FREQUENTLY ASKED QUESTIONS

Ok, how do I join?

Fill out our simple application. The next step would be Participating Provider Agreement. After you are a participating provider, you will have access to the managed care contracts and may decide whether you wish to participate.

Do we need to give up our practice and merge into a single group (single TIN)?

No. As an Independent Practice Association (IPA), when you join Beacon you keep your individual practice. This is in contrast to a large single TIN multi-specialty practice where you give up your practice. Here you maintain your own billing, employee decision-making, retirement planning and control of your practice.

Can I see the rates in your managed care contracts before joining?

No. Unfortunately, the managed care companies will not allow us to share these prior to coming into Beacon. However, once you are a member, you can see and more thoroughly evaluate whether you wish to opt-in to our contracts. You will though be bound by confidentiality to not share the details of our contracts, whether you opt-in or not.

What if I join, but do not want to stay after seeing the contracts?

You may leave at no cost before 90 days.

Can we join and only participate in some of the contracts?

Yes. You can join and then opt-in to any of our contracts. You do not have not opt-in to all of the contracts.

Can I join if a partner / associate in my practice does not want to join?

No. The entire group needs to be either in or out.

Can I be in other IPAs?

Yes. We do not have an exclusivity requirement at this time. We may however in the future, and at that point, notice will be given.

Can I be in other ACOs?

Yes and No. PCPs and Medical Specialists who will be attributed patients may only be in one ACO. Certain specialists who are not attributed patients may participate in more than one ACO.

Do we need to be on an EMR?

You need to be on a certified EMR or commit to being on an EMR within 12 months of joining Beacon.

Do we need to be on a specific EMR?

No. The EMR needs to be ONC-certified and have the ability to achieve meaningful use. We do have preferred vendors (Athenahealth and Epic), but we do not require a specific EMR.

Do we need to send more volume to CHS hospitals?

No. This deal was not done in exchange for volume to the CHS hospitals. That said, we believe that since CHS is the high-quality, lower-cost option in many instances that when patients need to go to the hospital, the CHS hospitals should be preferred. Additionally, we are developing IT interfaces with CHS to link to the hospitals and get notices when our patients are being admitted which will help us to care for our population better. Furthermore, we are developing relationships with the care management teams and discharge planners that will facilitate better hand offs and improved care as well. So, although there is nothing mandating the use of CHS facilities, we will be encouraging our network to do so because it is aligned with our goals as an ACO.

Do we need privileges in CHS hospitals?

We encourage this so that you can send and follow your patients at the CHS hospitals. Courtesy, refer and follow, non-active medical staff privileges are available as an option for those who do not wish to actively go to the hospitals.

What are the expectations from me as a provider?

Alignment with our values (people, empathy, teamwork, quality, accountability and leadership), adopt/utilize EMR meaningfully, embrace value based healthcare, complete quality measures, close clinical gaps in care, stay connected and actively participate.

What can you expect from us?

Represent your interests to payors, assist you to improve practice efficiencies, care management / social worker help with patients, educational workshops / webinars, and continually developing stronger strategic partnerships.

What is the economic impact to my practice?

Our objective is to improve the bottom line of your practice and help you maintain your independence. The precise economic impact is quite variable- and practice-specific. However, each of our practices have realized improved profitability as well as preparation toward an even more valuable future.

Revenue side: Enhanced managed care contracts based upon quality outcomes and cost-savings initiatives. Shared savings bonuses. Patient-Centered Medical Home benefits. Data-sharing reports to maximize revenue-generating codes, such as Annual Wellness Visits and Chronic Care Management fees. Assistance with tracking patients to avoid leakage. Encouraging in-network referrals and outpatient office visits.

Expense side: Resources are focused on improving office workflow efficiencies, decreasing cost of supplies (group purchasing), decreasing malpractice cost (PRI partnership, MedPro), decreasing payroll expense (ADP partnership), EMR (athenahealth, epic), and more.

Miscellaneous: Access to free business, non-clinical leadership training, office / practice manager education, consultative services. Free membership in the Advisory Board with access to information to help you better run your practice.

What does it cost to be a member?

There is no fee to join for the first 90 days. If you choose to opt-in to our managed care contracts there is an individualized participation fee based upon the size and historical activity of your practice. This fee is reviewed with each group after joining. At that time, there will be an opportunity to opt-in or out once you have access to all of the information you need to make a decision. If you do not opt-in to our managed care contracts, but still want to be in our network after the 90 period, there is an annual membership fee of $500 per PCP or $1,000 per specialist. This membership fee is waived if you opt-in to our managed care contracts.

Do we need to refer within the Beacon – CHS network?

No. There is no requirement to do so. That said, we support our network participants and in-network utilization is encouraged and incentivized through its incorporation into our shared savings distribution formula.

What if I just want higher rates?

We understand that sentiment, but it’s not for us. There are no free lunches. We are in this for the long haul and our mission is to accomplish the Triple Aim of Healthcare: improve quality (measurably, with data), enhance the patient experience (improve patient satisfaction) and lower cost by decreasing waste. Enhanced fee schedules and savings bonuses today as well as tomorrow are tied to this value-based approach. It does require some work, but we are here to help. We believe that the benefits far outweigh the costs, and these benefits will continue to grow as we move from a traditional fee-for-service healthcare system. If we aren’t on the same page about this, the fit will not be right, and we will wish you well elsewhere.

How are shared savings bonuses distributed?

Beacon takes the risk in funding the operation. If there is no savings bonus, Beacon realizes the loss without any cost to the physician participants. If there is a savings bonus, Beacon gets paid back for the expenses allocated to running the organization, along with a fixed management fee. After that, the entire bonus gets distributed to the participants in the shared-savings program. For more information here is a VIDEO to explain.

What is Population Health? What is an Accountable Care Organization?

For more information here is a VIDEO to explain:

What is a QUAC score?

QUAC is our population health composite metric. Quarterly QUAC scores are updated and distributed through dashboards. The leaderboard is highlighted and shared with the network. These are applicable to primary care physicians and medical specialists who cover those in the ACO. For more information here is a VIDEO to explain.

How does aligning with the hospital help the independent physicians?

Philosophically we have alignment around objectively improving quality care, enhancing the patient experience and decreasing cost—including decreasing avoidable hospitalizations, the readmission rate and over-utilization of the ED. Moreover, in order to be a true population health management organization, we require resources. The hospital system brings resources that we are investing in, and IT and HR that will allow us to execute even better on our contracts. This we believe can result in bigger shared savings bonuses as well as better contracts and strategic partnerships for our physicians as we strive to drive more and more value toward strengthening independent physician practices.

What is the governance structure? Who runs Beacon?

On October 1, 2014, CHS, a hospital group comprised of Catholic Health Services of Long Island and St John’s Episcopal Hospital, entered into a true 50-50 partnership with Beacon (see press release). What this means is that equity and governance is equal now between the independent physicians and the hospital. The governing Board is made up of 22 members: 11 from the Beacon independent physician side, and 11 appointed by the hospitals. The hospital does not have “tie-breaking authority,” either. If agreement between the two sides cannot be reached, there is a stalemate. The sides must be in agreement. Furthermore, the executive leadership team is employed by Beacon, not CHS, and the President of Beacon serves as Chairman of the Board.

FREQUENTLY ASKED QUESTIONS

What is Care Coordination?

Care Coordination is a means by which all of person’s healthcare needs are assessed and met through a variety of referrals, resources, navigation and sharing of information.

How can Care Coordination help the practice?

A Care Coordinator will telephonically assess the needs of your patient to see what type of assistance they may need in the home. This can prevent services from being duplicated and ensure that all preventive needs are met. Care Coordination will help you achieve the triple aim (increased quality, decreased cost, improved patient experience) and work to reduce unnecessary hospitalizations and ED visits.

What types of services can a Care Coordinator put into place?

Skilled Home Care Referra
Private Hire Assistance
Medicaid application/eligibility
MLTC referral
Home rehab services
PRI and Screen completion
SNF and Assisted Living placement
Adult Day Care Program referrals
Medical equipment evaluations
Home draw labs
Meals on Wheels referrals
Transportation assistance
Elder law referrals
Supportive Counseling
Hospice referrals

What is the cost to my patient?

There is no cost to the patient for Care Coordination services through Beacon.

How do I gain access to Care Coordination?

You can refer patients to Care Coordination at any time even if you are not sure what services the patient requires. The Care Coordination team will complete an intake to determine the needs of the patient. You can find our referral form here.

How can I refer for Care Coordination?

All patients with traditional Medicare, Blue Cross Blue Shield, Aetna and United Healthcare can be referred for Beacon Care Coordination. You may contact us regarding other patients and we will be happy to assist you in accessing resources.

How long will the patient receive coordination services for?

The Care Coordinator will remain in contact with the patient indefinitely unless he/she decides that they no longer want to hear from us. The patient can reach out to their Care Coordinator at any time or schedule calls monthly, quarterly, etc.

How will I know what services were put into place for my patient?

The Care Coordinator will send you regular updates regarding your patients.

Is my patient’s information secure?

Yes – We are a HIPAA (Health Information Portability and Accessibility Act) Compliant organization. We will not share any information without the patient’s consent. We will be happy to speak to family/friends at their request but will never do so without approval.

What is the difference between Care Coordination and Chronic Care Management?

Chronic Care Management is a billable service and must meet Medicare guidelines. Requirements are 20 minutes of non-face to face contact per month, signed consents from patient and care plan creation and management. The practice is responsible for billing this service, however the Beacon Care Coordination Team can provide the above service for a fee.

FREQUENTLY ASKED QUESTIONS

What is Care Coordination?

Care Coordination is a means by which all of person’s healthcare needs are assessed and met through a variety of referrals, resources, navigation and sharing of information.

How can Care Coordination help me?

A Care Coordinator will telephonically assess your needs to see what type of assistance you may need in the home. This can include calling providers for you, getting necessary equipment in your home, referring you for therapy services, etc. This can prevent services from being duplicated and ensure that all of your preventive needs are met.

What types of services can a Care Coordinator put into place?

Skilled Home Care Referra
Private Hire Assistance
Medicaid application/eligibility
MLTC referral
Home rehab services
PRI and Screen completion
SNF and Assisted Living placement
Adult Day Care Program referrals
Medical equipment evaluations
Home draw labs
Meals on Wheels referrals
Transportation assistance
Elder law referrals
Supportive Counseling
Hospice referrals

How do I gain access to Care Coordination?

Your Beacon Physician will forward a referral on your behalf. You can request a referral at any time.

What is the cost to me?

There is no cost to the patient for Care Coordination services through Beacon.

How long will I receive coordination services for?

Your Care Coordinator will remain in contact with you indefinitely unless you decide you no longer want to hear from us. You can reach out to your Care Coordinator at any time or schedule calls monthly, quarterly, etc.

Do my benefits change?

No – you continue to receive your healthcare benefits the same way you always have. Beacon is not an insurance company, but rather an organization designed to assist you in receiving the highest quality care.

Do my Providers change?

Do I now need referrals?  No – Your providers do not change and you will follow the same referral requirements as you have always followed.

Can I choose who provides my home care services?

Yes – Beacon has no allegiance to any one organization, but rather will work with a variety of agencies to suit your needs.

Is My Information Secure?

Yes – We are a HIPAA (Health Information Portability and Accessibility Act) Compliant organization. We will not share any information without your consent. We will be happy to speak to family/friends at your request but will never do so without your approval.

Accountable Care Organizations & You

Your doctors try hard to give you high quality care, but it can be a challenge to juggle information. Medicare wants to make sure your doctors have the resources and information they need to coordinate your care. Working together with Medicare, many doctors, hospitals, and other health care providers have decided to participate in Accountable Care Organizations (ACOs) to give better, more coordinated health care to patients like you.

If you have Original Medicare and your doctor, hospital, or health care provider decides to coordinate with other health care providers through an ACO, you’ll benefit because they’ll work together to get you the right care, at the right time, in the right setting.

You can still choose any doctor

Your Medicare benefits won’t be limited because your doctor is part of an ACO. You still have the right to choose any hospital or doctor that accepts Medicare, at any time, even if that hospital or doctor isn’t a part of an ACO. Your doctor may make recommendations, but it’s always your choice on what doctors or hospitals you use.

An ACO is NOT a Health Maintenance Organization (HMO), managed care, or an insurance company

An ACO is a group of doctors, hospitals, and other health care providers who communicate with you and with each other to make sure you get the care you need when you’re sick and the support you need to get and stay healthy. Unlike HMOs, managed care, and some insurance plans, an ACO can’t tell you which health care providers to see or hospital to visit, and can’t limit your Medicare benefits. Also, only people with Original Medicare can be assigned to an ACO. You can’t be assigned to an ACO if you have a Medicare Advantage Plan (like an HMO or a Preferred Provider Organization).

How to know if your doctor participates in an ACO

Doctors or health care providers who choose to participate in an ACO must display a poster that notifies you of your doctor’s participation in an ACO. It also informs you of your option to decline sharing your health care information by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you aren’t sure if your doctor or health care provider is participating in a Medicare ACO, ask him or her during your visit. For general information about ACOs, call 1-800-MEDICARE.

What to expect if your doctor is in an ACO

When your health care providers participate in an ACO, you should see better, more coordinated care over time. With an ACO, you’re the center of care, and your satisfaction is one of the goals. Over time, you may notice that:

  • You don’t have to fill out as many medical forms that ask for the same information.
  • The health care providers that you see all know what’s going on with your health because they communicate with each other.
  • You don’t need to repeat medical tests because your results are shared among your health care team.
  • The providers participating in the ACO will work with you to make sure their health care decisions reflect your preferences.

 

Know your rights if your doctor is in an ACO

You’ll continue to have the same rights all people with Medicare get. To help you to get the best-coordinated and highest quality care, Medicare will share certain information about your medical care with your doctor’s ACO, including medical conditions, prescriptions, and visits to the doctor unless you have called 1-800-MEDICARE to tell Medicare not to share your health care information with your doctor’s ACO or other ACOs. This information is important to help the ACO keep up with your medical needs and track how well the ACO is doing to keep you healthy. 3

Also, you may get a follow-up survey to ask about your experiences as a patient of a doctor who’s participating in an ACO. You’ll get a letter to let you know the survey is genuine. The ACO will use your feedback to help make sure you get high quality care.

ACOs are required to respect your privacy so you have the option to tell us not to share your health care information. You must call 1-800-MEDICARE (1-800-633-4227) to tell Medicare not to share information about your care with your doctor’s ACO or any other ACO. TTY users should call 1-877-486-2048. Unless you take this step, your medical information will be shared with your doctor’s ACO for purposes of care coordination and quality improvement.

Your medical information will be protected

Federal law protects the privacy and security of your medical information. The group of doctors, hospitals, and other health care providers in the ACO working together on your behalf will be able to read your medical records, along with other office staff authorized to help coordinate your care. Each of your health care providers won’t only know about the health issues that they’ve treated, they’ll have a more complete picture of your health by sharing information with your other health care providers.

Contact your doctor’s office for more information about how they protect your medical information, or call 1-800-MEDICARE to learn more about how Medicare protects your medical information.

Where you can find more information about ACOs

For more information about ACOs:

  • Visit CMS.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/.
  • Visit Medicare.gov/manage-your-health/coordinating-your-care/ accountable-care-organizations.html.
  • Talk to your doctor.
  • Call 1-800-MEDICARE.