MaineCare Initiatives Supported Through

The State Innovation ModelStefanie Nadeau, Director

Office of MaineCare Services

MaineCare’s Health Home Initiatives

MaineCare’s Accountable Communities

Initiative

Maine’s Health Homes – Stage A

Primary Care Health Home Practice (HHP)

Community Care Team (CCT)

Health Homes

Serves adults and children with chronic health conditions

Health Homes

SIM Year 1 SIM Year 2

• Implemented the Health Home Utilization Dashboard, allowing Health Homes access to MaineCare data to better identify gaps in care

• Reopened the Health Home application, adding 22 new practices to the initiative for a current total of 170

• Established a regular auto-assignment process, adding 3500 new members over the course of the year for a current total of 52,000

• Worked closely with providers, SIM partners, and Muskie School of Public Service to improve the Health Home Enrollment System Portal

• Increase the number of providers participating in the Health Homes initiative

• Increase the number of MaineCare members served by Health Homes

• Improve the ability of Community Care Teams to serve MaineCare members with intense care coordination needs

• Implement Health Home-specific quality reports

Maine’s Behavioral Health Homes

Behavioral Health Home Organization (BHHO)

A Primary Care Practice (HHP)

Behavioral Health Homes

Serves adults and children with significant behavioral health needs

Behavioral Health Homes

SIM Year 1 SIM Year 2

• Finalized and obtained CMS approval for Behavioral Health Home State Plan Amendment

• Developed and finalized MaineCare rule for the Behavioral Health Home program

• Opened the Behavioral Health Home application and approved the participation of 26 Behavioral health Home organizations (currently 24)

• Enrolled approximately 2,000 adults and children in the BHH program

• Convened the BHH Work Group to support feedback from providers, consumers, families, and others

• Increase the number of eligible MaineCare members participating in Behavioral Health Homes

• Work with providers and stakeholders to refine and implement the model

• Implement Behavioral Health Home specific quality reports

• Review cost and utilization data in order to stabilize and grow the service

MaineCare’s Accountable Communities

Initiative

Accountable Communities

• Linked to “Develop New Payment Model” Strategic Pillar.

• An “AC” is a group of primary care practices -- and possibly other providers types -- represented by a “Lead Entity” that contracts with the Department.

• Members are assigned to an AC based on where they get their primary care, and in a few cases, Emergency Department services.

• A “Total Cost of Care” benchmark is set for each AC.

• The AC can share in up to 50% of savings if savings are > 2% (for 5000+ members) or 2.5% (1000-4999) members.

• Exact amount of savings depends on the AC’s quality score, made up of 18 different measures.

Maine PCMH Pilot/HH NEW Timeline!

SIM Year 1 SIM Year 2

• Issued Request for Applications.• State Plan Amendment approved by

CMS.• Worked towards finalizing complex

contracts with four AC covering 30,000 members.

• Completed analytics necessary for summer 2014 start date.

• Timely delivered all monthly reports to ACs; feedback from ACs has been extremely positive.

• Revise benchmarks for Round 1 AC Year 2.

• Round 2 postponed from 2015 to 2016.• Communication plan to generate

provider interest in applying for Round 2.

Workforce Development

Workforce Development Under SIM

Two things were clear when developing the SIM Grant application:

1. Healthcare workers were going to need to develop new skills and competencies in order to adapt to the new service models developing under SIM.

2. The Intellectually and Developmentally Disabled (I/DD) are some of the highest utilizers of the healthcare system, but do to a duplication of service issue they would be largely carved out of the new service models. It was necessary to find a way for them to also benefit from the work of SIM.

I/DD Workforce Development

SIM Year 1 SIM Year 2

• MaineCare and OADS convened a group of stakeholders that met over the course of three months.

• Identified priority problems faced by this population and a work plan to address these problems.

• In SIM Quarter 4 a contract was signed with Maine Developmental Disabilities Council (DDC) to accomplish work plan.

The DDC will:

• Hold breakout sessions at the Quality Counts Learning Sessions, and Regional Forums to educate providers on topics like “Transitions of Care” and “Communication and Pain in Non-Verbal Patients”.

• Developing a curriculum for case managers, direct service providers, and guardians that will teach them how act as “care coordinators” and interact with physical health providers.

BHH Workforce Development

SIM Year 1 SIM Year 2

In SIM Quarter 3, SAMHS and the Office of MaineCare encumbered a contract with AdCare Educational Institute of Maine, Inc. to:

• Develop a physical health component in the redesign of the MHRT/C curriculum

• Identifying a list of core competencies for the Children’s BHH workforce.

• The new MHRT/C curriculum will be unveiled in June 2015.

• The identified core competencies for Children’s BHH workforce will also be presented at that time

• Recommendations for trainings will be presented help prepare the workforce to meet those competencies.