Population Health and Health Policy

Mental Health Status and Access to Health Care Services for Adults in Maine


Maine people with poor mental health describe significant challenges with affordability and access to health care.  A new report released by the Maine Health Access Foundation (MeHAF) and the University of Southern Maine, Mental Health Status and Access to Health Care Service for Adults in Maine, describes how adults 18 and older in Maine who report depression and poor mental health have many barriers to getting health care. These results have important implications for planning in a time when major changes in health insurance coverage are expected.

Analyzing data from the ongoing federal/state public health survey, the Behavioral Risk Factor Surveillance System (BRFSS), Dr. Ziller found that adults in Maine experiencing 14 or more mental health bad days are less likely to have a regular health care provider and more likely to report delays in getting needed health care services (for reasons other than cost). Poorer mental health status was associated with higher rates of foregoing needed medical care because of costs; 25 percent those adults experiencing 14 or more mental health bad days reported they were unable to access needed care from a doctor due to cost compared to 7 percent of adults with no mental health bad days.

MeHAF support allows inclusion of additional questions about access to insurance and health care services in the state’s BRFSS, which surveys a random sample of Maine people throughout the year.  Results from the compiled 2012, 2013 and 2014 surveys are included in the report.


For more information on the study design and methodology, please contact Erika Ziller, PhD, (207) 780-4615.

Media contact: Barbara Leonard, President & CEO, (207) 620.8266 x102

Suggested Citation: Ziller EC, Leonard B. Mental Health Status and Access to Health Care Services for Adults in Maine. Augusta, ME: Maine Health Access Foundation and USM Muskie School; February, 2017.

The brief is also available for download on the Maine Health Access Foundation website.

Publication Type: 
Research and Policy Brief
Publish Date: 
February 2, 2017

Health Information Exchange: A Strategy for Improving Acess for Rural Veterans in the Maine Flex Rural Veterans Health Access Program


This paper written by research staff at the Maine Rural Health Research Center reports on the design and implementation of a first in the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.

Implementation Lessons: Despite significant challenges, the Maine Rural Veterans Health Access Program (MeRVHAP) successfully established bi-directional connections with Maine’s statewide health information exchange (HIE), allowing for the exchange of clinical health information among U.S. Department of Veterans Affairs (VA) and non-VA providers.

Key factors that contributed to success include:
-A strong business case;
-Strong political and organizational commitment and leadership
-Project champions in the VA with enough seniority to overcome bureaucratic and technical hurdles
-Highly structured and detailed design and implementation plan
-Technical flexibility and capacity to adjust strategy mid-stream
-Collaboration and communication strategies developed by the stakeholders in the course of implementing this project which built a strong foundation for sustainability and replicability


For more information on this study, please contact Karen Pearson or Andrew Coburn

Suggested Citation: Pearson K, Burgess A, Gale J, Coburn A, Hansen A. Health Information Exchange: A Strategy for Improving Access for Rural Veterans in the Maine Flex Rural Veterans Health Access Program. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2016.

Publication Type: 
Working Paper
Publish Date: 
May 30, 2016

Access to Health Care Services for Adults in Maine


On October 17, 2016, the Maine Health Access Foundation (MeHAF) released a new research brief developed with the University of Southern Maine that found significant inequality in the ability of people in Maine to access quality health care. "Our research shows the devastating inequalities in whether people in Maine can get health care,” said Barbara Leonard, president and CEO of the MeHAF. “If you’re young, have a low-income, lack higher education or are a racial or ethnic minority, health care maybe a luxury that you struggle to afford. Many are just one health care crisis away from financial hardship. To make improvements that help people to live better, healthy and happier lives, we have to change the way we approach health care delivery, especially for those facing the greatest barriers to care.”

The authors, Barbara Leonard from MeHAF and Erika Ziller from the USM Muskie School, found that income, age and education are all closely associated with Maine people’s ability to receive appropriate and timely health care. Specifically, they found that among Maine adults 18 and older, those with family incomes less than $25,000 a year, young adults, racial and ethnic minorities, and people with less education are much more likely to:

  • Delay seeking health care even when sick;
  • Be unable to afford prescription medication;
  • Lack access to preventative check-ups and screenings or have a regular health care provider.

In addition, their analysis also found that Maine people, of all income groups, have reported difficulties in paying medical costs.

The brief is available for download on the Maine Health Access Foundation website.

FMI: Barbara Leonard, (207) 620-8266, ext. 102 or Erika Ziller, (207) 780-4615

Suggested Citation: Ziller E, Leonard B. Access to Health Care Services for Adults in Maine. Augusta, ME: Maine Health Access Foundation and USM Muskie School; October, 2016.

Publication Type: 
Publish Date: 
October 17, 2016

Maine Rural Health Profiles: A Statewide View of Rural Health


In an effort to inform and promote local discussions and strategic planning for transforming health and health care in rural communities, the Maine Health Access Foundation commissioned the Maine Rural Health Research Center to conduct a study of Maine’s health resources and health status. The result of this study, Maine Rural Health Profiles, presents a summary look at the health status of the state and each of the 16 Maine counties' health system, health system resources (such as workforce and facilities for health services provision), health care economy, and access to care.

Maine Rural Health Profiles uses a combination of narrative and maps to discuss and illustrate both the degree of rurality in each county and how the data reported reflect rural health challenges and opportunities. Many indicators at the county level, such as per capita hospital bed counts and per capita supply of various health professionals, are compared to the state as a whole. By design, the profiles focus on health care delivery sites, with special attention to hospital-based resources, and long-term services and supports. The profiles were developed using secondary data—combining federal and state licensure and provider information with resources such as the Maine Shared Health Needs Assessment & Planning Process (SHNAPP) Project reports and the University of Wisconsin Population Health Institute and Robert Wood Johnson Foundation’s County Health Rankings.


Suggested citation:

Kahn-Troster S, Burgess A, Coburn A, et al. Maine Rural Health Profiles. Portland, ME: University of Southern Maine, Muskie School, Maine Rural Health Research Center; September, 2016.

Publication Type: 
Publish Date: 
September 26, 2016

Maine Pediatric and Family Practice Survey Chartbook


In February 2010, Maine and Vermont were awarded a five-year demonstration grant from the Centers for Medicare and Medicaid Services to improve care quality for children who are insured by Medicaid and the Children’s Health Insurance Program (CHIP). In Maine, Improving Health Outcomes for Children (IHOC) is a public/private collaboration of health systems, pediatric and family practices, associations, state programs and consumers that is intended to 1) select and promote a set of child health quality measures; 2) build a health in­formation technology infrastructure to support the reporting and use of quality information; and 3) transform the delivery of health services for children using a patient centered medical home model.

As part of the IHOC initiative, the University of Southern Maine surveyed pediatric and family practices about how they use data, clinical guidelines and office systems to monitor and improve children’s healthcare quality. The purpose of the survey is to provide baseline information about quality improvement activities in primary care practices serving children in Maine. Survey data was used to inform IHOC activities and to monitor changes over time. The web-based survey was conducted in the winter of 2011-2012 and sent to practice man­agers at a sample of 168 practice sites, of which 64% responded. Responding practices represent more than one-quarter of family practices and nearly two thirds of all pediatric practices in the state. Together these prac­tices served more than half (57%) of all children insured by MaineCare, or nearly 68,000 MaineCare children. Respondents represent a broad distribution of practices across regions of the state and practice size and own­ership, and include nearly two-thirds of practices participating in IHOC’s First STEPS learning collaborative.

This report summarizes the results of the initial survey and assesses quality improvement activities in pediatric and family practices at baseline. In 2014, a follow-up survey will be conducted to assess how quality improve­ment has changed in child-serving practices statewide over time and within specific types of practices (e.g. those participating in First STEPS).

Key issues from the baseline survey results include the following:

  • Medical Home Recognition and Practice-Level Quality Improvement
  • Data Systems Used to Track and Monitor Care
  • Use of Electronic Health Records for Quality Improvement
  • Awareness and Use of Financial Incentives and Data for Quality Improvement from Payers

A follow-up survey was fielded during the final year of the initiative in 2014.The practice survey was designed to assess changes in knowledge and awareness of: child health quality measures; evidence-based clinical guidelines; recommended preventive screening tools; office systems and procedures; and the degree to which Maine practices use standardized protocols to monitor and improve children’s healthcare quality. Results of that survey can be viewed or downloaded here: Child Health Quality in Maine: Practice Survey Report 2011-2014

Publication Type: 
Publish Date: 
January 29, 2011

Developing Program Performance Measures for Rural Emergency Medical Services


 Prehospital Emergency Care

Developing Program Performance Measures for Rural Emergency Medical Services

Authors: John Gale, MS; Andrew Coburn, PhD; Karen Pearson, MLIS, MA; Zach Croll, BA; George Shaler, MPH

University of Southern Maine, Muskie School of Public Service

Background: The development of measures to monitor and evaluate the performance and quality of emergency medical services (EMS) systems has been a focus of attention for many years. The Medicare Rural Hospital Flexibility Program (Flex Program), established by Congress in 1997, provides grants to states to implement initiatives to strengthen rural healthcare delivery systems, including better integration of EMS into those systems of care.

Objective: Building on national efforts to develop EMS performance measures, we sought to identify measures relevant to the rural communities and hospitals supported by the Flex Program. The measures are intended for use in monitoring rural EMS performance at the community level as well as for use by State Flex Programs and the Federal Office of Rural Health Policy (FORHP) to demonstrate the impact of the Flex Program.

Methods: To evaluate the performance of EMS in rural communities, we conducted a literature search, reviewed research on performance measures conducted by key EMS organizations, and recruited a panel of EMS experts to identify and rate rurally-relevant EMS performance measures as well as emergent protocols for episodes of trauma, ST Elevation Myocardial Infarction (STEMI), and stroke. The rated measures were assessed for inclusion in the final measure set.

Results: The Expert Panel identified 17 program performance measures to support EMS services in rural communities. These measures monitor the capacity of local agencies to collect and report quality and financial data, use the data to improve agency performance, and train rural EMS employees in emergent protocols for all age groups.

Conclusion: The system of care approach on which this rural EMS measures set is based can support the FORHP's goal of better focusing State Flex Program activity to improve program impact on the performance of rural EMS services in the areas of financial viability, quality improvement, and local/regional health system performance. [Journal abstract provided by authors]

Suggested citation:

Gale, J., Coburn, A., Pearson, K., Croll, Z., & Shaler, G. (2016). Developing program performance measures for rural emergency medical services. Prehospital Emergency Care, 1-9. doi: 10.1080/10903127.2016.1218978

FMI: John Gale

Publication Type: 
Journal Article
Publish Date: 
September 9, 2016


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