ANNOUNCEMENT: Multiple traning sessions have been scheduled for community health workers and those dealing with diabetes and pain management among individuals with developmental disabilities. For information, visit the SIM calendar or check out these flyers:

SIM – Year Four – 2017

In 2013, Maine was awarded a three-year, $33 million dollar State Innovation Model (SIM) grant from the Center for Medicare and Medicaid Innovation. Over the last three years, SIM established an unprecedented partnership among physical and behavioral health providers, public and private insurers, data and system analysts, purchasers, workforce developers, and Maine consumers in an attempt to advance the Triple Aim goals.

Over the last three years, SIM facilitated important and impactful work, and has received a No-Cost Extension (NCE) to continue the work, with a narrower focus, for an additional year. The two focus areas are prevention of diabetes, and avoidable hospital readmissions. The activities for this fourth year have been designed to directly impact these two areas within Maine’s healthcare system. The main activities for the remaining year of SIM are as follows:

Behavioral Health and Health Information Technology (HIT): Includes the funding necessary to continue expansion of the HIT connection. The NCE will provide for aligning practice workflow discussions with real use of data, and assuring that the behavioral health community continues prioritizing coordination of care for the high-cost, high-need patients they serve. MaineCare continues to expand its Behavioral Health Homes program, and this cost represents an extended contract with HealthInfoNet, which will continue completing electronic medical record connections and providing technical assistance to the behavioral health community in usage of the Health Information Exchange.

Predictive Analytics: As Maine uses the NCE period to complete expected growth in the Health Home, Behavioral Health Home, and Accountable Community models, we also intend to expand the usage of innovative HIT for those models. The Emergency Department usage notification and clinical dashboard technologies have shown great promise for Maine’s SIM to date, and continue to innovate with these technologies as the models expand. These monies will be allocated both to HealthInfoNet for the continued provision and development of the technologies, and by the State to expand the expertise of resources on this technology usage through a predicative analytics pilot. A predictive analytics pilot will provide essential tools to DHHS to provide high quality and cost effective care to MaineCare members. The pilot will provide DHHS with awareness of the MaineCare members who are likely to become the highest service utilizers and those with increasing risk scores. Appropriate use of predictive analytics will enable proactive care management and result in cost avoidance for these members. This pilot is modeled after the work of St. Joseph’s Hospital in Bangor, Maine.

Public Health Data: In addition to SIM’s core success measures, MaineCare and the Maine Centers for Disease Control and Prevention (CDC) also collect and report population health metrics collected by the Maine Tracking Network and the Pregnancy Risk Assessment Monitoring System (PRAMS).

Maine Tracking Network: The Maine Tracking Network provides data tables, maps and charts for the following health topics: lead poisoning, asthma, air quality, birth defects, birth outcomes, cancer, heat illness and Lyme disease. Data can be found at

Pregnancy Risk Assessment Monitoring System (PRAMS): PRAMS is an on-going, population-based surveillance system designed to identify and monitor selected maternal behaviors and experiences before, during, and after pregnancy among women who have recently given birth to a live infant. Data are collected monthly from women using a mail/telephone survey. The overall goal of PRAMS is to provide data and analyses on maternal behaviors during pregnancy and early infancy which will be used to improve maternal and infant health in Maine. Data can be found at

Workforce Development: Over the SIM’s first three years, there was an integrated health workforce development component focused on mental health. The component included the development of specialized curriculums and informational resources for Health Home coordinators, peers, and families that are part of the Behavioral Health Home team. The educational resources were placed into a portal that is accessible to those who need the information. The NCE provides for the management of the educational portal, facilitating access to the critical information and the maintenance of the content.

The Maine Developmental and Disabilities Council will work to improve care for individuals with Intellectual and Developmental Disabilities (I/DD) who also have diabetes. The NCE year will provide evidence-based methods other than antipsychotic usage that caregivers can use to decrease challenging behaviors. A targeted effort will be used to highlight preventative diabetes care, identifying pain in individuals with diabetes and I/DD, and strategies to manage diabetes in the I/DD population. In one year, it is anticipated that a minimum of 50 medical practitioners and 200 direct service providers/case managers will be engaged.

Diabetes Prevention: The focus during the NCE continues to be on diabetes prevention, and these funds will be used to expand the National Diabetes Prevention Program dashboard, which tracks those who have used the program and then aids the practices with updates on the participants.

Data Focused Learning Collaborative (DFLC): Quality Counts will continue providing training to Health Homes (HH) and Behavioral Health Homes (BHH) to improve care based on effective data use and the implementation of a continuous improvement process. These funds will be allocated to Quality Counts to continue providing these services to MaineCare. Health Homes and Behavioral Health Homes are in the following tiers:

    1. Tier One – Beginners: HHs and BHHs, which have yet to achieve Core Standards and all new HH and BHH practices
    2. Tier Two – Improvers: HHs/BHHs chosen by MaineCare that have achieved Core Standards and/or whose performance is below average on the chosen SIM diabetes measures
    3. Tier Three – Achievers: HHs/BHHs chosen by MaineCare that have achieved Core Standards that are above average in performance results for the chosen SIM diabetes measures.
    4. Tier Four – Innovators: The HH/BHHs chosen throughout the year by MaineCare that are regularly in top tier results for the chosen SIM diabetes measures and have capacity to build additional data-driven improvement practices.

Accountable Communities: The continued expansion of the Accountable Community model in Maine requires ongoing support for the analytics necessary to calculate the shared savings. Funds allocated during the NCE will be used by the Maine Health Management Coalition for the continued provision of these services.