MaineCare Launches New Payment Model to Improve Primary Care Services

July 20, 2022

The Office of MaineCare Services has launched Primary Care Plus (PCPlus), a new initiative to support primary health care, advance health care quality, and improve the efficiency of health care spending. PCPlus enables MaineCare to replace the prior outdated and convoluted system of payments and offer primary care practices a single, integrated process for reimbursement with greater flexibility and incentives to meet MaineCare members’ health care needs. 

Over 220 primary care practices are participating in PCPlus as of July 1. These practices care for over 210,000 MaineCare members – or one in six Maine residents – of all ages. Through PCPlus, primary care providers take accountability for patient care, build bridges to community resources, use data to inform performance management, and work collaboratively with families and MaineCare members to improve service delivery. The model focuses on coordination and integration of primary and behavioral health care, providing access to a broad range of preventive services and screenings, and connecting members with a range of additional services including oral health care and treatment for substance use disorders. In addition, to support broader health care transformation, PCPlus is aligned with Primary Care First, which is a multi-payer advanced primary care initiative through the federal Center for Medicare and Medicaid Innovation.

PCPlus is part of MaineCare’s work to continue improving the way it pays for health care services, so the system works better for MaineCare members and providers. PCPlus replaced three separate and administratively complex primary care programs within MaineCare, some of which had remained relatively unchanged for over 20 years. With this change, MaineCare is transitioning away from a fee-for-service payment system toward an approach that provides payments tied to cost- and quality-related outcomes. Over time, PCPlus will offer increasing levels of flexibility through these value-based payments.

The PCPlus payment model is an example of an Alternative Payment Model (APM). An APM is a health care payment method that uses financial incentives to raise the quality of care, improve health outcomes, and lower costs for patients, purchasers, payers, and providers.  In concert with other strategies, APMs are key tools to advance policies that improve the quality and value of health care. The Maine Department of Health and Human Services and the Office of MaineCare Services set a goal to have at least 40 percent of MaineCare payments paid through APMs by the end of 2022. By the end of 2020, MaineCare had reached 36 percent of payments paid through APMs and is currently calculating its performance for 2021. 

Through mechanisms such as MaineCare Rate System Reform, codified this past legislative session through LD 1867, stakeholders will have ample opportunity to continue to shape the prioritization and implementation of the next wave of APMs. The Department looks forward to partnering with MaineCare members, providers, legislators, and associations to drive and support this critical work.

More information about APMs is available from the Health Care Payment Learning & Action Network.

For more information on PCPlus, please review the PCPlus policy (MaineCare Benefits Manual, Chapter VI, Section 3).