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In 2007-2008, the Maine Legislature created a bipartisan Commission to Study Primary Care Medical Practice. The Commission, in turn, recommended the development of the Patient-Centered Medical home (PCMH) Pilot. The legislature appropriated $500,000 for that purpose in 2009, and three collaborators – the Maine Quality Forum (part of the state’s Dirigo Health Agency), Quality Counts (a health care quality improvement collaborative), and the Maine Health Management Coalition (an employer-led coalition) – agreed to jointly lead the PCMH Pilot development. In 2009, 50 practices applied for participation. Twenty-two adult practices and four pediatric practices were selected. Together, these practices serve more than 68,000 Mainers.
Enhanced payments to practices began in January 2010. Participating practices receive per member per month (PMPM) payments from Medicaid, the state’s major commercial payers, and as of January 1, 2012, Medicare fee-for-service. They also receive a variety of transformation supports, including a learning collaborative, practice coaching, and consultation with key experts. Pilot leaders launched eight community care teams (CCTs) in early 2012 to support primary care providers in operating as medical homes. In April 2012, pilot leaders announced the pilot would expand to an additional 50 adult practices in its second phase, more than double the number planned. The pilot will also reopen the Community Care Team application process during summer 2012.
Federal support:
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Maine is one of the eight states selected to participate in the Medicare Advanced Primary Care Practice (MAPCP) demonstration program.
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Maine has received a planning grant from the Centers for Medicare & Medicaid Services (CMS) to develop a state plan amendment to implement Section 2703 of the Affordable Care Act (ACA), establishing health homes for Medicaid enrollees with chronic conditions.
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The Bangor Beacon Community was awarded $12.7 million in 2010 over three years to improve care for patients with chronic disease, reduce acute care utilization, and increase the use of Maine HealthInfoNet (the state health information exchange). Some practices in the PMCH Pilot will likely benefit.
Further information is available on the PCMH Pilot website.
Last Updated: May 2012
| Forming Partnerships |
A variety of stakeholders have helped develop Maine’s Patient-Centered Medical Home (PCMH) Pilot, including:
The convening entities – the Maine Quality Forum, Quality Counts, and the Maine Health Management Coalition – also bring the perspectives of a diverse range of constituencies, including employers, unions, and providers.
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| Defining & Recognizing a Medical Home |
Definition: According to the Maine Commission to Study Primary Medical Practice, “Principles of a patient centered medical home include a personal physician who leads a medical team that collectively takes responsibility for the ongoing care of patients with a whole-person orientation. Under the model, primary care is coordinated and integrated, and quality, safety and access are of the utmost importance. Hallmarks of the patient-centered medical home include planning, evidence-based medicine, clinical decision support tools, accountability, active participation in decision making by the patient and appropriate information technology supporting an environment of continual quality improvement and increased access through means including expanded hours, open scheduling and new options for expanded communication between doctor and patient.”
Recognition: Under the Patient-Centered Medical Home (PCMH) Pilot, practices are expected to attain at least National Committee for Quality Assurance (NCQA) Level 1 recognition within six months of beginning participation in the pilot. Practices are also expected to meet 10 “core expectations”:
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| Aligning Reimbursement & Purchasing |
For the duration of the Maine Patient-Centered Medical Home (PCMH) Pilot, participating practices will receive per member per month (PMPM) payments of $7.00 for each eligible MaineCare (Medicaid) beneficiary. Medicare fee-for-service will be paying $6.95 PMPM to the practices and $2.95 PMPM to the Community Care Teams (CCTs).
In addition to MaineCare and Medicare fee-for-service, three commercial payers – Anthem Blue Cross Blue Shield, Aetna, and Harvard Pilgrim – are also voluntarily participating in the Pilot. The amount that commercial insurers pay to practices is not publicly available.
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| Supporting Practices |
The Maine Patient-Centered Medical Home (PCMH) Pilot is offering a variety of supports to participating practice. These supports include:
Maine launched eight community care teams (CCTs) in early 2012 to support medical home practices. “The primary goal of the CCT is to provide support for the most complex, high risk, high need, and/or high-cost patients served by ME PCMH Pilot.” According to Maine Quality Counts, “CCTs will coordinate and connect patients to additional healthcare and community resources in order to support their health improvement goals, achieve better health outcomes and reduce avoidable costs.” The pilot will reopen the Community Care Team application process for Phase 2 of the pilot this summer.
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| Measuring Results |
The University of Southern Maine’s Muskie School of Public Service is undertaking an evaluation of Maine’s Patient-Centered Medical Home (PCMH) Pilot. The evaluation is assessing the impact of the PCMH Pilot on clinical outcomes, cost, and patient experience. PCMH Pilot sites are being compared with two control groups: (1) a group of highly capable practices that applied for participation in the Pilot but were not selected, and (2) a group of less capable practices (“usual care”).
The Centers for Medicare & Medicaid Services (CMS) is also evaluating the impact of the CSI-RI on outcomes for Medicare and Medicaid patients through a contract with RTI International. NASHP and the Urban Institute are subcontractors to RTI.
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