Health Services Access, Quality, and Financing

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

Abstract: 

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
Author: 
URL: 
http://www.mehaf.org/content/uploaded/images/reports-research/MeHAF_MH-Status-Access-Brief-Feb2017_FINAL.pdf

Access to Health Care Services for Adults in Maine

Abstract: 

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: 
Report
Publish Date: 
October 17, 2016
URL: 
http://www.mehaf.org/content/uploaded/images/reports-research/Access%20to%20Health%20Care%20Brief_Oct%202016.pdf

Early Lessons Learned in Implementing MaineCare Health Homes

Unpublished
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

High Deductible Health Insurance Plans in Rural Areas

Unpublished
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

Understanding Changes to Physician Practice Arrangements in Maine and New Hampshire

Unpublished
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

Unpublished
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

Children Served by MaineCare 2012: Survey Findings

Unpublished
Abstract: 

The purpose of the annual Survey of Children Served by MaineCare is to monitor the quality of services delivered by MaineCare, the State's Medicaid and CHIP program.  The 2012 survey examines the experiences of families with children. ages 0-17, who are enrolled in MaineCare using a standardized survey instrument (Consumer Assessment of Healthcare Providers and Systems--CAHPS--4.0H Child Medicaid Health Plan Survey). MaineCare scores very favorably compared with national benchmarks on CAHPS measures of Getting Needed Care, Getting Care Quickly, and How Well the Child's Doctors Community, with ratings at or above the 75th percentile on all the composites and individual items.  Overall ratings of the child's personal doctor, ratings of the child's specialist, and ratings of all the child's health care are also among the highest nationally.  Areas for improvement included MaineCare customer service and care coordination.  Continued administration of the CAHPS 4.0H Child Medicaid Health Plan Survey is recommended for 2013 and beyond to allow for ongoing monitoring of patient experience with and computation of trend results of the MaineCare program as well as ensuring that the MaineCare program complies with federal CHIPRA measure reporting requirements.

Suggested citation: Anderson, N., Fox, K., Thayer, D., & Croll, Z. (2013, January). Children served by MaineCare, 2012: Survey findings. Portland, ME: University of Southern Maine, Muskie School of Public Service.

Publication Type: 
Report
Publish Date: 
January 1, 2013
URL: 
http://www.maine.gov/dhhs/oms/pdfs_doc/ihoc/Maine-2012-MaineCare-Children-Survey.pdf

Why Do Some Critical Access Hospitals Close Their Skilled Nursing Facilities While Others

Unpublished
Abstract: 

Critical Access Hospitals (CAHs) have long played an important role in the provision of Skilled Nursing Facilities (SNF), swing bed, and other long term care (LTC) in rural communities and are more likely than other rural and urban hospitals to offer these services. The implementation of the Medicare SNF prospective payment system (PPS) in 1998 and subsequent exemption of CAH-based swing bed services from the SNF PPS in July, 2002 created financial incentives from CAHs to close their SNF units in favor of providing skilled level care using swing beds. During the period 2004 through 2007, 42 CAHs closed their SNF units. Despite the changing financial incentives related to the operation of SNF units by CAHs, 42% of CAHs (456) in 2010 continued to operate SNF units. Little is known about the reasons CAHs decide to close or retain their LTC services. This briefing paper and associated policy brief address this gap by examining the factors related to operation of skilled nursing services by CAHs, and specifically the factors related to closure of skilled nursing units by some CAHs and the continued provision of these services by others.

Key Findings:

  • Critical Access Hospitals (CAHs) that closed Skilled Nursing Facility (SNF) units cited a range of financial challenges related to payer mix, operating costs, cost allocation methods, and service utilization patterns.
  • The availability of alternative local long term care services, including swing beds, often contributed to hospitals’ decisions to close their SNF units.
  • CAHs that continued to operate SNF units were driven primarily by community need, despite the financial disincentive for doing so.
  • Hospitals reported substantial variation in their strategies for using swing beds for SNF, rehabilitation, and post-acute services.
  • Given ongoing concerns about financial viability and low census rates among some CAHs, further research on the ability of CAHs to expand patient services and revenues through swing bed use is warranted.
  • Additional research on the quality and outcomes of skilled care delivered by CAHs in SNF and swing beds is also recommended.

Suggested citation: Gale JA, Croll ZT, Coburn AF, et al.  Why Do Some Critical Access Hospitals Close Their Skilled Nursing Facilities While Others Retain Them?  Portland, ME: Flex Monitoring Team; December 2012.

Publication Type: 
Report
Publish Date: 
December 30, 2012
URL: 
http://flexmonitoring.org/documents/PolicyBrief31-CAh-SNF-services.pdf

Improving Health Outcomes for Children (IHOC): Summary of pediatric quality measures for children enrolled in MaineCare FFY 2009 - FFY 2012

Unpublished
Abstract: 

This report, authored by USM Muskie School research staff, presents the results of the 16 CHIPRA Core Measures that were collected using MaineCare claims or Vital Statistics data and reported in the State of Maine’s FFY 2012 CHIP Annual Report to the Centers for Medicare and Medicaid Services (CMS). Also included in this report are an additional three measures from the Improving Health Outcomes for Children (IHOC) project’s Master List of Pediatric Measures. In addition to presenting results in graphs and narrative, this report also provides measure definitions and background information about each measure topic.

The goal of this document is to present the claims- and vital statistics-based CHIPRA and IHOC measure results in a user-friendly format for IHOC project stakeholders. Measures are grouped by topic. For each topic, a Background section provides a brief description and rationale for collection. (The background discussion for CHIPRA Core Measures is drawn from the Background Report for the Initial, Recommended Core Set of Children’s Healthcare Quality Measures for Voluntary Use by Medicaid and CHIP Programs. Available at: http://www.ahrq.gov/chipra/corebackgrnd.htm) Next, we provide a general description of how each measure is defined, followed by the results.

Suggested citation: Anderson N, Meagher T. Improving Health Outcomes for Children (IHOC): Summary of Pediatric Quality Measures for Children Enrolled in MaineCare FFY 2009 - FFY 2012.   Portland, ME: University of Southern Maine, Muskie School of Public Service; April 2013.

Publication Type: 
Report
Publish Date: 
April 30, 2013
URL: 
http://www.maine.gov/dhhs/oms/pdfs_doc/ihoc/Summary_of_Pediatric_Quality_Measures_2012.pdf

Improving Health Outcomes for Children (IHOC) First STEPS Phase I Initiative: Improving Immunizations for Children and Adolescents

Unpublished
Abstract: 

This report, co-authored by Kimberley Fox and Carolyn Gray, provides a final evaluation of the initial phase of First STEPS (Strengthening Together Early Preventive Services), a learning collaborative led by Maine Quality Counts to support 24 pediatric and family practices in improving their childhood immunization rates. The evaluation found that all participating practices had higher immunization rates after participating in First STEPS. On average, overall child immunization rates increased by 5.1% at 12 months and 7.1% at 15 months, and average immunization rates across practices increased significantly from 74.2% to 81.3%. Practices also reported significant improvement in the use of recommended office practices, including staff training, recall/reminder procedures, and the use of data/registries.

This work was conducted under a Cooperative Agreement between the Maine Department of Health and Human Services and the Muskie School of Public Service at the University of Southern Maine and is funded under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) authorized by Section 401(d) of the Child Health Insurance Program Reauthorization Act (CHIPRA). These contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.

Suggested citation: Fox K, Gray C. Improving Health Outcomes for Children (IHOC) First STEPS Phase I Initiative: Improving Immunizations for Children and Adolescents. (Final Evaluation Report).  Portland, ME: University fof Southern Maine, Muskie School of Public Service; March 2013.

Publication Type: 
Report
Publish Date: 
March 29, 2013
URL: 
http://www.maine.gov/dhhs/oms/pdfs_doc/ihoc/first-steps-phase1-eval-report.pdf

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