Process Methods: Service Systems Integration

Members Dually Eligible for MaineCare and Medicare Benefits: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. Chartbook.

Abstract: 

This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services.  This first report provides a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008-2010.  This report provides baseline data on the characteristics of Medicare-MaineCare members who are dually eligible, the distribution of expenditures across categories of service for MaineCare and Medicare, and the cost of care for people with select chronic conditions. The report includes information on members considered full benefit as well as those who are partial benefit members.  Partial benefit members are also know as Qualified Medicare Beneficiaries, Specified Low Income Medicare Beneficiaries; Qualified Individuals; and Qualified Disabled and Working Individuals.  Individuals who are dually eligible for MaineCare and Medicare typically have multiple chronic conditions, high medical and long term care costs, and low income. Medicare covers hospital, medical, skilled long term care and pharmacy services while Medicaid pays for behavioral health, community based long term services and supports and nursing home services. The integration of services and benefits for people who are dually eligible is a challenge for states and the federal government. As states move to introduce value based purchasing initiatives through health homes, accountable care communities and other managed care efforts, the need to coordinate services and align incentives between the Medicaid and Medicare programs becomes increasingly critical. Many states are involved in dual eligible demonstrations to improve the integration of services, benefits and care.

Suggested Citation:

McGuire C, Gressani T, Bratesman S, Fralich J, Griffin E.  Members Dually Eligible for MaineCare and Medicare Benefits: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. (Chartbook).  Portland, ME: University of Southern Maine, Muskie School of Public Service; October 2012.


Publication Type: 
Report
Publish Date: 
October 30, 2012
URL: 
http://muskie.usm.maine.edu/Publications/DA/DualEligible-Chartbook-SFY2010.pdf

Maine's Community Living Program: Implementation and Outcomes

Abstract: 

Over the last five years, options counseling has evolved from a general set of activities and functions within Area Agencies on Aging and Aging & Disability Resource Centers (AAAs/ADRCs) to a more standardized and generally accepted role within the Aging Network. With the award of the Community Living Program (CLP) grant in 2009, Maine proposed to develop more consistent methods for identifying people at risk of residential facility placement and to begin to develop standards for the options counseling functions. In 2010, Maine was also awarded an Options Counseling Standards Grant which has provided support for furthering the work started under the CLP grant.

Muskie School staff developed a Consumer Satisfaction Survey, A Survey of Options Counselors and Options Counselor Manager/Supervisor Survey. Results of the surveys and data from the follow-up form developed by the Steering Committee are included in the Outcomes section of this report. Muskie staff also conducted the evaluation of Maine's Options Counseling Standards Grant. The results of this evaluation are organized into two main sections: Implementation of Options Counseling which examines the processes, protocols and practices that were developed , and Outcomes which examines the implementation of the options counseling services along four dimensions:

  • Consumer Outcomes;
  • Staff Outcomes;
  • Organizational Outcomes; and
  • System Outcomes.

Suggested citation:

Fralich J, Richards M, Olsen L. Maine's Community Living Program: Implementation and Outcomes. Portland, ME: University of Southern Maine, Muskie School of Public Service; December 2011.

Publication Type: 
Report
Publish Date: 
December 30, 2011
URL: 
http://muskie.usm.maine.edu/Publications/DA/Maine-Community-Living-Program-Implementation-Outcomes.pdf

Designing a Reportable Event System: A Collaborative Quality Improvement Project

Abstract: 

The objectives of this project were to document current quality management and improvement efforts across departments and programs, develop criteria for selecting areas for potential coordination or collaboration, select a collaborative project to improve the quality of care to persons with disabilities, and design and implement this project. The project chosen was in the area of serious event management. This report outlines the process of project selection, pre-design planning and system design for a reportable event system for aged and disabled populations.

Publication Type: 
Report
Publish Date: 
October 28, 2005
URL: 
http://mainerealchoices.org/qi_collabqi_materials/CollabQIReport.pdf

Roadmap for Change: Maine's Response to the Olmstead Decision,

Abstract: 

For ease of use, the report is broken down into the following sections:

  • Introduction and Summary of Recommendations;
  • Advocacy, Self-Advocacy and Quality Monitoring;
  • Flexible Funding to Promote Integrated Services Using Data to Make Sure Needed Services Are Funded;
  • Coordination of Services;
  • Improving Quality and Availability of Direct-Care Workers;
  • Affordable, Appropriate, Integrated Housing;
  • Transportation Issues and Problems;
  • Barriers and Issues for Employment;
  • Public Comments;
  • Glossary

Suggested Citation:

Maine's Workgroup for Community-Based Living. Roadmap for Change, Maine's Response to the Olmstead Decision. Portland, ME: University of Southern Maine, Muskie School of Public Service; October 2003.

 

Publication Type: 
Report
Publish Date: 
October 1, 2003

Improving Access and Quality Using Volunteer Patient Navigators

Duration: 
1/1/2005 - 1/30/2007
Abstract: 

The premise of this project is that volunteer patient navigators are able to provide supportive services that empower patients to collect information to make decisions about their own care and quality of life. To the degree that patients do not question or assert control over their own
care ? and lives ? that is the degree to which they limit their own access to the best possible choices and services. These choices include the right to quality, comprehensive care based on research that supports the context as well as clinical parts of the patient?s life. Hence the outcomes we will propose address the patient?s psychosocial, decision-making, and involvement in the decision process. In this project our chief goals are to (1) increase the ability of patients with cancer to access and benefit from both clinical services and community-based supportive and information services and (2) demonstrate that trained volunteers functioning as patient navigators are able to assist patients with cancer in assuming more responsibility for ?taking care of themselves? as demonstrated by positive changes in self-efficacy, decision-making, quality of life measures, and degree of involvement in the decision process. These outcomes have been linked to improvements in clinical status. In addition, we will be looking at the volunteer processes of recruiting, screening, selecting, training, placing, monitoring, and retaining - that lead to the volunteer?s ?conversion? to assuming the role of a patient navigator.

Start Date: 
Sat, 2005-01-01
End Date: 
Tue, 2007-01-30
Legacy Muskie ID: 
2 934

National Child Welfare Resource Center for Organizational Improvement

Duration: 
1/30/2011 - 10/31/2013
Director: 
Peter Watson, M.P.P.
Principal Investigator: 
Kris Sahonchik
Research Staff: 
Sara Needleman
Abstract: 

<p>The National Child Welfare Resource Center for Organizational Improvement's (NRCOI) mission is to support organizations committed to the welfare of children, youth and families and help them achieve better systemic outcomes.</p>

<p>We are funded by the Children's Bureau, U.S. Department of Health and Human Services to provide free, on-site training and technical assistance (T/TA) to State and Tribal child welfare agencies.</p>

<p>Through training, technical assistance, research and evaluation we help agencies improve management and operations, expand organizational capacity and promote service integration. We focus T/TA in six primary areas, including: Strategic Planning, Quality Improvement, Collaboration, Workforce, Training Systems, and the federal Child and Family Services Review process.</p>

Project URL: 
http://www.nrcoi.org
Start Date: 
Sun, 2011-01-30
End Date: 
Thu, 2013-10-31
Legacy Muskie ID: 
8 149

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