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

Children served by MaineCare, 2012: Survey findings

The purpose of the annual Survey of Children Served by MaineCare is to monitor the quality of services delivered by MaineCare, the State\u27s Medicaid and CHIP program. The 2012 survey examines the experiences of families with children. ages 0-17, who are enrolled in MaineCare using a standardized survey instrument (Consumer Assessment of Healthcare Providers and Systems--CAHPS--4.0H Child Medicaid Health Plan Survey). MaineCare scores very favorably compared with national benchmarks on CAHPS measures of Getting Needed Care, Getting Care Quickly, and How Well the Child\u27s Doctors Community, with ratings at or above the 75th percentile on all the composites and individual items. Overall ratings of the child\u27s personal doctor, ratings of the child\u27s specialist, and ratings of all the child\u27s health care are also among the highest nationally. Areas for improvement included MaineCare customer service and care coordination. Continued administration of the CAHPS 4.0H Child Medicaid Health Plan Survey is recommended for 2013 and beyond to allow for ongoing monitoring of patient experience with and computation of trend results of the MaineCare program as well as ensuring that the MaineCare program complies with federal CHIPRA measure reporting requirements

How Does the Rural Food Environment Affect Rural Childhood Obesity?

Objective: Assess the impact of the rural food environment on the eating behaviors and BMI of rural low-income children. Method: Statewide (Maine, 2009) household survey of parents of children on Medicaid (n=1722), oversampled in six rural communities, resulting in n=272 for six target communities. Food environment measured using modified Nutrition Environment Measures Survey in Stores (NEMS-S) for 46 retail food outlets. Multi-variate analysis assessed factors affecting home food environment, child\u27s eating behavior and BMI. Results: Home food behaviors (how often: family eats together, child eats breakfast, vegetables served) and parent food consumption were significantly associated with children\u27s healthy eating behaviors. The only significant predictor of childhood obesity was parent eating behavior. We observed several alternative strategies such as hunting, gathering and buying from local farmers. Parents who drove over 20 miles to shop were found to shop at stores with higher NEMS scores as compared to parents who drove shorter distances.Conclusion: Defining and identifying food deserts is not a promising approach to measuring the rural food environment due to long distance trips, careful price shopping, and local, alternative strategies. Strategies to place healthier food in the home should be combined with interventions directed at parents\u27 and families\u27 eating behaviors

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

Achieving Consensus on Measure-Driven Child Health Quality: Maine’s Improving Health Outcomes for Children Initiative

This brief describes Maine’s process for selecting child health quality measures, including identified strengths and limitations of the CHIPRA core measures that led to the inclusion of additional state-specific measures and the factors considered for selection. Subsequent articles will describe how measures have been implemented and used to improve child health quality and how they have been integrated into systems of care (e.g. health information technology systems, policy changes)

MaineCare Stage A Health Homes Year 1 Report: Implementation Findings and Baseline Analysis

In January 2013, Maine established Health Homes under federal authority pursuant to Section 2703 of the Affordable Care Act to improve care coordination for MaineCare members with chronic conditions. Stage A of the Health Homes initiative focuses on members with complex medical chronic conditions. Stage B, planned for early 2014, will focus on persons with severe and persistent mental health conditions and children with serious emotional disturbances. The Stage A demonstration builds off the State’s existing Maine multi-payer Patient Centered Medical Home (PCMH) Pilot project and Maine’s Medicare Advanced Primary Care Practice (MAPCP) Demonstration by providing add-on payments to primary care practices and strengthening the community care team (CCT) model to provide care management and social support services to high-need MaineCare patients. As part of the initiative, MaineCare commissioned the Muskie School of Public Service to evaluate this new model of care. This report presents evaluation findings after the first year of Stage A implementation and provides preliminary baseline data on quality, use and cost of care for eligible MaineCare members in Health Homes (HH) relative to a comparison group that will form the basis for assessing overall impact at the close of the two years of enhanced federal match under the initiative. The report is divided into two parts. Part I focuses on how the model has been implemented in Year 1 including the number of practices and members that are participating and how practices and Community Care Teams (CCTs) have enhanced service delivery based on program data and qualitative interviews with participating practices, CCTs and stakeholders. Part II presents baseline data from 2011, prior to the beginning of the Stage A, comparing the quality, utilization and cost of services for MaineCare members that are participating in Health Homes with members with similar HH eligible conditions that did not enroll in Health Homes. Preliminary baseline data included in this report will be updated and used in the final report to assess how quality, use and cost of MaineCare services changed over time in each of these groups, to evaluate the impact of the intervention