Health Services Access, Quality, and Financing

Tiered Provider Networks

Duration: 
1/1/2004 - 1/31/2006
Principal Investigator: 
Andrew Coburn
Collaborators: 
Bill Thomas, Ph.D.
Abstract: 

The purpose of this project is to determine where and how tiered provider networks are utilized, to describe the characteristics of these networks, and to develop insights into strategies used by health plans when implementing and operating tiered provider networks. The concept underlying tiered networks is that health plans may be able to reduce costs and/or improve quality by directing consumers to certain providers and to avoid others. Unlike traditional HMO arrangements, tiered network plans typically allow members to access all providers, not just a subset. Through a variety of tactics, such as the disclosure of provider ?scores? as well as differential cost sharing arrangements, consumers are encouraged to shop for health care services among select and non-select providers.
In collaboration with Mercer Human Resource Consulting, a set of questions will be included in this firm?s 2005 web-based Survey of Employer Sponsored Health Plans. To answer questions that cannot be addressed with a structured response survey, site visits will be conducted, including personal interviews and focus groups, in five case study communities in which tiered provider networks are operational. Finally, to assess the direction and magnitude of changes occurring in tiered network programs, information derived from the analyses of 2005 survey results and site visits will be used to develop a refined set of tiered network questions for the 2006 Mercer survey.

Start Date: 
Thu, 2004-01-01
End Date: 
Tue, 2006-01-31
Legacy Muskie ID: 
2391

The Impact of Statewide Public Performance Reports on the Quality of Primary Care

Duration: 
1/1/2008 - 1/30/2009
Director: 
Judith Tupper
Collaborators: 
Quality Counts Maine Health Information Center (MHIC) Maine Health Management Coalition (MHMC)
Abstract: 

A recent systematic review found no studies of the impact of public performance reports on the quality of primary care. The proposed multi-method study will begin to fill that gap by exploring the relationship between health care performance reports, providers' responses to the reports, and the quality of care provided by primary care practices. Public performance reports can improve the quality of care by raising awareness among clinicians of evidence-based practices, encouraging providers to improve quality to maintain reputation and market share, directing patients to high-quality providers, or serving as the basis of pay-for-performance incentives. The study will focus on the first two mechanisms: raising awareness of evidence-based practices and encouraging providers to improve quality.

The study will explore the impact of an innovative and well-established statewide performance reporting system, The Maine Health Management Coalition

Start Date: 
Tue, 2008-01-01
End Date: 
Fri, 2009-01-30
Legacy Muskie ID: 
5867

State Children?s Health Insurance Program (SCHIP) Survey 2005-2006

Duration: 
1/1/2005 - 1/31/2006
Abstract: 

Project staff will conduct a telephone survey of parents of children enrolled in MaineCare through three benefit categories (TANF, Medicaid expansion, and SCHIP, the States' Children's Health Insurance Program). The sample will include 1200 current enrollees, 300 disenrollees, and 300 new enrollees. Findings will include satisfaction with providers, satisfaction with MaineCare services, unmet needs, health behaviors, insurance, and employment status.

Start Date: 
Sat, 2005-01-01
End Date: 
Tue, 2006-01-31
Legacy Muskie ID: 
3103

National Rural Hospital Flexibility Monitoring Project 2010-2011

Duration: 
1/30/2010 - 1/31/2011
Director: 
Andrew Coburn
Research Staff: 
Andrew Coburn
Andrew Coburn
Zachariah Croll
John Gale
Karen Pearson
Abstract: 

Cooperative agreement through the University of Minnesota, to monitor and evaluate the Medicare Rural Hospital Flexibility Grant Program (Flex Program). The monitoring project is assessing the impact of the Flex Program on Critical Access Hospitals and their communities and the role of states in achieving overall program objectives.

Project URL: 
http://flexmonitoring.org/
Start Date: 
Sat, 2010-01-30
End Date: 
Mon, 2011-01-31
Legacy Muskie ID: 
8011

CHIPRA Cat A Yr3

Duration: 
1/22/2012 - 1/21/2013
Principal Investigator: 
Kimberley Fox, MPA
Abstract: 

Maine, in partnership with the State of Vermont was awarded a five-year Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant to "test promising ideas for improving the quality of children's health care." The Department of Health and Human Services (DHHS) is the designated lead agency for the federally-funded initiative. The Improving Health Outcomes for Children (IHOC) project promotes the use of quality measures and information technology to improve Medicaid member children's timely access to quality care.
In Category A of the IHOC project, Maine proposes to enhance the state's current quality performance measurement and incentive payment systems to include child health quality indicators with the goal of reducing unnecessary variation in pediatric care, aligning payment and financial incentives with pediatric quality measures, and improving the health of low-income and other children in Maine.

Project URL: 
http://www.maine.gov/dhhs/oms/provider/childrens.html#ihoc
Start Date: 
Sun, 2012-01-22
End Date: 
Mon, 2013-01-21
Legacy Muskie ID: 
8507

State Children's Health Insurance Program (SCHIP) Survey 2004-2005

Duration: 
1/1/2004 - 1/31/2005
Abstract: 

This project involves a series of surveys and focus groups designed to measure consumer satisfaction, program knowledge, access to health care services and the quality of those services for children who are currently enrolled in MaineCare via the SCHIP eligibility option. Chronic care-related questions will also be added to the surveys this year and a focus group of parents of former SCHIP-enrolled children, who are currently enrolled through Dirigo will be conducted in the summer of 2005.

Start Date: 
Thu, 2004-01-01
End Date: 
Mon, 2005-01-31
Legacy Muskie ID: 
1182

CHIPRA Cat B Yr3

Duration: 
1/22/2012 - 1/21/2013
Principal Investigator: 
Kimberley Fox, MPA
Abstract: 

Maine, in partnership with the State of Vermont was awarded a five-year Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant to "test promising ideas for improving the quality of children's health care." The Department of Health and Human Services (DHHS) is the designated lead agency for the federally-funded initiative. The Improving Health Outcomes for Children (IHOC) project promotes the use of quality measures and information technology to improve Medicaid member children's timely access to quality care.
Under IHOC's Category B, both Maine and Vermont propose to enhance their Health Information Technology (HIT) infrastructures to improve the flow and use of child health quality information. Vermont will expand the Vermont Blueprint for Health infrastructure to support guideline-based care and performance measurement in pediatric populations; Maine will automate EPSDT data collection and comprehensive health assessments of children in foster care.

Project URL: 
http://www.maine.gov/dhhs/oms/provider/childrens.html#ihoc
Start Date: 
Sun, 2012-01-22
End Date: 
Mon, 2013-01-21
Legacy Muskie ID: 
8508

State Health Access Reform Evaluation (SHARE)

Duration: 
1/1/2008 - 1/31/2010
Abstract: 

This study will examine the impact of program cost sharing features on the access to care for low income persons and populations who face particular barriers to care due to pre-existing health conditions. The Muskie School is seeking the cooperation of the states of Vermont, Maine, and New Hampshire in making this study feasible. Such cooperation would require assisting the research team in accessing claims and administrative databases for persons enrolled in the state access initiatives.

Start Date: 
Tue, 2008-01-01
End Date: 
Sun, 2010-01-31
Legacy Muskie ID: 
5287

Tennessee Rural Hospital Patient Safety Project

Duration: 
1/1/2005 - 1/30/2007
Director: 
Judith Tupper
Principal Investigator: 
Andrew Coburn
Abstract: 

Patient safety standards and systems have been developed and conducted in large, urban hospitals and the relevance of such standards and systems for smaller, rural hospitals has not been established. The purpose of this project is to test the feasibility, cost, and impact of implementing patient safety standards in small, rural hospitals. Working with 8 hospitals in Tennessee, this project will create a sustainable infrastructure for assisting rural hospitals to implement critical safety improvements and to more toward a universal culture of safety. The resulting materials and tools will allow for broader replication in Tennessee and other states.

Project URL: 
http://www.mainecahpatientsafety.net/
Start Date: 
Sat, 2005-01-01
End Date: 
Tue, 2007-01-30
Legacy Muskie ID: 
2807

Understanding Changes in the Organization and Finance of Physician Practice in Maine and New Hampshire

Duration: 
1/1/2006 - 1/30/2007
Director: 
Jennifer Lenardson, MHS
Principal Investigator: 
Catherine McGuire
Collaborators: 
Chris Shannon, New Hampshire Medicaid
Abstract: 

The Office of MaineCare Services and the New Hampshire Medicaid Program have 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. The extent and consequences of these changes are largely unknown; however, reimbursement is higher for Medicaid patients when care is provided within these facilities rather than physician offices. This project will result in an understanding of changes to the organization and finance of physician practice in Maine and New Hampshire, the contribution of the federal process for approving FQHCs / RHCs on these trends, and potential policy options for mitigating the impact to Medicaid.

The project includes a literature review, interviews with state Medicaid officials and practice administrators, and analysis of claims data.

Start Date: 
Sun, 2006-01-01
End Date: 
Tue, 2007-01-30
Legacy Muskie ID: 
3786

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