Providing Better Care at Lower Cost: Building Maine\u27s health data infrastructure to support financing and delivery system reform

Maine needs a robust and functional health data infrastructure to support efforts by health care providers and purchasers to improve quality, address Maine’s health care cost problems, and improve the health of individuals and populations through payment and delivery system reform. Although Maine has been a leader in building and using health data systems such as the hospital discharge data set and the all-payer claims database, new performance-based financing and delivery system arrangements are highlighting shortcomings in these systems and the need for a renewed vision of Maine’s future health data infrastructure. The Health Data Workgroup was created by The Advisory Council for Health Systems Development (ACHSD) to address the stated goal of the 2010 – 2012 Maine State Health Plan to develop a “roadmap” for continuing to build Maine’s health data, analysis and research infrastructure to support health care payment and delivery system reform. This report presents the Workgroup’s recommendations. These recommendations focus on incremental steps needed to strengthen the capacity of Maine’s health data systems to support the key functions integral to new healthcare financing and delivery arrangements. Each of the recommendations is followed by a discussion of priority needs identified by the Workgroup and selected findings from the Workgroup’s background research and presentations to the Workgroup

Models for Integrating and Managing Acute and Long-term Care Services in Rural Areas [Working Paper]

Post-acute and long term care services for older persons and persons with serious disabilities are responsible for an ever-larger share of the costs of the Medicare and Medicaid programs. The need to control demand and expenditures has led states and the federal government to seek new managed care strategies, such as capitated financing and coordinated case management, that integrate the financing and delivery of primary care, acute and long term care services. Integration and managed care are viewed as encouraging a substitution of less costly and more appropriate home and community-based services for high cost medical and long term care services which have been heavily funded under fee-for-service financing systems. From a rural perspective, the development of organizational and delivery systems which better integrate and manage primary, acute and long term care services may help address long-standing problems of limited availability of and access to long term care services. Over the past decade, many rural hospitals have developed or acquired postacute care services such as home health agencies and/or skilled nursing facilities as a strategy for managing their inpatient use and diversifying their revenue base. And some rural hospitals have ventured into the world of long term care as well, offering assisted living, adult day service programs, respite programs, or sponsoring meal sites for older persons. The growing involvement of rural hospitals in the post-acute and long term care services may provide important opportunities to develop more integrated acute and long term care systems in these communities. Notwithstanding the significant challenges, there are emerging examples of rural networks and managed long term care programs that offer important insights into the opportunities and challenges of using these approaches in rural settings. This paper discusses the concept of integrated acute (medical) and long term care service networks, some of the model programs that have been demonstrated, the challenges that health care providers, state policymakers, and others have faced in developing these new integrated structures, and the future of integrated approaches in rural areas. The paper updates and expands upon key findings, insights, and conclusions from a recent study of several of these programs (Coburn et al. 1997)

After Closure: Options for Pursuing a High Performance Rural Health System

Presented at the 2017 National Rural Health Association Annual Meeting. Coburn, a member of the Rural Policy Research Institute Panel, discussed the following key questions: What kind of rural health system is possible in places that cannot support a full-service hospital? How does a rural community navigate the transition from hospital-centric care toward new models that deliver high performance? What implementation support will be needed? Coburn noted that there is no single model for re-configuring the rural health system after hospital closure; local assets, affiliations and partnerships, financial and delivery flexibility and capacities must be critically assessed to determine the community’s options and strategies

Federal Health Care Reform: An Overview

This policy brief discusses three of the main components of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare . These components are helath insurance coverage, delivery system improvement, and cost containment. The policy brief highlights some of the provision of the law that have already been implemented and those where importnat implementation decisions will have to be made. The brief is authored by Dr. Andrew Coburn, PhD, Professor of Public Health and Director of the Population Health and Health Policy program at the USM Muskie School, and was presented at the Maine Policy Leaders Academy Health Care Forum breakfast session, Feb. 26, 2013 at the Senator Inn in Augusta,sponsored by the Maine Health Access Foundation

Private health insurance in rural areas: Challenges and opportunities

KEY FINDINGS: Private insurance is less common in rural areas. Rural residents under age 65 are less likely than their urban counterparts to have private health insurance coverage. This difference is driven by the unique characteristics of rural places that make it challenging to create and sustain viable private insurance pools. Chief among these are the predominance of small businesses and self-employed, part time, and low wage workers. Rural workers are less likely to have an employer that offers coverage. Among those employed by a business, only 67% of rural employees work for a firm that offers coverage. Rural businesses, families and individuals pay more for the same benefits. Because of the higher premiums paid by small businesses, employees’ share of premiums is often high. Premiums for such policies tend to be high, and typically offer less generous coverage (fewer benefits and higher out-of-pocket costs). Strategies to improve access to private health insurance have particular implications for rural areas. Some of these strategies, and the rural considerations they raise, include: Employer mandate, purchasing pools/alliances/exchanges, or tax credits for individual insurance

The Underinsured in Rural America: The Root of the Problem and Possible Solutions

Presentation to National Congress on the Un- and Under-Insured Washington DC

Rural coverage gaps decline following public health insurance expansions

Following the implementation of the State Children’s Health Insurance Program (SCHIP), rural health researchers noted that this public insurance expansion had the potential to dramatically improve health insurance coverage for rural children.1 At the time, rural children were more likely than their urban counterparts to be uninsured, and also were more likely to have family incomes in the range targeted by SCHIP (100- 200% of Federal Poverty Level-FPL).2 This brief uses the Medical Expenditure Panel Survey (MEPS) to compare the health insurance coverage of rural and urban residents in 1997 and 2005 to assess how uninsured rates and sources of coverage have changed since SCHIP was enacted.* We also discuss the characteristics of the rural uninsured and the implications for health insurance reform. Rural is defined as living in a non-metropolitan county, as designated by the Office of Management and Budget (OMB). All presented results are statistically significant at p. ≤ .05

Innovations in Rural Health System Development: Recruiting and Retaining Maine\u27s Health Care Workforce

This series of briefs were produced by the Maine Health Access Foundation (MeHAF) in conjunction with the Maine Rural Health Research Center to describe robust and innovative models and strategies from Maine and other parts of the country related to the areas of health finance and payment, governance, workforce, and service delivery that have the potential to be replicated or adapted here in Maine. Other briefs in this series: Moving Rural Health Systems to Value-Based Payment Governance Maine\u27s Behavioral Health Services Service Delivery Advances in Care Coordination Emergency Care, and Telehealth Federally Qualified Health Center Initiatives Learn more at www.mehaf.or

Integrated Care for Older Adults in Rural Communities

Recognizing that traditional models of health care delivery and payment often produce fragmented and costly care and poor outcomes for those with the highest needs, many reforms under the Affordable Care Act (ACA) focus on realigning payment incentives and integrating care. These reforms presuppose the existence of supporting infrastructure and capacity, including dedicated care management staffing and health information technology and exchange. With a focus on community-dwelling older adults in need of integrated physical, behavioral health services, and long term services and supports (LTSS), this brief reviews the opportunities and challenges these reform initiatives present for rural communities: How easily can current models for integrating care be adapted to a rural context and culture? How well do they account for gaps and variations in local delivery systems, capacity, and infrastructure? Which strategies offer the greatest promise for addressing the needs of rural residents? Because Medicaid is a primary source of funding for LTSS, we focus this inquiry on models serving Medicaid-eligible individuals; in some cases these programs may also serve individuals who are also eligible for Medicare