Cutler Institute for Health and Social Policy

Disability and Aging Products: Integrated Care, Payment, and Quality

Relationship Between Mental Illness and Diabetes

Maine’s Multiple Chronic Conditions (MCC) Project
The MCC Project, funded by the Agency of Healthcare Research and Quality in partnership with Maine’s Office of Quality Improvement, explored the impact of co-occurring behavioral disorders and chronic medical conditions on interventions, outcomes, and medical costs across health and mental health systems of care.

Half of this study’s cohort had a behavioral health disorder (mental illness, substance abuse, both mental illness and substance abuse, or developmental disability/brain injury).  Those with behavioral health disorders have significantly higher rates of multiple medical co-morbidities, higher total and non-behavioral health costs and higher rates of utilization of medical services, including emergency room use, hospitalization, avoidable hospitalization, readmission, and outpatient care.  While it has long been known that total medical costs are influenced by behavioral health conditions, project findings suggest that behavioral health disorders have as much of an impact on medical costs as having three chronic medical conditions. 

The project also studied the comparative impact of fragmented and continuous primary care on the cost and utilization of MaineCare members with multiple medical and/or behavioral conditions.  Project findings indicate that fragmentation of primary care is higher among people with behavioral health disorders, multiple medical co-morbidities, and complicated diabetes, and is associated with significantly higher costs and utilization of emergency room and other services.

For more information on MCC project findings and products, please visit the project’s website at: or contact Cathy Mcguire

Profiles of People Who are Dually Eligible for Medicare and Medicaid in Maine

Chartbook: Members Dually Eligible for MaineCare and Medicare Benefits
Prepared in cooperation with the Maine Department of Health and Human Services under the State Profile Tool Grant, this report provides a profile of the cost and use of services of people who are dually eligible for Medicare and MaineCare services.  

Chartbook: MaineCare Members Who Use Long Term Services and Supports
Prepared in cooperation with the Maine Department of Health and Human Services under the State Profile Tool Grant, this report provides a profile of the MaineCare and Medicare costs and use of MaineCare members who use long term services and supports. The report provides separate data on the cost and use of MaineCare only members and dually eligible members. 

Implementation and Evaluation of Health Homes in Maine

Maine Health Homes and Stakeholder Engagement
The Muskie School has facilitated the engagement of stakeholders in the design and development of the Maine Health Home program. Based on input from stakeholders, we prepared consumer friendly brochures for members to explain Maine’s health home program. For more information contact Nadine Edris

Maine Health Home Enrollment System 
The Department plans to implement health homes in selected primary care and community care team sites.  The Muskie School of Public Service School will design and develop a secure web-based health home enrollment system (HHES) that will allow two way communication and information sharing between health home providers, community care teams and Department staff.  The Health Home initiative will be implemented in two stages. Stage A will include the implementation of health homes for people with specified multiple chronic conditions and will include a special payment to qualified health home practices and community care teams (CCTs). Stage B will include the implementation of health homes for adults with serious and persistent mental illness and children with serious emotional disturbances.  Stage B health homes will include a special payment to qualified mental health community care teams as well as health home practices.

The development of the Health Home Enrollment System (HHES) will include the following functionality for Stages A and B using:

  1. Identification and tracking of members eligible for health homes,
  2. Member opt out/in letter generation and transmission to the Department for mailing,
  3. Secure web based portal accessible to the Department, health home practices and CCT staffs,
  4. Curriculum and training for providers and Department staff,
  5. Enrollment management reports for providers and state,
  6. Capture monthly attestation by provider, by member of meeting requirements for payment,
  7. Calculation of Health Home Payments and transmitting to the Department  for payment,
  8. On behalf of state, provide electronic Health Home member protected health information to Maine Health Management Collation.

An incremental software development life cycle (ISDLC) approach will be used to implement deliverables. For more information contact, Cathy McGuire

Maine Health Home Evaluation

The Muskie School is conducting the evaluation of the implementation and outcomes of the Maine Health Home program.  The Muskie School is developing the evaluation plan for the Health Homes, coordinating with national evaluators on the plan design,  will conduct  the implementation evaluation for the first year, and produce baseline analyses comparing health homes study and comparison sites for the outcomes component of the evaluation. For more information, contact Kim Fox

Evaluation of State Demonstrations for Dual Eligible Beneficiaries 

The Medicare-Medicaid Coordination Office (MMCO) and Innovation Center at the Centers for Medicare & Medicaid Services (CMS) have created new opportunities to test integrated care programs for beneficiaries who are dually eligible for Medicare and Medicaid (Medicare-Medicaid enrollees). The goal of these demonstrations is to develop person-centered care delivery models integrating the full range of medical, behavioral health, and long-term services (LTSS) for Medicare-Medicaid enrollees, with the expectation that integrated delivery models will address the current problems associated with the lack of coordination of Medicare and Medicaid benefits, financing, and incentives. Twenty-five states have submitted proposals to CMS and are moving forward to further develop and implement their demonstrations.

CMS contracted with RTI International to monitor the implementation of the demonstrations and to evaluate their impact on quality, utilization and costs under the evaluation titled Measurement, Monitoring, and Evaluation of State Demonstrations to Integrate Care for Dual Eligible Individuals over time. The evaluation includes an aggregate cross-state evaluation and state-specific evaluations.  RTI has partnered with the Muskie School of Public Service, Urban Institute, the National Academy of State Health Policy, American Institutes for Research, Actuarial Research Corporation and the Henne Group to conduct the evaluation which will include site visits, key informant interviews, focus groups, and analyses of quality, service use, and cost data. 

Managed Long Term Care Services and Supports (MLTSS)

The Muskie School, in partnership with L&M Policy Research, designed and developed an online curriculum offering states guidance on program design, Medicaid authorities andother information related to the effective management of MLTSS. Conducted for the Centers for Medicare &Medicaid Services, the tool is structured in accordance with the decisions a state must make when considering MLTSS, including the implications of the various options and their trade-offs. Click here to visit the MLTSS site.