Strengthen Primary Care

The Maine State Innovation Model award is funding the following efforts to strengthen primary care:

Implement MaineCare Accountable Communities - Through the MaineCare Accountable Communities Initiative, the Department will engage in shared savings arrangements with provider organizations that commit to coordinating the care of all patients who rely on those organizations as their point of access to healthcare services. Accountable Communities that demonstrate cost savings and meet quality performance benchmarks will share in savings generated under the model.
Six Accountable Communities have applied to participate in the first round of the initiative. The Department is working on rulemaking with the Attorney General's Office with the target implementation date of May 1, 2014. An estimated 50,000 members will be attributed through these Accountable Communities in 2014. An additional 25,000 members, while not directly attributed, receive some of their care through these Accountable Communities and will also benefit from improved systems of care coordination. In whole, almost 30% of the MaineCare population will benefit from the Accountable Communities Initiative in this first round.

Accountable Communities will result in such improvements as:

  • Reductions in inpatient readmissions
  • Less non-emergent Emergency Department use
  • More effective use of Electronic Medical Records and real-time data through Maine's Health Information Exchange
  • Increased investment in care management for members with chronic conditions, and
  • More emphasis on preventive care

MaineCare Notification Project - Currently, MaineCare Care Managers receive Emergency Department (ED) and inpatient discharge summary reports for their members from the treating hospital via fax as requested. HealthInfoNet (HIN) will automate this process between the hospitals and MaineCare, on the hospitals behalf, using the Health Information Exchange. HIN will provide MaineCare Care Managers real-time electronic "notifications" using secure email of these events of care. The new electronic process aims to create a more efficient workflow for both the hospital and MaineCare staff while supporting MaineCare member's best possible care.

MaineCare Clinical Dashboard - HealthInfoNet (HIN) will provide a "Clinical Dashboard" to MaineCare using their member's information available in the Health Information Exchange (HIE). The goal is to make the HIE clinical data available to MaineCare as a payer to support program and policy development related to population health efforts.

Provider Portal- One of the benefits of having an all-payer claims database in Maine is the ability to offer healthcare providers an in-depth look at the makeup of their patient populations. Under the Maine SIM award, the Maine Health Management Coalition has been contracted to build secure portals for providers to log in and examine claims data. This data will allow providers to allocate resources at their practice appropriately, and to target struggling patients that may need additional support.

Provider Practice Reports - 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.

Patient Portal Pilot - HealthInfoNet will partner with one Health Information Exchange (HIE) health care organization to provide their patients with access to their statewide Health Information Exchange (HIE) record. The pilot site must be able to connect their current "Patient Portal" to the HIE to allow patients to download a medical record summary document from the HIE known as the "Continuity of Care Document" (CCD).