News & Resources

As a service to you, we have provided links to the NPPES website:

 

To search for a provider’s NPPES information, click here to access the NPI registry.
• To update your own NPPES information, click here to access the NPI login page.

 

Here is the latest news from ECPHO:

 

NEW HEALTH PLAN FOR ECHN EMPLOYEES

Please be aware that ECHN has selected Aetna as the health carrier to administer its employees’ health plan which will result in a major shift of patients from ConnectiCare to Aetna, effective January 1, 2010. 

 

HEALTH PLAN CONTRACTING NEWS

Aetna:  ECPHO’s agreement with Aetna has been favorably amended effective January 1, 2010.  Currently, 186 ECPHO physicians participate in Aetna’s provider network. 

Coventry/First Health:  An increase to the fee schedules of our agreement with Coventry went into effect on January 1, 2010. There are 166 PHO physicians participating w/ Coventry.  

NorthEast Health Direct (NEHD):  New rate schedules went into effect on November 1, 2009.  There are 183 ECPHO physicians participating with NEHD. 

Availability of ECPHO Fee Schedules:  ECPHO compensation schedules are made available on the secure ECPHO Website at www.ECPHO.org as soon as they are received from the respective health plans.

 

2010 ENROLLMENT FOR MEDICARE ADVANTAGE PROGRAMS 

Each year Medicare Advantage plans typically change their premiums and their benefit plans, and then market aggressively to enroll new beneficiaries. The 2010 open enrollment period ran from November 15 to December 31, 2009. During that time, Medicare beneficiaries could add, drop or change their Medicare Advantage health plan for 2010 coverage. Starting in January 1 and through March 31, 2010, Medicare Advantage enrollees have the opportunity to switch their selected Medicare Advantage Program. For your information, ECPHO has existing agreements with Aetna, ConnectiCare and WellCare for their respective Medicare Advantage Programs.   Please contact the PHO if you have any questions.

 

COLLABORATION WITH CSMS-IPA

CSMS-IPA has approached ECPHO to collaborate on a Medical Management approach that involves a network of providers who agree to participate in a Patient Centered Practice Model (“PCPM”) of care.  The goals of the PCPM are to:

1.  Improve communication and care coordination between physicians and patients;

2.  Facilitate increased quality of patient care;

3.  Elevate the role of primary care physicians and provide enhanced reimbursement to PCPs;

4.  Establish a shared savings program among the health plans, CSMS-IPA and physicians.

 

COLLABORATIVE EFFORTS BETWEEN ECPHO AND ECHN

ECPHO is collaborating with ECHN on many initiatives with the overall objective to develop a high quality, coordinated, patient centered provider system to improve the health care of the communities we serve.  The initiatives include the following:

1.  The PHO is happy to announce that a new agreement between Aetna and ECPHO has been executed with an effective date of January 1, 2010.   The contract discussions were drawn out and difficult, but resulted in a favorable agreement in large part due to the support and collaboration of ECHN.  

2. Seeking additional contracts for our “system” approach – PHO physicians and ECHN hospitals under a single agreement to allow financial incentives for coordinated care.

3. Health Information Technology – ECHN, ECPHO and HealthWise are working with other stakeholders in the development of a statewide Health Information Exchange (HIE) and on programs to support adoption of Electronic Medical Records (EMR) by ECHN physicians. 

4. Medical Management Initiatives -   ECHN and ECPHO are collaborating on medical management and QA initiatives, with Saud Anwar, MD serving as Medical Director for the collaborative effort. 

5. Community outreach through ECHN’s Business Alliance for Community Care (BACH) – ECPHO is actively involved in the BACH program with the goal to help communicate the roles that local employers and their employees must accept to enhance the health of our community. 

 

A NEW FOCUS OF ECPHO – MEDICAL CARE MANAGEMENT

ECPHO recently created a committee to work with ECHN to establish a coordinated Medical Care Management Program that takes advantage of our existing hospital-physician relationship and joint resources to move our provider community further down the road towards true clinical integration. As the Chair of the new Committee, M. Saud Anwar, MD explained his vision for the PHO as being a central vehicle for encouraging improved patient care quality and efficiency, through improved communication, data analysis and information sharing among key stake holders. 

The PHO Committee will collaborate with ECHN’s existing Medical Management and Quality Assurance resources on various goals including the following: 

1.  Establishing an environment that supports a “coordination of care” model,  with a focus on management of patients across the continuum of care with an initial emphasis on reducing the rate of readmissions to hospitals and Chronic Disease Management;

2.  Recommending ways to strengthen working relationships and communications among all community providers (including VNA’s and sub-acute/chronic facilities); 

3.  Providing performance reporting to physicians to assist in identifying opportunities for improvement in both efficiency and quality performance; 

4.  Exploring collaborative Medical Management initiatives with other PHO’s, IPA’s and/or health plans (there are ongoing discussions with St. Francis PHO, CSMS-IPA, Aetna and ConnectiCare);

5.  Seeking opportunities for ECPHO and ECHN to contract together with health plans that support the development of clinical integration.