Adding Up Impact: Promise of Improved Care
This case study is part of MANP’s Stories of Impact series, highlighting the many ways Maine’s nonprofits are essential to a strong and healthy Maine.
For decades, Mainers have been plagued by chronic diseases such as diabetes, cardiovascular disease, cancer, and depression. Effective prevention and better coordination of care delivered through a relationship with a primary care provider/practice team can dramatically change this picture, while improving outcomes, creating a better experience of care, and lowering costs in the process. Over the past five years Maine Quality Counts (MQC) has worked with several partners to support primary care practices across the state to improve care.
To date, MQC has:
- Convened key partners to create the Maine Patient Centered Medical Home Pilot that has brought over $40 million into the State of Maine, through direct payments to providers, transforming how primary care practices coordinate care for patients and providing greater flexibility to accommodate diverse needs of patients.
- Worked with practices to decrease hospital re-admissions, a critically important focus given the average cost of a hospital medical admission is estimated to total over $15,000.
- Worked with pediatric and family medicine practices to implement a “First STEPS” program, which has increased childhood immunizations by 12% and developmental screenings for children birth to three years by over 300% in those practices over 12 months.
- Expanded the pilot project to 50 additional practices, now representing all of Maine’s 16 counties and collectively providing care for over 300,000 people annually.
The Story Behind the Impact
As a state, we face dramatically rising health care costs associated with preventable chronic diseases, and as individuals, we face the challenges of fragmented care and timely access to primary care providers, especially in rural areas.
Recognizing the essential role of primary care in our health care system, the Dirigo Health Agency’s Maine Quality Forum (MQF), Maine Quality Counts, and the Maine Health Management Coalition have modeled cross-sectoral collaboration with their co-leadership of the Maine Patient Centered Medical Home (PCMH) Pilot, originally in 26 primary care practices—22 adult and four pediatric practices – beginning in January 2010. The Pilot expanded in 2013 to include 50 additional practices, now representing all of Maine’s 16 counties and collectively providing care for over 300,000 people annually throughout the state.
A “medical home” is not a building or a place, but a team of health professionals who work together to better coordinate care for their patients. The Maine PCMH Pilot implemented innovative patient-centered solutions, including the use of interconnected electronic medical records that enable health care providers to better manage patient care. Implementation of electronic health data increased efficiencies in tracking important health care data such as diabetes management and hypertension as well as subsequent emergency room visits and hospital re-admissions. The patients of a Community Care Team from one participating practice had a 76% decrease in emergency department visits and an 86% reduction in hospital admissions over a one year time frame. Electronic monitoring also enhances cross-disciplinary collaboration within the Pilot’s patient centered medical home.
The First STEPS initiative implemented in the Pilot’s four pediatric practices is one of the many ways in which the Patient Centered Medical Home strives to provide inclusive holistic care and treatment for patients. In the participating pediatric practices, the goal to improve immunization rates by at least four percentage points within one year of project initiation was exceeded nearly three-fold. Implementing changes in office procedures advocated by the American Academy of Pediatrics’ Bright Futures curriculum allowed for more expansive MaineCare reimbursements for these preventative procedures.
Care through the Pilot is not limited to the doctor-patient visit: care includes a multi-disciplinary approach with a professional team to better integrate both behavioral and physical health care services, all of which take place at the patient’s primary care practice. This model, if implemented beyond the practices participating in the Pilot, has the potential to create health care savings statewide and improve the overall well-being of the State of Maine.
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