News from NEPHO – FEBRUARY 2023 Edition


  • Rafael Kakazu, MD of North Shore Center for Orthopedic Surgery and Sports Medicine, 4 State Road Danvers, MA 01923 Phone: 978-774-3400 Fax: 978-774-5883
  • William Murzic, MD of North Shore Center for Orthopedic Surgery and Sports Medicine, 4 State Road Danvers, MA 01923 Phone: 978-774-3400 Fax: 978-774-5883
  • Yu Cheng Peter Zhao, MD of Microsurgical Eye Consultants, 31 Centennial Drive Peabody, MA 01960 Phone: 978-531-4400 Fax: 978-531-7106


  • No practice changes or updates this month. 


Office Manager Meeting
Date: Wednesday, March 8th, Noon
Speaker: Christine Ouellette
Topic: MassHealth WellSense ACO
Location: Teams Meeting


2023 Primary Care Quality Meeting
Date: Tuesday, March 21st, 12:15-1:00PM
Location: Teams Meeting

NP/PA Meeting
Wednesday, March 22nd, Noon
Speaker: Jody Neimark
Topic: Clinovations
Location: Teams Meeting


Tuesday, March 7, 2023 @12:30pm
Join Zoom Meeting
Meeting ID: 981 6179 7489
Passcode: 900555
One tap mobile: +13126266799,,98161797489#

WednesdayMarch 22, 2023 @5:30pm
Join Zoom Meeting
Meeting ID: 976 2070 3453
Passcode: 945992
One tap mobile: +19292056099,,97620703453#

Thursday, March 30, 2023 @7:00am
Join Zoom Meeting
Meeting ID: 945 0612 3895
Passcode: 126015
One tap mobile: +19292056099,,94506123895#

  • These meetings will be virtual using Zoom. Emails with the Zoom links and meeting details were sent by Lisa Driscoll on 1/20/2023 and 1/23/2023. If you have any questions about the Open Meeting I sessions, please contact Lisa Driscoll at or 978-236-1744.
  • Please note: the same presentation will be repeated at each of the three Open Meeting I sessions.
  • Open Meeting I will take the place of the March POD meeting.


Congratulations to our NEPHO Physicians who were recognized as Top Doctors in Northshore Magazine

2023 Top Doctors


The Northeast PHO would like to recognize Dr. Melissa Sherman of Essex County OB/GYN for being awarded the Community Clinician of the Year Award by the Essex South District Medical Society. 

Dr. Sherman is the Essex County OB/GYNs Champion of Care for pregnant women and New Moms with Substance Abuse Disorder/Trauma Informed Care.

For those of you who are interested in seeing your NEPHO colleague honored, please click here for further registration information.


Below is a list of dates for BILHPN Acuity Training for Epic users and a link to the recording of the September 12, 2022 Session. Click on each date to register.

Provider Acuity Training Series with CME Credit

Click here to request access to view the Recording for the September 12th Provider Acuity Training Series Session.

March 7, 2023, from 5:30 – 6:30 p.m.

May 2, 2023, from 12 – 1 p.m. 

July 18, 2023, from 5:30 – 6:30 p.m. 

Arcadia Acuity Trainings

May 10, 2023, from 12:05 – 1 p.m. 

August 10, 2023, from 12:05 – 1 p.m. 

November 7, 2023, from 12:05 – 1 p.m.


Blue Cross Blue Shield of Massachusetts

Submit referrals, authorization requests, and inquiries electronically starting June 1. Click here for more information.

BCBS Evaluation Payment Policy Update
Click here to review the BCBS Evaluation Payment policy. Effective May 1, 2023, BCBS will no longer reimburse the CMS annual wellness initial and subsequent visit codes, G0438 and G0439, when billed on a professional claim for commercial members. BCBS will continue to reimburse these codes when billed on a professional claim for Medicare Advantage members. This change is in accordance with industry CMS standards.

  • G0438: Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit
  • G0439: Annual wellness visit; includes a personalized prevention plan of service (PPS), subsequent visit
  • For commercial members, use CPT codes 99381-99397.

Please make sure to register for Provider Central to get full, personalized access to news, updates, and other administrative information from BCBS of MA.

BCBSMA is Removing Prior Authorization for Certain Child Psychiatric Treatments
Consistent with the Massachusetts Chapter 177 of the Acts of 2022, an act aimed at addressing barriers to care for mental health, we have removed prior authorization requirements for children and adolescents up to the age of 18* for the following services: Intensive community-based treatment (ICBAT); Community-based acute treatment (CBAT); Inpatient psychiatric treatment. To view the complete notification, click here.

BCBS Will Not Cut Telehealth Payments
In December, Blue Cross Blue Shield Massachusetts announced it would cut telehealth payments for primary care providers and chronic conditions by 20%, effective July 1. BCBS Announced, “We have decided that we will continue to pay these services at the current rates and not implement a telehealth reimbursement reduction on July 1 as we originally communicated.” Click here for more information.


Our Name is Evolving. Our Commitment to You Remains the Same
Cigna is becoming Cigna Healthcare. This evolution of our brand signifies our renewed focus as an advocate for better health through every stage of life, as well as for improving the health, well-being, and peace of mind of our customers – your patients. Together, Cigna Healthcare and Evernorth Health Services will comprise The Cigna Group, a global health company committed to creating better health for all. Click here for more information.

What this means to you

Your day-to-day business with us – including contracts, reimbursement, and network status – will remain the same. Only the Cigna Healthcare name and logo will change. You will start to see the new name and logo in communications and websites, and at events over the course of 2023 and beyond.

Going forward, your partnership will continue to be key in improving the health of our customers. Working together, we will help the people we serve have access to the very best care.


Flu Shot Update
ICD-10 Code: Z23 has been added to the website. To view the webpage, click here.

ICD-10-CM Official Guidelines for Coding and Reporting FY 2023
Narrative changes appear in bold text. Items underlined have been moved within the guidelines since the FY 2022 version. Italics are used to indicate revisions to heading changes. To view the updated document, click here.

2023 ICD-10-CM
In an effort to better enable the collection of health-related social needs (HRSNs), defined as individual-level, adverse social conditions that negatively impact a person’s health or healthcare, are significant risk factors associated with worse health outcomes as well as increased healthcare utilization, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing 42 new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), for reporting effective April 1, 2023. The files in the Downloads section contains information on the ICD-10-CM updates effective with discharges on and after April 1, 2023. To view the notification, click here.

WellSense MassHealth

As of April 1, 2023, all primary care providers (PCPs) participating in MassHealth’s ACO program will be paid through the Primary Care Sub-Capitation Program. The Primary Care Sub-Capitation Program is a required component of the MassHealth program during the new waiver that begins on April 1.

As part of MassHealth’s Sub-Capitation program requirements, PCPs will no longer be paid fee-for-service (FFS) for certain CPT and HCPCS codes. They will instead receive a monthly per member per month (PMPM) payment based on their panel size.

More information can be found on WellSense’s website by clicking here.

We strongly encourage the billing and finance teams of participating groups to review the program description in detail.

If you have questions about the Primary Care Sub-Capitation Program, please contact your assigned Provider Relations Consultant, or send an email to


Heart Failure (HF) Pharmacy Initiative

In an effort to reduce hospitalization readmissions due to HF, the BILHPN pharmacy team will be reviewing HF patients who may benefit from Guideline Directed Medical Therapy (GDMT), a focus area outlined in the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. For more information see the January 2023 BILHPN Newsletter.

Data supports use of quadruple therapy as the foundation for Guideline Directed Medical Therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF, with LVEF < 40%).

Quadruple therapy consists of the following medication:

  • ARNI (angiotensin receptor-neprilysin inhibitor) sacubitril/valsartan (Entresto), ACE-inhibitor (any), or ARB candesartan, losartan or valsartan
  • Beta blocker metoprolol succinate, carvedilol or bisoprolol
  • MRA (mineralocorticoid receptor antagonist) eplerenone or spironolactone
  • SGLT-2i (sodium-glucose cotransporter-2 inhibitor) empagliflozin or dapagliflozin 

Some Facts:

  • About 14.3% of BILHPN Medicare patients have heart failure.
  • Average cost is $14,300 per HF admission, $14,800 per HF readmission with a current 19.8% readmission rate
  • Goal is to reduce HF readmission rate by 6.75%
  • Baseline data reveals about 44% of HF patients are on dual therapy and 15% on triple therapy

Over the next several months, several educational programs and newsletters will be shared with Primary Care Providers and Cardiology Specialists on Guideline Directed Medical Therapy (GDMT).

Diabetes Medication Cost and Coverage Chart 

Please click here to find an updated Diabetes Medication Cost and Coverage Chart (updated as of 2/10/23).

Drug Shortages

See below for updates on several medication back-orders/shortages. (updated as of 2/22/23)

GLP 1 RA’s: see conversion chart

  • Trulicity 0.75 and 1.5 mg IN STOCK; 3 mg and 4.5 mg limited release by manufacturer
  • Ozempic 0.25 mg/0.5 mg 3ml pen IN STOCK; 1.5 ml pen, 1 mg and 2 mg – limited release by manufacturer
  • Mounjaro 5 mg/ 0.5 ml IN STOCK; 2.5 mg, 7.5 mg, 10 mg and 15 mg limited release by manufacturer
  • Bydureon Bcise 2mg IN STOCK
  • Victoza 18 mg/3ml IN STOCK
  • Rybelsus 1 mg, 3mg and 7 mg IN STOCK

ADHD Meds: see conversion chart

  • Adderall/mixed amphetamine salts IR and XR – very limited availability
  • Ritalin LA/methylphenidate – 10, 30, 40 mg IN STOCK
  • Vyvanse – supplier is in full recovery; product in transit to distributor; ALL Chew Tab doses available
  • Concerta: 18, 27, 36 mg IN STOCK
  • Generic methylphenidate ER – ALL doses backordered (sporadic release)


  • AMOX/CLAV Suspension – limited availability – (AMOX-CLAV 250-62.5 MG/5 ML , AMOX-CLAV 600-42.9 MG/5 ML , AMOXICILLIN 125 MG/5 ML)
  • AMOX/CLAV tabs -200-28.5 MG TAB CHEW; IN STOCK
  • AMOXICILLIN – 250, 500 caps, 875 mg tabs – limited IN STO


  • 160mg/5ml – early April 2023 release; full recovery TBD
  • Tylenol 160/5ml – Available on-line from Amazon

BILHPN Pharmacy Newsletters:

Each month the BILHPN Pharmacy Team publishes a valuable newsletter with current pharmacy related issues. You can access them by using the Website under Pharmacy Resources*.

*please note, a password is now required to log into Pharmacy Resources on the website. If assistance is needed, please contact Alycia Messelaar at

For more information please contact Carol Freedman at or at 978-380-4089.


Virtual Networking videos from NEPHO providers can be found here.

Please reach out to Alycia Messelaar at if you are interested in being featured in a Virtual Networking video. 

Click here for the PDF version of the updated PHO Directory as of February 2023. For your convenience, click here for the separate Specialists Only PDF directory to refer to as needed.

Please share this directory with your office by printing or showing them how to visit us online for an easy to use directory search tool.

Note: Primary care providers (PCPs) in the BILH Performance Network no longer need to submit an administrative referral to refer Blue Cross Blue Shield of MA, Harvard Pilgrim Health Care, or Tufts Health Plan members to a specialist in the BILH Performance Network. Please reach out to Alycia Messelaar at regarding questions pertaining to providers within the BILHPN Network. 

As a reminder, it is important to use the NEPHO Physician Directory when referring to a specialty physician. 

Here are the key memos that have been sent out over the last month – JUST in case you missed it!

  • Monthly BILH Pharmacy Newsletters
  • Monthly BILHPN BMC WellSense MassHealth ACO Newsletter
  • Monthly Beth Israel Lahey Health Performance Network CDI Newsletter
  • 2023 Risk Sharing Incentive Letters
  • From the Desk of Stacey Keough: 2021 Settlement Funds
  • From the Desk of Stacey Keough: MIPS Submission Reminder to Medicare ACO Providers CY 2022
  • MassHealth ACO: Upcoming member communications – Key Messages for Providers
  • Reuben Shin: Hernias and the Emergence of Robotic Surgery Beverly Hospital CME – March 9, 2023 @ 6pm
  • 2023 Primary Care Quality Meeting for Office Managers
  • Boston Children’s Hospital
    • BCHMedEd February Newsletter | See Upcoming Courses
  • Q3 2022 Risk Sharing Dashboards and Referral Reports

Please reach out to for a specific communication that you are unable to find.

Important Supports for Perinatal Mental Health

The recent news related to the tragedy in Duxbury has reiterated the importance of clinicians taking proactive measures to assess perinatal mental health before, during and after pregnancy. The public’s current focus on this topic presents an opportunity for providers to educate and treat with urgency individuals who may be at risk for significant perinatal challenges. 

Click here for resources for you and for your patients.


In March the Quality Team will be hosting a meeting for primary care office managers. Some of the topics we will focus on are:

  • 2023 Quality Measures
  • 2022 Performance
  • Reporting timelines
  • Office Manager suggestions and feedback

We greatly appreciate all of the work that our practice managers and primary care staff do each year to help us reach our quality goals. Quality is not just about numbers – it is about providing the best care possible so our patients can have the best outcomes! Our partners in the practices are a vital part of this process.

If you have any questions or would like to suggest a topic for the Primary Care Quality Meeting, please reach out to Laureen Viel at

We will be sending a survey to the office managers asking for feedback and suggestions.


OPTUM NEWSLETTERFebruary- Conditions of the Heart

Please click here to view the 2023 Optum webinar schedule.

M.E.A.T: Monitor, Evaluate, Assess, Treat

These four factors help providers establish the presence of a diagnosis during an encounter and ensure proper documentation:

M: Monitor—signs, symptoms, disease progression, disease regression
E: Evaluate—test results, medication effectiveness, response to treatment
A: Assess/Address—ordering tests, discussion, review records, counseling
T: Treat—medications, therapies, other modalities

Documentation Tips:

  • Document each patient encounter as if it is the only encounter.
  • Codes should be assigned for every condition documented in the chart note that has evidence of MEAT, not just the condition for which the patient came in.
  • All chronic and complex conditions need to be coded annually.
  • Review and document conditions managed by a specialist.
  • When seeing a patient who comes in infrequently, ensure that chronic conditions are reviewed at the visit, even if they are only presenting for an acute issue.
  • When refills are made outside of a visit, encourage patient to schedule a check-up so that the condition can be reviewed and managed at least once a year.
  • Review and update the patient’s active problem list at each visit. If a condition is no longer active, either remove it from the list or add “history of.”
  • Specify the basis for ordering additional testing/treatment.
  • Show patient’s progress or lack of progress 
  • Avoid using the words “history of” for a condition that is chronic but currently stable, such as COPD, Diabetes, or atrial fibrillation.

Simply listing every diagnosis in the medical record does not support a reported HCC code and is not accepted by CMS (Medicare). Documentation must support evaluation and treatment for each condition that is captured as an ICD-10 CM.

More helpful tips and documentation examples can be found here.


Beth Israel Lahey Health Primary Care, Beverly – 100 Cummings Center

  • Dr. Pierre Ezzi – Liz front desk is the very best person and so helpful. Brittany nurse makes you feel very comfortable.

Beth Israel Lahey Health Primary Care, Beverly – 30 Tozer Road

  • I would, and have, recommended Dr. Spencer Amesbury to several people
  • The nurse was also very helpful and kind. Dr. Gail Ellis is wonderful- caring, listens, takes her time.
  • Dr. Neerah Mahajan is the best! He is very caring, compassionate, and knowledgeable.

Beth Israel Lahey Health Primary and Specialty Care, Beverly – 30 Tozer Road Suite 203

  • I love Dr. Deborah Shih.

Beth Israel Lahey Health Primary Care, Danvers – 5 Federal Street

  • Dr. Brent Fryling is the best PCP I’ve ever had. Genuinely warm, connecting, interested in me as a person, clearly concerned about my health. Also very professional, thorough, and knowledgeable. He not only gives me first rate medical care, but lifts my spirits when I see him.
  • Dr. Margaret Legner listened to my questions and gave me answers that were very helpful. I trust her with my care.

Beth Israel Lahey Health Primary Care, Danvers – 480 Maple Street Suite 204

  • All good. I have referred Dr. Kristina Jackson to others who use this provider as well, and they are very satisfied.
  • Dr. Timothy Loughran was amazing. I truly appreciate the way he made me feel like a human and not a billing chart.

Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor

  • Excellent! Dr. Victor Carabba is very good at what he does and I have complete confidence in his care
  • Caring, knowledgeable practice. I am very pleased with my care from Dr. Karen Damico

Beth Israel Lahey Health Primary Care, Hamilton – 15 Railroad Avenue

  • Dr. William Medwid – Always a pleasure sick or not. Such wonderful doctors and nurses

Beth Israel Lahey Health Primary Care, Manchester – 195 School Street

  • Dr. Jana Oettinger is wonderful. She spent extra time with me, addressed all my concerns, showed empathy and compassion, and treated me like a fellow human being. I am very lucky and grateful to have her for my PCP.
  • Best doctors appointment ever. Dr. Matthew Plosker is a penultimate doctor.

Cape Ann Medical Center, Gloucester – 1 Blackburn Drive

  • Dr. Janet Doran and staff work together as a team! Blood work is ordered prior to my 6 month scheduled visit! I review online. But, staff does call.
  • I really enjoy Dr. Yuliya Mandel’s uplifting energy and sense of humor! She’s very clear, straightforward, and enjoyable to be with!
  • Dr. Shawn Pawson spends time and does not rush the visit.

Cape Ann Pediatricians, Gloucester – 298 Washington Street

  • This was our first visit with Dr. Brian Orr. I’m totally happy with my grandsons visit!

Danvers Family Doctors, Danvers – 140 Commonwealth Avenue

  • Dr. Subroto Bhattacharya – as always compassionate and knowledgeable- treated my concerns with respect and urgency. I Feel confidence In his recommendation. Thank you.

Garden City Pediatrics, Beverly – 83 Herrick Street

  • We really like Dr. Meghan Weir for our daughter as first time parents it can be nerve-wracking and she always takes the time to listen to and answer our questions overall the staff is phenomenal. Every time I have to call the nurse triage line about our daughter I feel understood and like I’m being taken seriously – which is all I can ask for where my daughter is involved.

Leonard Horowitz, MD, Danvers – 7 Federal Street

  • Dr. Leonard Horowitz is the best PCP I’ve ever seen. Excellent manner, courteous, thoughtful and takes time to discuss my opinions.

Thomas Pearce, MD, Gloucester – 279 East Main Street

  • Dr. Thomas Pearce is excellent! He keeps up with the latest in medicine. – He’s caring, pleasant and very informative. I love coming to see him!


The Northeast PHO recognizes colleagues who provide a positive experience for our patients, help us keep care local, meet our quality targets and support their colleagues.

This month’s winners are:

Sandy Maloney, Beth Israel Lahey Health Primary Care, Danvers, was recognized for her patient comment: “The staff is wonderful! Sandy is amazing! She is kind, efficient and goes above and beyond.”

Tracy Pelletier, Beth Israel Lahey Health Primary Care, Danvers, was recognized for outstanding year-long support and collaboration with the NEPHO Population Health Team and proactively outreaching to patients to meet quality measures.

Please let us know if you would like to nominate a team member in your practice or another practice for the recognition program. 

We will deliver gift cards to the winners each month, and they will be announced here in the newsletter. Please be sure to look for the new winners in next month’s issue!