Maine PCMH Pilot &
Community Care Teams:
A Targeted Strategy to Improve Care
& Control Costs for High-Needs
Patients
Lisa M. Letourneau MD, MPH
MeHAF Legislative Breakfast
March 2013
The Medical Home:
A Start for Change!
Providers transform practice,
create value with viable &
sustainable payment for desired
services
= Practice Transformation
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N
D
Employers & payers pay for
desired services because
primary care demonstrates value
& saves money
= Payment Reform
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Maine PCMH Pilot Leadership
DHA’s
Maine
Quality
Forum
Maine
Quality
Counts
Maine
Health
Management
Coalition
MaineCare (Medicaid)
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Maine PCMH Pilot Expansion
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Maine PCMH Pilot
Practice “Core Expectations”
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Demonstrated physician leadership
Team-based approach
Population risk-stratification and management
Practice-integrated care management
Same-day access
Behavioral-physical health integration
Inclusion of patients & families
Connection to community / local HMP
Commitment to waste reduction
Patient-centered HIT
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Community Care Teams
• Multi-disciplinary, community-based, practiceintegrated care teams
• Build on successful models (NC, VT, NJ)
• Support patients & practices in Pilot sites, help
most high-needs patients overcome barriers –
esp. social needs - to care, improve outcomes
• Key element of cost-reduction strategy,
targeting high-needs, high-cost patients to
reduce avoidable costs (ED use, admits)
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Maine PCMH Pilot Community Care Teams
Environment
Schools
Transportation
Housing
Workplace
Outpatient
Services
Care Mgt
Family
Food Systems
High-need
Individual
Shopping
PCMH Med Mgt
Practice
Specialists
Coaching
Behav. Health
& Sub Abuse
Income
Physical
Therapy
Heat
Faith
Community
Literacy
Hospital
Services
Maine Medicaid (MaineCare)
Health Homes Initiative
Stage A:
• Health Home = PCMH primary care practice + CCT
• Payment weighted toward medical home
• Eligible Members:
• Two or more chronic conditions
• One chronic condition and at risk for another
Stage B:
• Health Home = CCT with behavioral health expertise + PCMH
primary care practice
• Payment weighted toward CCT
• Eligible Members:
• Adults with Serious Mental Illness
• Children with Serious Emotional Disturbance
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MaineCare Health Homes Proposal
Stage A: Help Individuals
with Chronic Conditions
Care Mgt
Health Homes
Beneficiary
Med Mgt
PCMH Practice
Coaching
Behav. Health
& Sub Abuse
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MaineCare Health Homes Proposal
Stage B: Help Individuals
with Severe Mental
Illness and/or Children
with Serious Emotional
Disturbance
Behav Health &
Sub Abuse
Health Homes
Beneficiary
Med Mgt
Coaching
PCMH Practice
Care Mgt
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Unique Features of Maine Approach
• Defining “Health Home” as PCMH + CCT
• Adding CCT services to specifically support
high-needs, high-cost members (recognizing
these mbrs can often outstrip capacity of most
primary care practices – even PCMHs!)
• Recognizes differences between
“routine”/chronic disease care management &
CCT multi-disciplinary team approach for most
high-needs mbrs
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Financing CCTs: Maine Approach
• Linked CCT model, payment to multi-payer
PCMH model
• Leveraged public, private payers agreement to
provide pmpm payment
• Participation in CMS MAPCP demo brought in
Medicare as payer
• Alignment of ACA Health Homes with multipayer Pilot provided opportunity to leverage
federal 90:10 match for CCT services
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Maine’s Medical Home Movement
~ 540 Maine Primary Care
Practice Sites
100+ NCQA PCMH
Recognized Practices
70 MaineCare
HH-only Practices
Payers:
• Medicare
• Medicaid (HH)
• Commercial
plans (Anthem,
Aetna, HPHC)
• Self-funded
employers
25 Maine
PCMH Pilot
Practices
50 Pilot
Phase 2
Practices
14 FQHCs
CMS APC
Demo
Payer:
Medicaid
Payer:
Medicare
: Who We Are
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Independent, multi-stakeholder alliance in Maine
working to transform health and healthcare by leading,
collaborating, and aligning improvement efforts
Only organization working to improve quality of care
for all Maine people
Members include consumers, doctors, nurses,
hospitals, health systems, payers, employers,
government, policy makers, and others working to
improve health and healthcare
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Contact Info / Questions
 Lisa Letourneau MD, MPH
• LLetourneau@mainequalitycounts.org
• 207.415.4043
 Maine Quality Counts
• www.mainequalitycounts.org
Maine PCMH Pilot
• www.mainequalitycounts.org
(See “Programs”  PCMH)
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