MaineCare's Health Homes Initiative
Program Location:
Augusta, ME
Payer Type:
Medicaid
Parent Program:
Payers:
Medicaid
Accreditation/Recognition:
NCQA
Reported Outcomes
Description:
Maine has three Health Homes programs, the first is their traditional chronic conditions HH. On January 17, 2013, the Centers for Medicare & Medicaid Services (CMS) approved a Section 2703 health home State Plan Amendment for Medicaid enrollees with chronic conditions that is closely tied to the state's Patient-Centered Medical Home pilot. To be eligible, patients must have two qualifying chronic conditions, or one qualifying chronic condition and risk for a second. Conditions include: Mental health condition (non‐SMI), Substance use disorder, Asthma, Diabetes, Heart disease, BMI over 25, tobacco use, COPD, hypertension, hyperlipidemia, developmental disabilities or autism spectrum disorders, acquired brain injury, seizure disorders and cardiac and circulatory congenital abnormalities.
The second is a Behavioral Health Home (BHH), and the third is an Opioid Health Home (OHH). Opioid Health Homes (OHH) deliver integrated office-based Medication Assisted Treatment (MAT), opioid dependency counseling, and comprehensive care management for eligible MaineCare members and uninsured individuals with opioid use disorder.
The Maine Health Homes initiative builds on the 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.
For more information, view the Year 1 Report: Implementation Findings and Baseline Analysis
Payment Model:
Health homes receive a $12.00 per-member per-month (PMPM) care management fee in addition to fee-for-service payments. Community care teams receive $129.50 PMPM, supported by Maine’s community care teams, who provide intensive care coordination and other wrap-around services to the top 5-percent of high-cost, high-risk beneficiaries.
PCMH/HH practices and CCTs in the MAPCP demonstration also receive payments from Medicare for each Medicare benefi ciary assigned to their practice (in addition to usual fee-for-service paid claims, i.e. $6.95 PMPM for practices and $2.95 PMPM for CCTs) to pay for care coordination, improved access, patient education, and community based support, and other patient support services.
Fewer ED / Hospital Visits:
Some CCTs who have analyzed their own data reported finding reductions of up to 50 percent in emergency department visits and hospital stays.
Other Outcomes:
Maine’s community care teams (CCTs), who provide care coordination services to the top 5 percent of high service utilizers enrolled in health homes, reported seeing the positive impacts their services have on their complex-need patients, including better self-management, treatment adherence, and lower utilization of emergency and hospital
services.
Data Source(s):
Last updated Marzo 2019
