CMS State Innovation Model Testing Award - Maine

Program Location: 
Augusta, ME
Payer Type: 

Maine believes that its healthcare system can improve the health of Maine people, advance the quality and experiences of healthcare, and reduce healthcare costs by 2016.  During the next three years, an unprecedented partnership among physical and behavioral health providers, public and private insurers, data and system analysts, purchasers, workforce developers, and Maine consumers will put this belief to the test through the Maine State Innovation Model (SIM). Federal partners are confident in its potential and have funded Maine and five other states to each implement their state level healthcare innovation reform plan.

The Maine SIM intends to achieve the Triple Aim goals of improving the health of Maine’s population, improving the experience Maine patients have with their care, and reducing the total costs of care.  The model has a foundation in emerging healthcare initiatives, promising community-based demonstration projects, and evidence-based strategies that empower consumers with long-term health conditions.  The power of the innovation, however, comes from the concurrent application of existing efforts with enhanced investments, all within a shared commitment to accountability, transparency, and quality.

The 2014 Annual Report for year one reported, in the first year "1,211 providers were included, along with 6 payers, impacting more than 700,000 beneficiaries across the State." 

Among the accomplishments in SIM Year One are:

  1. rolling in 102 new single payer (Medicaid) primary care practices to the Learning Collaborative, including performing on-site practice assessments, focused support and tracking for achieving NCQA Medical Home recognition, and orientation sessions for them on the HH requirements and 10 Core Expectations;
  2. convening several large face-to-face Learning Session with all the PCMH and HH practices, now totaling about 177 primary care practices, to explore their transformation with national experts and network with their colleagues on best practices.
  3. succeeding in collecting deliverables and reporting requirements from the practices as defined in their participation expectations; and
  4. meeting and in many cases surpassing our Health Home Learning Collaborative quarterly accountability targets. 
Payment Model: 

This award will support the following enhancements in health care infrastructure: the data analytic structure needed for multi-payer claims analysis, public reporting, and secure information sharing; quality improvement support, training, and collaborative learning to achieve accountable care; support for purchaser-led payment reform, including the potential for investment in performance based shared savings; patient training and tools for shared health care decision-making; support for value-based benefit design; and development of new workforce models to more appropriately support the transformed system.

Last updated May 2015
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