Research Methods: Research Design

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 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

High Deductible Health Insurance Plans in Rural Areas

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.

Associated Research & Policy Brief: Rural Residents More Likely to be Enrolled in High Deductible Health Plans

Suggested Citation: Lenardson JD, Ziller EC, Coburn AF. High Deductible Health Insurance Plans in Rural Areas. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014. Working Paper #55.

Publication Type: 
Report
Publish Date: 
May 13, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/High-Deductible-Insurance-Plans-Rural.pdf

Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences?

Abstract: 

Adolescent alcohol use is a significant public health problem among U.S. adolescents. Past studies, including our own work, have found that rural adolescents were more likely to use alcohol than urban adolescents. Research suggests that protective factors, such as peer and parental disapproval, may be weaker among youth living in rural areas. This study examines the factors associated with adolescent alcohol use, whether they differ between rural and urban populations, and the extent to which these differences account for rural-urban variations in adolescent alcohol use. This knowledge is crucial to the development of rural-specific prevention strategies, targeted research on rural adolescent alcohol use, and long-term policy interventions. Our findings confirm higher rates of binge drinking and driving under the influence among rural youth than among urban youth. Rural residence is associated with increased odds of binge drinking (OR 1.16, p< .05) and driving under the influence (OR 1.42, p< .001) even when income and protective factors are taken into account. Our findings suggest that adolescents who start drinking at an earlier age are more likely to engage in problem drinking behavior as they get older, leading to a need for interventions that target pre-teens and younger adolescents. Moreover, since we found urban-rural differences in specific protective factors, these may be the most promising for evidence-based, rural-specific prevention strategies targeting parents, schools, and churches. These are the factors that convey and reinforce consistent messages discouraging adolescent alcohol use from an early age.

Suggested Citation:

Gale JA, Lenardson JD, Lambert D, Hartley, D.  Adolescent Alcohol Use: Do Risk and Protective Factors Explain Rural-Urban Differences. (Working Paper #48).  Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; March 2012.

Publication Type: 
Working Paper
Publish Date: 
March 1, 2012
URL: 
http://muskie.usm.maine.edu/Publications/WP48_Adolescent-Alcohol-Use-Rural-Urban.pdf

Understanding Changes to Physician Practice Arrangements in Maine and New Hampshire

Abstract: 

This report examines trends in the organization and ownership of physician practices in Maine and New Hampshire. The Maine Office of MaineCare Services and the New Hampshire Office of Medicaid Business and Policy observed a trend in the conversion of physicians from private practice to other practice arrangements including Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), hospital-owned practices, and hospital outpatient departments. Faced with increased costs for care provided within these facilities, both Medicaid programs sought to understand more about these changes, including their magnitude, the forces driving them, and their short and longer-term implications.

Suggested Citation:

Lenardson J, McGuire C, Alfreds S, et al.  Understanding Changes to Physician Practice Arrangements in Maine and New Hampshire. Portland, ME: University of Southern Maine, Muskie School of Public Service, Institute for Health Policy; January 2008.

Publication Type: 
Report
Publish Date: 
January 31, 2008
URL: 
http://muskie.usm.maine.edu/Publications/ihp/PhysicanPracticeChanges.pdf

Health Care Access and Use Among the Rural Uninsured

Abstract: 

The uninsured have poorer access to care and obtain care at greater acuity than those with health insurance; however, the differential impact of being uninsured in rural versus urban areas is largely unknown. Using data from the 2002–2007 Medical Expenditure Panel Survey, we examine whether uninsured rural residents have different patterns of health care use than their urban counterparts, and the factors associated with any differences. We find that being uninsured leads to poorer access in both rural and urban areas, yet the rural uninsured are more likely to have a usual source of care and use services than their urban counterparts. Further, controlling for demographic and health characteristics, the access and use differences between the uninsured and insured in rural areas are smaller than those observed in urban areas. This suggests that rural providers may impose fewer barriers on the uninsured who seek care than providers in urban areas.

Suggested Citation:

Ziller EC, Lenardson JD, Coburn AF.  Health Care Access and Use Among the Rural Uninsured. J Health Care Poor Underserved. 2012; 23(3):1327-1345.  doi: 10.1353/hpu.2012.0100

Publication Type: 
Journal Article
Publish Date: 
August 1, 2012
URL: 
http://muse.jhu.edu/login?auth=0&type=summary&url=/journals/journal_of_health_care_for_the_poor_and_underserved/v023/23.3.ziller.pdf

Child Care and Children With Special Needs: Challenges for Low Income Families.

Abstract: 

Findings from this mixed methods study include:

  • Parents of young children with special needs face significant challenges finding and keeping child care arrangements for their child.
  • Parents report significant problems with the child care arrangements they have used for their child with special needs.
  • There are significant programmatic and financial barriers to supporting parents of children with special needs so they can work, and balance work and family.
  • The combination of all of these problems and the particular demands of caring for a child with special needs often result in employment problems and job instability.
  • Families of children with special needs face more economic difficulties (poverty, food and rent insecurity, lack of health insurance) than do families of children without special needs.
  • Certain types of disabilities have a greater impact on the number of child care and work problems than others.
  • Having a child with multiple special needs or having more than one child with special needs significantly increases the likelihood of employment difficulties and job instability.

Suggested Citation: Ward H, Morris L, Oldham E, et al.  Child Care and Children With Special Needs: Challenges for Low Income Families.  Portland, ME: University of Southern Maine, Muskie School of Public Service, Cutler Institute for Child and Family Policy; December 2006.

Publication Type: 
Report
Publish Date: 
December 1, 2006
URL: 
http://muskie.usm.maine.edu/Publications/CYF/Children-With-Special-Needs-Challenges-for-Low-Income-Families.pdf

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