The CDC defines health equity as being achieved when “every person has the opportunity to attain their full health potential, and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.”

ACO in Action

MaineHealth Allocates More than $2 Million in CPM Funds to Care Transformation Projects

When Community Physicians of Maine (CPM) was folded into the MaineHealth ACO in 2015, funds from the organization were earmarked for projects that support physician engagement, physician leadership development, effective care management, improved transitions of care, population health projects and efforts to meet the needs of underserved patients.

In 2022, MaineHealth decided to allocate more than $2 million in accrued CPM funds to care transformation projects in a competitive application process managed by the ACO and open to all MaineHealth ACO participants. Applicants could request up to $500,000 for multi-year projects. Applications were reviewed by a committee of physicians and leaders from across the ACO that made funding decisions based on detailed criteria and defined focus areas.

In Practice: Commentary by Rob Chamberlin

Doing Better

“This patient of mine I’m seeing tomorrow for a telehealth visit is doing so much better,” I said to a colleague as I reviewed my schedule for the next day.

“Oh yeah, what’s going on?” he responded. As I heard my description of W, it struck me that it didn’t sound like he was doing very well at all.

“So he’s on opiates and a benzodiazepine?” my colleague reflected.

“I know,” I said with a twinge.

“And does he have a psychiatrist?”

“Well, no. He tried one about a year ago and it didn’t work,” I said. I continued sharing about how he has weaned down his opiates by 50%, but his pain is pretty bad in part because his BMI is 46.

Wow,” said my colleague, “that’s really high.”

I pulled up W’s health maintenance list in Epic – he’s overdue for six routine health care needs. His last blood pressure was 159/89. He weighs over 300 pounds. W would not be considered to be doing “well” by anyone who did a review of his medical record. But he was doing better.

Need to Know: Important Updates

October BACON Podcast: Using Shared Savings to Fund Innovation Projects

MHACO Chief Medical Officer Rob Chamberlin, MD, announces the innovation projects that the ACO is funding this year through a special allocation of shared savings. Also, we meet Heather Ward, MD, BACON’s new co-host.

BACON is the MaineHealth ACO’s short monthly news and information podcast, hosted by Mike Clark, MD and Heather Ward, MD. Find it on your podcast app by searching for “mainehealth” or listen at our website.

MHACO Compliance and Privacy Policies Available

MHACO Compliance and Privacy Manual Policies are now available on the MHACO Provider Resources page under Participation in the ACO. Participants may review and save PDF copies of any MHACO compliance policy. The Conflict of Interest policy has been updated and a new Beneficiary Incentives policy has been approved.

Resources

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.

Registration & Info for all sessions. Questions? Contact Kelly Barnes.

Upcoming Care Management Training

MAs, RNs, LPNs, Social Workers, and other clinical support staff are an integral part of the health care 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.

CM Training dates, next session offered November 1, 8, 15, 29, 2022.

Questions? Contact Beth Wilcox at [email protected]

Payer News

Beacon Direct Notice

Please note that the contract between MaineHealth Accountable Care Organization and Beacon Direct is ending on 12/31/2022. After 12/31/22, Beacon Direct will no longer be the third-party administrator for the Northern Light Employee Health Plan.

As of 1/1/2023, the Northern Light Employee Health Plan will be using UMR as the new Third Party Administrator. UMR is a unit of United Healthcare. Northern Light Employee Health Plan will use United Healthcare’s Choice Plus network for its provider contracts. You will continue receiving updates from Beacon and the MaineHealth ACO as they become available.

Anthem | MaineHealth offers Medicare Advantage plans to Mainers for its fourth year

This fall marks the fourth year that Anthem | MaineHealth (AMH Health) will offer Medicare Advantage plans to Medicare-eligible Mainers with plan options available in all 16 counties. AMH Health has enrolled over 18,000 members since announcing the 50/50 joint venture in 2019. Plans being offered for 2023 include HMO, HMO-DSNP, HMO-POS and PPO options.

In addition to common Medicare Advantage benefits like dental, hearing and vision, some AMH Health plans offer an “Essential Extras*” package, which focuses on addressing social determinants of health (SDOH). With Essential Extras*, members can choose from a list of robust services to tailor their plan to their lifestyle needs.

MaineHealth Employee Health Insurer

Effective January 1, 2023, MaineHealth employees will be insured by Aetna. We are alerting you so you can start planning for claim filing, prior authorizations, and obtaining copies of new ID cards for the new year. More information will be forthcoming from Aetna as it becomes available.

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.

Anthem, now Elevance Health, Updates

Updates to Claims Attachment Workflow, learn more.

Harvard Pilgrim Health Care Updates

Migration to 2022 InterQual SmartSheets
As you are likely aware, Harvard Pilgrim utilizes InterQual criteria for clinical authorization review for a number of services/medical policies. View more information.

United Healthcare

Reduced Services Policy - changing name and updating on 12/01/2022 (commercial), learn more about this update.
UHC Portal has a new look, view the changes and new features.

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 OR Subscribe for Network eUPDATE

Beacon Health - Northern Light Health System

No longer provides a newsletter

Centers for Medicare and Medicaid Services (CMS)

Frequency: Weekly

View online OR Subscribe for Medicare Learning Network