Cooperative agreement through the University of Minnesota, to monitor and evaluate the Medicare Rural Hospital Flexibility Grant Program (Flex Program). The monitoring project is assessing the impact of the Flex Program on Critical Access Hospitals and their communities and the role of states in achieving overall program objectives.
Health Services Access, Quality, and Financing
Maine, in partnership with the State of Vermont was awarded a five-year Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant to "test promising ideas for improving the quality of children's health care." The Department of Health and Human Services (DHHS) is the designated lead agency for the federally-funded initiative. The Improving Health Outcomes for Children (IHOC) project promotes the use of quality measures and information technology to improve Medicaid member children's timely access to quality care.
Under IHOC's Category E, Vermont will build upon its leadership role as convener of the National Improvement Partnership Network to increase the number of participating states (particularly non-Demonstration states), expanding the reach of CMS's child health improvement efforts. As part of its sustainability plan, Maine will be one of the states working with Vermont to establish a child health Improvement Partnership program.
Muskie staff will prepare a white paper summarizing the existing evidence on successful medication management strategies to help inform future grant-making by the Foundation and program implementation by current and future grantees. The summary will assess strategies that have been proven effective in improving adherence, optimizing therapeutic outcomes, reducing overuse of medications and improving appropriateness of drugs prescribed for uninsured and underinsured individuals. It will particularly focus on strategies focused on chronic care management and/or strategies employed to improve medication management during transitions in care from one setting to another.
The purpose of this project is to determine where and how tiered provider networks are utilized, to describe the characteristics of these networks, and to develop insights into strategies used by health plans when implementing and operating tiered provider networks. The concept underlying tiered networks is that health plans may be able to reduce costs and/or improve quality by directing consumers to certain providers and to avoid others. Unlike traditional HMO arrangements, tiered network plans typically allow members to access all providers, not just a subset. Through a variety of tactics, such as the disclosure of provider ?scores? as well as differential cost sharing arrangements, consumers are encouraged to shop for health care services among select and non-select providers.
In collaboration with Mercer Human Resource Consulting, a set of questions will be included in this firm?s 2005 web-based Survey of Employer Sponsored Health Plans. To answer questions that cannot be addressed with a structured response survey, site visits will be conducted, including personal interviews and focus groups, in five case study communities in which tiered provider networks are operational. Finally, to assess the direction and magnitude of changes occurring in tiered network programs, information derived from the analyses of 2005 survey results and site visits will be used to develop a refined set of tiered network questions for the 2006 Mercer survey.
A recent systematic review found no studies of the impact of public performance reports on the quality of primary care. The proposed multi-method study will begin to fill that gap by exploring the relationship between health care performance reports, providers' responses to the reports, and the quality of care provided by primary care practices. Public performance reports can improve the quality of care by raising awareness among clinicians of evidence-based practices, encouraging providers to improve quality to maintain reputation and market share, directing patients to high-quality providers, or serving as the basis of pay-for-performance incentives. The study will focus on the first two mechanisms: raising awareness of evidence-based practices and encouraging providers to improve quality.
The study will explore the impact of an innovative and well-established statewide performance reporting system, The Maine Health Management Coalition