Beacon Health Contracted Provider Network

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All Maine providers contracted through Beacon Health (hospitals, doctors, ambulatory surgery centers, and some others) should use Beacon Health forms to perform credentialing functions for Maine and the EMHS Medical Plan. 
 
Beacon Health forms are available on our website, or by calling Beacon Health at (207) 973-9798.
 

  *** EMHS EMPLOYEE PLAN SWITCHES TO MAGELLAN ***
 

Frequently Asked Questions

JPS_010915_0005.JPGBeacon Health is aptly named a pioneer – blazing new trails is a daily occurrence! Just four years into our healthcare delivery transformation and wow are we making progress.

As with any change, having the right people at the table is critical. Since we first began this journey, we knew a shift in the culture of how we engaged our providers, frontline staff, patients, and community was an essential component.

Developing a forum for those delivering care to work together on how to make things better, more meaningful, and of the highest quality was at the core of our work. Before we knew it, a revolution was underway.

By providing leadership, structure, and expertise, Beacon Health is able to support standardizing care across the network through collaborative performance improvement, powered by real time data and teamwork. The results to date have been nothing short of inspiring.

Our patients tell us they are feeling healthier; our providers tell us they are able to deliver more personalized care – and that care standard is improving the quality of their patients’ lives. Beacon Health is proving when you have the passion and commitment to make things better, nothing is impossible.
The ACO model is designed for healthcare organizations and providers that are experienced in coordinating care for patients across the various care settings. It is designed to work in coordination with private payers by aligning provider incentives, which will improve quality and health outcomes, as well as cost savings.
  • ACOs will accept accountability to improve the quality of healthcare while reducing the cost of care delivered for a defined population of patients.
  • ACOs will pave the way for continuity and seamless care, and perhaps most importantly, will help people be able to stay at home and be healthy instead of being in a hospital bed or sick if it can be avoided.
  • Hospitals and other providers of healthcare will be rewarded for delivering that kind of care.
  • It’s important to note that Medicare patients have not lost any choices with ACOs. In fact, some patients may receive more care in the most appropriate setting.
  • The ACO simply takes on the responsibility of coordinating better care, building more cooperation, investing in care coordination, adopting electronic medical records (EMR), and working in such a way that people can stay out of hospitals and stay healthy.
  • ACO does not mean skimping on care. In fact, there are 33 measures of quality tracked that are very carefully watched. Additionally, all of the normal measures of antitrust are closely monitored.
  • An ACO does not affect people’s Medicare benefits. An ACO does not put the insurance companies in charge of patient care. ACOs put the doctor in charge and it is the doctor’s, or other primary care healthcare provider’s responsibility to make sure the patient receives the treatment needed to stay well and out of the hospital.
  • The change is reflected in how healthcare providers get paid for providing care. In the ACO model, doctors benefit financially by keeping people healthy. To help primary care providers provide better coordinate care.
  • Medicare has offered to provide their patient’s medical insurance claims history.
  • People do have the option of preventing Medicare from sharing that data, this is known as “opting out.” You can do so by calling 1-800-MEDICARE or complete the Declining to Share Personal Health Information form and returning it to your primary care practice. If you change your mind at any time you can use the Consent to Change Personal Health Information Preference form and return it to your primary care practice. 
  • Patients should discuss that decision with their provider, and the provider should make sure their patients fully understand what that means before they opt out.
  • For general questions or additional information about Accountable Care Organizations, please visit www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.
The Beacon Health Network focuses on customizing patient care for three populations: High-Risk Population, Rising-Risk Population, and Low-Risk Population. Each population requires different goal, resources, and care models. This proven team approach includes the patient engaging as an active and central participant in their care.

Our network providers and care coordinators deliver intensive, comprehensive, and proactive care. They trade high-cost acute care services for low-cost care coordination wherever and whenever it is clinically effective.

High-Risk Population: These patients have at least one complex illness, multiple comorbidities, and/or psychosocial problems. These patients do best with a one-on-one relationship with the health system, primarily with a nurse care coordinator. Their care team is led by a nurse care coordinator who partners with them in order to develop and support a comprehensive care plan.
Rising-Risk Population: Our goal is to prevent these patients from becoming high-risk. This population has multiple risk factors that if left unaddressed push them into high-risk. Health coaches identify these patients with underlying risk factors that can lead to a chronic disease and work with them to address areas like obesity, smoking, blood pressure, or cholesterol level.
Low-Risk Patient: Approximately 75 percent of patients fall into this category. They’re either healthy or have a well-managed chronic condition. These patients are looking for convenient access to the services they want most. Because of the limited relationship we have with this group, we build loyalty and trust with them so they turn to our primary care practices first (rather than emergency departments and walk-in clinics) by offering convenient access and alternatives.

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NCQA-accredidation.jpgThe Beacon Health care coordination program is the first clinically driven program in the country to achieve a NCQA (Nationally Committee on Quality Assurance) designation. NCQA is considered the gold standard of quality. A nurse care coordinator is a part of each EMHS primary care practice team across our state, supporting and encouraging patients toward a new way of life.

The Beacon Health Wellness services support employees, families, and the communities in the active pursuit of total health and well-being. Click here to find out more about our wellness services.

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