A project funded by State Health Access Reform Evaluation (SHARE) to inform federal and state implementation of the Medicaid expansions under the ACA by estimating the size and characteristics of rural residents likely to be newly eligible. The study will provide nationally representative information that identifies the extent to which rural residents live in states that have already expanded coverage to low-income adults; how many eligible individuals have participated; the characteristics of the remaining pool of the rural uninsured; and the potential impact of Medicaid expansions on rural primary care and delivery system capacity.
Health Services Access, Quality, and Financing
The purpose of this Maine Patient Centered Medical Home (PCMH) Pilot is to improve quality of care, efficiency, and patient/family satisfaction provided by primary care practices. Its premise is that the resources provided to practices through the Pilot (including enhanced payments, training, consultation, and learning collaborative) will help them transform themselves and reach a higher level of functionality as medical homes, which in turn will lead to improvements in quality of care, efficiency, and patient/family satisfaction. The three-year Pilot was convened by MaineCare, the Maine Quality Forum, and Quality Counts. The participating payers are MaineCare (Maine Medicaid), Aetna, Anthem, and Harvard Pilgrim Health Care. Three aspects of the Pilot are being evaluated by the Muskie School of Public Service: 1) patient’s experiences; 2) the implementation process and interim results during Year 1; and 3) changes in the quality and efficiency of primary care. This report focuses on findings from the implementation evaluation. The objectives of the implementation evaluation are to
• Profile the characteristics of the Pilot practices
• Describe the practices’ objectives and strategies for implementing the Pilot
• Describe the implementation process during Year 1
• Provide practical guidance to the practices, the Pilot conveners, and MaineCare
• Develop profiles of the Pilot practices for use in the quality and efficiency evaluation
• Make recommendations for use by evaluators of other PCMH pilots
Background: National data demonstrate that mental health visits to the emergency room (ER) comprise a small, but not inconsequential, proportion of all visits; however, we lack a rural picture this issue. Purpose: This study investigates the use of Critical Access Hospital (CAH) ERs by patients with mental health problems to understand the role these facilities play in rural mental health needs, and the challenges they face. Methods: We collected primary data through the combination of a telephone survey and ER visit logs. Our sampling frame was the universe of CAHs at the time the survey was fielded.
Key Findings: 43% of CAHs surveyed operate in communities with no mental health services, while 9.4% of all logged visits were by patients identified as having some type of mental health problem. The most common problems identified were substance abuse, anxiety and psychotic disorders. Only 32% of CAHs have access to onsite detoxification and 2% have inpatient psychiatric services, meaning that patients in need of these services typically must leave their communities to gain treatment. Conclusions: The lack of community resources may impact CAHs ability to assist patients with mental health problems. Among those with a primary mental health condition 21% left the ER with no or unknown treatment, as did 51% of patients whose mental health condition was secondary to their emergent problem. Patients in need of detoxification or inpatient psychiatric services often must travel over an hour to obtain these services, potentially creating significant issues for themselves and their families.
Suggested Citation: Hartley D, Ziller E, Loux S, Gale J, Lambert D, Yousefian AE. Use of Critical Access Hospital Emergency Rooms by Patients with Mental Health Symptoms. J Rural Health. 2007;23(2):108-115.
This report includes a final list of recommended core quality measures for use in assessing the quality of home and community-based services (HCBS) Waiver services. The indicators are organized according to the HCBS Quality Framework, a document developed by the Centers for Medicare & Medicaid (CMS) to provide a common frame of reference for conducting productive dialogue among stakeholders. The report also includes recommendations for implementing the core quality indicators, lessons learned throughout the three-year grant, and a plan for sustaining the work of this grant.
Suggested Citation: Fralich, J., & Bratesman, S. (2004). Quality indicators for home and community-based services. Portland, ME: University of Southern Maine, Edmund S. Muskie School of Public Service.
[article abstract]: In response to continuing concerns about escalating health care costs and poor quality care, many health plans have adopted a strategy called
The authors studied the early impact of Part D on older or disabled Medicaid beneficiaries who had prescription drug coverage prior to Part D through MaineCare ("dual eligibles") or the DEL benefit; local and statewide organizations that work with and advocate for Medicare beneficiaries, which often stepped forward to help make Part D work for the beneficiaries; and Medicare beneficiaries who were not duals or DEL enrollees.
- Just over one-third of all children with a mental health problem received a mental health visit in the past year;
- Controlling for other characteristics that affect access to care, rural children are 20% less likely to have a mental health visit than urban children;
- Having Medicaid or SCHIP increases the likelihood that a child will receive services, and this is pronounced in rural areas.
Lambert D, Ziller EC, Lenardson JD. Rural Children Don't Receive the Mental Health Care They Need. (Research & Policy Brief). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; January 2009.
Project staff will conduct a telephone survey of parents of 1200 current enrollees, 300
disenrollees, and 300 new enrollees of a sample of the MaineCare population; it will be stratified by traditional
Medicaid, Medicaid expansion, and Separate Child Health Program populations. The survey collects information on
satisfaction with MaineCare providers and services, unmet needs, provider education practices, health status, health
behaviors, insurance, and parent's employment status. The survey instrument was revised in 2006 to include several
measures from the National Survey of Children's Health (NSCH), including medical home, children with special
health care needs (CSHCN), and specific physical and mental health conditions. Because past surveys identified a
high prevalence of overweight among children on MaineCare, the survey instrument also includes a series of items
designed to measure physical activity and nutrition behaviors among children.