Develop New Payment Models

The Maine State Innovation Model award is funding the following payment reform activities:

Provide Quality Improvement Support for Behavioral Health Homes Learning Collaborative – Maine Quality Counts will support a Learning Collaborative for 27 Behavioral Health Home organizations. The Learning Collaborative will offer practitioners the opportunity to come together in a structured way to learn from national, state, and local experts and from each other to improve the quality of services they provide.  The BHH Learning Collaborative will focus on evidence-based best practices to improve the integration of behavioral and physical health services to improve care for adults with Serious Mental Illness (SMI) and children with Serious Emotional Disturbance (SED). Additionally, the Collaborative will seek to identify best practices that can help BHHOs enhance coordination of care and bring about improvements and efficiencies that will help to decrease costs. The Learning Collaborative will incorporate provider and consumer perspectives and will present evidence-based and emerging best practices to participants for shared learning. Participants will be involved in a series of meetings to learn about best practices in chosen areas, quality improvement methods, and change ideas, and to engage in peer learning where participants share experiences on what has worked in their settings. Quality Counts will offer three day-long Learning Sessions per year as well as conduct site visits to assess baseline; hold webinars to share best practices and innovative approaches; and provide technical assistance as needed.

Provider Practice Reports – Provider Practice Reports, like the provider portal, offer healthcare providers valuable insight into how well their practice is performing on key cost and quality metrics.  The reports give providers insight into which areas they are performing well in, and which areas are in need of improvement.

Public Reporting for Quality Improvement & Payment Reform – We know that what gets measured gets improved, so in an effort to strengthen the quality and lower the cost of healthcare in Maine, the State Innovation Model award will provide additional funding to develop new quality and cost metrics that will be publicly reported on the Maine Health Management Coalition's website, www.getbettermaine.org. Patients will be encouraged to use the information to find top performing doctors and hospitals, and employers will be encouraged to use the information in their benefit designs.

Stimulate Value-Based Insurance Design (VBID) – One of the reasons the US healthcare system is the most expensive in the world is because our current "fee-for-service" system incentivizes high volume, high cost care. At most hospitals and medical practices around the country, doctors are paid based on the number of services provided, not for making patients healthy.

One way the State hopes to impact high healthcare costs is by changing the incentives in the market and aligning costs with the relative value of healthcare services. Value-Based Insurance Design is a form of health benefit design that provides incentives to consumers/patients that opt for care that is both high quality and low cost. It also incentivizes healthcare providers to choose lower cost care options when a range of equally effective approaches to care are available for a given patient.

To explore VBID in more detail and assess its potential for increasing healthcare value in Maine, the Maine Health Management Coalition (MHMC) convenes the VBID Workgroup.  Facilitated by the MHMC's VBID Manager, the workgroup is charged with examining VBID examples around the country and identifying best practices in a value-based insurance design.  They are also responsible for creating a means to rank insurance plans according to adopted VBID metrics, and encouraging Maine businesses to adopt the new benefit model.