Research Methods: Policy Analysis

Understanding the Business Case for Telemental Health in Rural Communities

Abstract: 

Telemental health has been promoted to address long-standing access barriers to rural mental health care, including low supply and long travel distances. Examples of rural telemental health programs are common; there is a less clear picture of how widely implemented these programs are, their organization, staffing, and services. There is also a need to understand the business case for these programs and assess whether and how they might realize their promise. To address these gaps, a national study was conducted of rural telemental health programs including an online survey of 53 programs and follow-up interviews with 23 programs. This article describes the current landscape and characteristics of these programs and then examines their business case. Can rural telemental health programs be sustained within current delivery systems and reimbursement structures? This question is explored in four areas: need and demand, infrastructure and workforce, funding and reimbursement, and organizational fit and alignment. [Journal Abstract]

Suggested Citation: Lambert, D., Gale, J., Hartley, D., Croll, Z., & Hansen, A. (2015). Understanding the business case for telemental health in rural communities. Journal of Behavioral Health Services and Research. doi: 10.1007/s11414-015-9490-7 [epub ahead of print].

FMI: John Gale

Publication Type: 
Journal Article
Publish Date: 
December 22, 2015

Exploring the Business Case for Children's Telebehavioral Health

Abstract: 

This brief, authored by John Gale, M.S. and David Lambert, Ph.D. from the University of Southern Maine's Muskie School of Public Service, Maine Rural Health Research Center, explores terminology, reimbursement and business issues, and provides examples from the field in the development of telebehavioral health services. In the first section, the authors place children’s telebehavioral health within the context and demands of today’s rural healthcare system, where the majority of children’s telebehavioral health services are delivered. They then describe three examples of the use of telebehavioral health to serve children, adolescents, and families in rural communities. The brief concludes by exploring the business case for telebehavioral health including the issues and challenges of service delivery, coordination, and financing. This brief is informed by a national study of telemental health (serving children, adults, and older persons) in rural health systems conducted by the authors and updated to reflect the latest information on three case examples.

For more information, please contact John Gale at john.gale@maine.edu

Suggested citation: Gale J, Lambert D. Exploring the Business Case for Children's Telebehavioral Health. Washington, DC: The Technical Assistance Network for Children's Behavioral Health, The Institute for Innovation & Implementation; March, 2015. Brief.

Publication Type: 
Research and Policy Brief
Publish Date: 
March 2, 2015

Gender-Responsive Policy Development in Corrections: What We Know and Roadmaps for Change

Abstract: 

Erica King, research staff at the Muskie School, co-authored this policy bulletin for the US Department of Justice National Institute of Corrections with Jillian Foley, a recent Muskie School graduate.

Lack of gender-informed policy creates challenges for correctional practitioners. When there is a gap between training that is evidence-based and gender-informed and what is written in policy, staff may find themselves hindered in their attempts to work toward establishing a gender-responsive environment. This policy bulletin, released in February 2015 and based on survey data and focus groups with women, is an initial step to determine the existence of gender-informed policy within correctional agencies. The findings of this bulletin provide an overview of the current state of gender-responsive policies for women and define a focus for future research, training and technical assistance in the effort to create a more effective, and efficient correctional approach for women offenders.

Suggested Citation: King E, Foley J. Gender-Responsive Policy Development in Corrections: What We Know and Roadmaps for Change. Washington, DC: U.S. Department of Justice, National Institute of Corrections; October, 2014.

Publication Type: 
Research and Policy Brief
Publish Date: 
October 1, 2014
Author: 
URL: 
https://s3.amazonaws.com/static.nicic.gov/Library/029747.pdf

Early Lessons Learned in Implementing MaineCare Health Homes

Abstract: 

This Issue Brief, authored by researchers at the University of Southern Maine's Muskie School, highlights key lessons learned from the first year of implementation of the MaineCare Health Homes Initiative.

Key Findings:

  • MaineCare's Health Homes Initiative has expanded Maine's capacity for chronic care management in primary care practices and community care teams (CCTs);
  • CCTs provide valuable additional support to patients of Health Homes, including home visits and social supports in the community;
  • Flexibility in program design allowed for wide variation of service delivery models within CCTs;
  • Three percent of Health Home members were referred to CCTs by the end of the first year, but overall practice referral rates varied by CCT--from 1% to 7% of Health Home members within their associated practices.

To view or download the full study, click here

To view or download the Issue Brief on enrollment in the first year of MaineCare Health Homes implementation, click here

Suggested Citation: Fox K, Gray C, Rosingana K. Early Lessons Learned in Implementing MaineCare Health Homes. Portland, ME: University of Southern Maine, Muskie School of Public Service; September, 2014.

Publication Type: 
Research and Policy Brief
Publish Date: 
September 30, 2014
URL: 
http://muskie.usm.maine.edu/Publications/PHHP/MaineCare-HealthHomes-Implementation.pdf

MaineCare Health Homes Enrollment in the First Year of Implementation

Abstract: 

This Issue Brief, authored by researchers at the University of Southern Maine's Muskie School, highlights enrollment trends and characteristics of MaineCare's Health Homes initiative during the first year of implementation.

Key Findings:

  • MaineCare initially estimated 42,000 members were Health Home eligible; 48,000 members were enrolled by December 2013;
  • Health Homes practices increased referrals to Community Care Team (CCT) services over the course of the first year of the initiative, increasing from 60 members enrolled in CCTs in January 2013 to 1,392 in Decmber (3% of Health Home members);
  • Health Home members had an average of three chronic conditions.  Two out of the five most common conditions were behavioral health related.

To view or download the full study click here

To view or download the Issue Brief on implementation in the first year of MaineCare's Health Home Initiative click here

Suggested Citation: Fox K, Gray C, Rosingana K. MaineCare Health Homes Enrollment in the First Year of Implementation. Portland, ME: University of Southern Maine, Muskie School of Public Service; September, 2014.

Publication Type: 
Research and Policy Brief
Publish Date: 
September 30, 2014
URL: 
http://muskie.usm.maine.edu/Publications/PHHP/MaineCare-HealthHomes-Enrollment.pdf

Rural and Remote Food Environments and Obesity

Abstract: 

Researchers at the Maine Rural Health Research Center Rural have published a review in the January 2015 issue of Current Obesity Reports describing the rural community, home, and individual food environments and what is known about their roles in healthy eating.

Abstract: Rural residents are more likely to be obese and overweight compared to their urban counterparts. Studies of specific rural communities have found that the limited availability of healthy foods in the community and home as well as individual characteristics and preferences contribute to poor diet and overweight. The rural food environment is varied and may be affected by climate, regional and cultural preferences, transportation access, and remoteness among other factors. Given this diversity and the vulnerabilities of rural residents, who are more likely to have low-income, substandard housing or low educational attainment compared to their urban counterparts, policy and programmatic interventions should target specific needs and communities.

Suggested Citation: Lenardson, J. D., Hansen, A. Y., & Hartley, D. (2015). Rural and remote food environments and obesity. Current Obesity Reports. doi: 10.1007/s13679-014-0136-5

Publication Type: 
Journal Article
Publish Date: 
January 30, 2015
URL: 
http://link.springer.com/article/10.1007%2Fs13679-014-0136-5#page-1

Rural Health Clinic Readiness for PCMH Recognition

Abstract: 

The patient-centered medical home (PCMH) model reaffirms traditional primary care values including continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access, and positions providers to participate in accountable care and other financing and delivery system models. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). Researchers at the Maine Rural Health Research Center (University of Southern Maine) present findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discuss the implications of the findings for efforts to support RHC capacity development.

Key Findings

  • Based on their performance on the “must pass” elements and related key factors, Rural Health Clinics (RHCs) are likely to have difficulties gaining National Center for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) Recognition.
  • RHCs perform best on standards related to recording demographic information and managing clinical activities, particularly for those using an electronic health record.
  • RHCs perform less well on improving access to and continuity of services, supporting patient self-management skills and shared decision-making, implementing continuous quality improvement systems, and building practice teams.
  • RHCs are likely to need substantial technical assistance targeting clinical and operational performance to gain NCQA PCMH Recognition.

For more information on this study, please contact John Gale.

Suggested Citations:

(Working Paper) Gale JA, Croll Z, Hartley D. Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; January, 2015. Working Paper No. 57.

(Policy Brief) Gale J, Croll Z, Hartley D.Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; January, 2015. Research & Policy Brief PB-57.

 

Publication Type: 
Working Paper
Publish Date: 
January 30, 2015
URL: 
http://muskie.usm.maine.edu/Publications/rural/RHC-Readiness-for-PCMH-Recognition-Working-Paper

Adults with Intellectual Disability or Autism Spectrum Disorder. Executive Summary

Abstract: 

Adults with intellectual disability or autism spectrum disorder (ID/ASD) have a variety needs for long term services supports to enable them to live as independently as possible. In Maine, the Office of Aging and Disability Services/Developmental Services provides a wide array of services to adults with ID/ASD, the majority of which are funded through MaineCare. This Chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; an analysis of the utilization and cost of services for adults with ID/ASD who were on the waitlists for home and community based waivers services in SFY 2013; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine.

This Chartbook is unique in its detailing of the service and costs of adults with intellectual disability or austim spectrum disorder (ID/ASD) in Maine. The Chartbook focuses on adults with ID/ASD who are eligible only for MaineCare (Maine's Medicaid system) or who are dually eligible for MaineCare and Medicare.

The Executive Summary provides key findings in the areas of:

  • Historical Trends
  • Claims Analysis of Dually Eligible and MainCare-only Eligible Adults with ID/ASD in 2010
  • MaineCare Claims Analysis of Members on the HCBS Waitlists, SFY 2013
  • Quality Measures, SFY 2010
  • Supports Intensity Scale, 2013
  • ID/ASD Providers in Maine Compared to the Nation, 2005-2010

Click here for the Executive Summary.

Click here for the Executive Summary with Charts. 

Click here for the full Chartbook.

Suggested Citations: Snow KI, Bratesman S, Bowe T, Fralich J. Adults with Intellectual Disability or Autism Spectrum Disorder: Population and Service Use Trends in Maine, 2014 Edition. (Executive Summary). Portland, ME: University of Southern Maine, Muskie School of Public Service;2014.

Snow KI, Bratesman S, Bowe T, Fralich J. Adults with Intellectual Disability or Autism Spectrum Disorder: Population and Service Use Trends in Maine, 2014 Edition. (Chartbook). Portland, ME: University of Southern Maine, Muskie School of Public Service;2014.

Prepared for the Office of Aging and Disability Services, Maine Department of Health and Human Services by the Muskie School of Public Service, University of Southern Maine.

Publication Type: 
Report
Publish Date: 
December 1, 2014
URL: 
http://muskie.usm.maine.edu/Publications/DA/Exec-Sum-Charts-Adults-with-Intellectual-Disability-or-Autism-Maine-2014.pdf

Profile of Rural Residential Care Facilities: A Chartbook

Abstract: 

As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook from the Maine Rural Health Research Center presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF).  Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents.  Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs.  Compared to urban facilities, the policies of rural RCFs appear less likely to support aging in place.

Suggested Citation: Lenardson JD, Griffin E, Croll Z, Ziller EC, Coburn AF. Profile of Rural Residential Care Facilities: A Chartbook. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014.

Publication Type: 
Report
Publish Date: 
May 20, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/Chartbook-Rural-Res-Care-Facilities.pdf

Rural Residents More Likely to be Enrolled in High Deductible Health Plans

Abstract: 

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

Full report (Working Paper): High Deductible Health Insurance Plans in Rural Areas

Suggested Citation: Lenardson JD, Ziller EC, Coburn AF. Rural Residents More Likely to Be Enrolled in High Deductible Health Plans. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014. Research & Policy Brief PB-55.

Publication Type: 
Research and Policy Brief
Publish Date: 
May 13, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/PB55-High-Deductible-Health-Plans-Rural.pdf

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