Maine Patient-Centered Medical Home Pilot

PROJECT STATUS
Pilot/Demo Length: 
2-3 years

The Maine Patient-Centered Medical Home Pilot is the first step in achieving statewide implementation of the PCMH model. We are working with participating practices to support their continued transformation to a more patient-centered model of care, and are working with all major private payers in the state and Medicaid (MaineCare) to pilot an alternative payment model that recognizes and rewards practices for demonstrating high quality and efficient care.

We will evaluate the pilot using a comprehensive approach that includes nationally recognized measures of quality, efficiency, and patient centered measures of care that reflect the six aims of quality care identified by the Institute of Medicine (i.e. safe, effective, timely, efficient, equitable, and patientcentered). The ultimate goal of this effort is to sustain and revitalize primary care both to improve health outcomes for all Maine people and to reduce overall health care costs. The Pilot is committed to undertaking a rigorous evaluation and plan to compare outcomes from intervention and controls groups using a quasiexperimental design with interrupted timer series.

CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
Maine Quality Forum, Quality Counts, and Maine Health Management Coalition
Primary Contact: 
Lisa Letourneau MD, MPHLisa Letourneau MD, MPH
E-mail: 
letourneau.lisa@gmail.com
Phone: 
207/415-4043
Additional Contact
Name: 
Josh Cutler MD
Phone: 
207/287-9959
Participating Stakeholders: 

Maine Quality Forum; Quality Counts; Maine Health Management Coalition; Anthem BCBS of Maine; Aetna; CIGNA; Harvard Pilgrim Health Care; MaineCare (Maine Medicaid); Maine Association Family Physicians; Maine Chapter, American College of Physicians; Maine American Academy of Pediatricians; Maine Medical Association; Maine Osteopathic Association; Maine Primary Care Association; Consumers for Affordable Healthcare; Multiple provider organizations; University of Maine Employees; Maine Nurse Practitioners Association.

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
26
Number of Participating Physicians: 
221
Physicians per practice: 
1-34
Types of Practices: 
Internal Medicine, Family Medicine, Pediatrics
Health Plan Lines of Business Included: 
Commercial;Other: Medicaid—through Primary Care Care Management Program
Overall Number of Covered Lives: 
75000
Technology Characteristics at Start of Pilot: 

Estimated % of practices with practice management systems: 76-95%
Estimated % of practices with electronic medical record: 76-95%
Estimated % of practices with registry software: 76-95%
Other: Two practices using patient portals into their EMRs

Consumer Involvement: 

Formal patient advisory panel(s) Consumer organization input incorporated in the project design process Consumer organization input incorporated in evaluation process Coments: Have also included consumers on our governance group for PCMH Pilot, and have explicit expectation that participating practices will include at least two patients or family members in their local redesign efforts. Furthermore, consumers are involved as members of a task force, reviewers of audiovisual and written materials, participants in focus groups, and participants at conferences and working meetings. Consumer family members are participants in quality improvement activities.

PRACTICE TRANSFORMATION SUPPORT (INCLUDING TECHNOLOGY)
Focal areas of transformation: 

Care Coordination
Increased Access
Information Technology (e.g., registries, patient portals)
Team Approach to Care
Other:
Leadership; population risk stratification and management; practice-integrated care management; behavioral-physical health integration; inclusion of patients and families; connection to community; committment to reducing unnecessary health care spending; reducing waste and improving cost effective use of health care services. The pilot is incorporating a PCMH learning collaborative as well as external quality improvement coaches for practices.

Payment Model: 

Prospective care management fee (pmpm payment)

PROJECT EVALUATION
Types of data to be collected : 

Clinical Quality
Cost/Efficiency
Patient Experience/Satisfaction
Provider Experience/Satisfaction

Which of the data types are being shared?: 

Clinical quality measures, patient experience of care, cost/resource use (via claims)

Are the practices involved in the demonstration participating in any data sharing arrangements? If so please describe.: 

Yes

Relevant links: 

General summary info: http://www.mainequalitycounts. org/patient-centered-medical-home/main/
Press release: http://www.mainequalitycounts.org/ about-qc/maine-patient-centered-medicalhome- pilot-launched.html