Comparison of Primary Care Received by New Hampshire Medicaid Members at Different Practice Settings, 2006

This study was conducted under a sub-contract between the Maine Health Information Center (MHIC) and the Muskie School of Public Service at the University of Southern Maine. This subcontract is part of a larger contract between the MHIC and the State of New Hampshire Department of Health and Human Services, Office of Medicaid Business and Policy, titled New Hampshire Comprehensive Health Care Information System. The views expressed are those of the authors and do not necessarily represent the views of the MHIC, New Hampshire DHHS, or the University of Southern Maine

Improving Health Outcomes for Children (IHOC) First STEPS Phase I Initiative: Improving Immunizations for Children and Adolescents

This report, co-authored by Kimberley Fox and Carolyn Gray, provides a final evaluation of the initial phase of First STEPS (Strengthening Together Early Preventive Services), a learning collaborative led by Maine Quality Counts to support 24 pediatric and family practices in improving their childhood immunization rates. The evaluation found that all participating practices had higher immunization rates after participating in First STEPS. On average, overall child immunization rates increased by 5.1% at 12 months and 7.1% at 15 months, and average immunization rates across practices increased significantly from 74.2% to 81.3%. Practices also reported significant improvement in the use of recommended office practices, including staff training, recall/reminder procedures, and the use of data/registries

First STEPS Phase I Initiative: Improving Immunizations for Children and Adolescents

This evalution report, authored by research staff at the USM Muskie School, assesses the change in immunization rates in participating pediatric and family practices that serve a high volume of children insured by MaineCare (Maine\u27s Medicaid system). The authors also summarize lessons learned in implementing changes in practices and challenges in using the immunization measures at the practice-level to inform quality improvement

First STEPS Phase III Initiative: Improving Oral Health and Healthy Weight in Children Final Evaluation Report

This report summarizes evaluation findings from Phase III and assesses change in oral health and healthy weight screening rates, referrals and related office system procedures in participating practices. The report also highlights challenges encountered and lessons learned in implementing changes to office systems, in responding to state policy changes, and in collecting and tracking oral health and healthy weight measures at the practice-level to inform quality improvement

Early Lessons Learned in Implementing MaineCare Health Homes

The MaineCare Health Homes Initiative is designed to improve care coordination for MaineCare members with complex chronic medical conditions. The initiative, which began in January 2013, builds off the State’s existing multi-payer Patient Centered Medical Home (PCMH) Pilot project and Medicare Advanced Primary Care Practice (MAPCP) Demonstration by providing add-on payments to primary care practices to provide “whole person” integrated care coordination for MaineCare members with specific chronic conditions. For the highest need patients, practices work with Community Care Teams (CCT) that provide short-term care management and social support services. The Muskie School of Public Service is evaluating the implementation of this new care model. This issue brief highlights key lessons learned from the first year of implementing Health Homes. A separate issue brief describing MaineCare members enrolled in the first year can be found at http://digitalcommons.usm.maine.edu/healthpolicy/1

MaineCare Health Homes Enrollment in the First Year of Implementation

The MaineCare Health Homes Initiative is designed to improve care coordination for MaineCare members with complex chronic medical conditions. The program is being implemented in two stages: Health Homes (HH), which began in January 2013, focuses on members with chronic health conditions. Behavioral Health Homes (BHH), which began in April 2014, is designed to meet the needs of people with Severe Mental Illness (SMI) or Serious Emotional Disturbances (SED). The HH first stage builds off the State’s existing multi-payer Patient Centered Medical Home (PCMH) Pilot project and Medicare Advanced Primary Care Practice (MAPCP) Demonstration by providing addon payments to qualifying primary care practices to provide “whole person” integrated care coordination for MaineCare members with specific chronic conditions. For the highest need patients, practices work with Community Care Teams (CCT) that provide short-term care management and social support services. The Muskie School of Public Service is conducting an evaluation of this new model of care. The evaluation is designed to assess how the program has been implemented as well as how the enhanced care coordination provided by HH has affected MaineCare members’ quality, use and cost of care. This brief highlights HH enrollment trends and characteristics of members enrolled in the first year of implementation. A separate brief highlighting lessons learned in implementing this new care model can be found at http://digitalcommons.usm.maine.edu/healthpolicy/101

Engaging Patients in Health System Transformation: The experience of the Maine Health Access Foundation\u27s (MeHAF) Advancing Payment Reform Initiative

In 2001, the Institute of Medicine (IOM) identified patient centeredness as one of six essential aims of “a new health care system for the 21st century”.1 Since that time, we have begun a gradual shift from a professionally driven system toward one that is more “patient centered” or “consumer centered,” recognizing and incorporating patients’ perspectives in decisions in clinical care, delivery system, and policies. As the health care system responds to new payment approaches and positions itself to achieve the Triple Aim (i.e. better care, lower cost, enhanced patient experience), it is important to assess how organizations that are moving to advance health care service delivery and payment reform are integrating patient engagement into the health system transformation process. Since 2011, the Maine Health Access Foundation’s Advancing Payment Reform initiative has funded 13 health system transformation projects. Diverse in their approach, each has undertaken efforts to achieve greater patient engagement ranging from involving patients and families as informed and active participants in their own health care (e.g. shared decision making, self-management) to involving patients at the organizational or policy-level through consumer advisory boards and other means to provide guidance for health system transformation. This brief summarizes the experience of these grantees in developing and implementing strategies to engage patients in payment reform and delivery system redesign.2 The purpose is to identify common themes and lessons within and across these initiatives to inform future patient engagement efforts

First STEPS Phase II Initiative: Improving Developmental, Autism, and Lead Screening for Children

First STEPS (Strengthening Together Early Preventive Services) is a learning initiative supported by Maine\u27s CHIPRA quality demonstration grant to support measure-driven practice improvement in pediatric and family practices across the state on improving developmental, autism, and lead screening for children. This report, authored by research staff at the USM Muskie School, evaluates the impact of Phase II of Maine\u27s First STEPS initiative, which was implemented from May to December 2012 and included 12 practices serving more than 20,000 children on MaineCare (Maine\u27s Medicaid system). The authors assess changes in developmental, autism, and lead screening rates and evidence-based office processes in participating practices before and after the initiative, as well as related systems changes. They also summarize lessons learned in implementing changes in practices and challenges in using CHIPRA and IHOC developmental, autism, and lead screening measures at the practice-level to inform quality improvement