Maine

Maine has had an impressive history and continued commitment to improve the health of its citizens through strengthening its system of primary care across the State. In the fall of 2007, the Maine Legislature convened the Commission to Study Primary Care Practice to examine the issues facing primary care and ways to stabilize and support it. In the 2008-2009 State Health Plan, the Governor’s Office for Health Policy and Finance identified the need to promote primary care as the foundation for our state’s health system.

Formed in 2003 and incorporated in 2006, Maine Quality Counts (QC) has provided leadership, advocacy and support for improving primary care in partnership with the State through several multi-stakeholder initiatives including PCMH learning collaboratives, a Multi-payer Advanced Primary Care Practice program, Coordinated Care Teams, Quality Counts for Kids, and Integrated Behavioral-Physical Health, to name a few. Maine Quality Counts, as one of the State’s designated partners in the State Innovation Model (SIM) Initiative, is working to ensure all State health improvement measures build upon the success of these and other established PCMH programs. Quality Counts is leading the learning collaborative to implement the new Maine Behavioral Health Home Initiative.

Primary Care Innovations and PCMH Activity

Dual Eligible	2703 SPA	CPC	CPC+	PCMH QHP	PCMH Legislation	Private Payer

Multi-Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program	Outcomes
Maine Patient-Centered Medical Home Pilot	Multi-Payer	Statewide	Multi-Payer Advanced Primary Care Practice (MAPCP)

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
Beacon, LLC - CMS Pioneer ACO	Medicare	Statewide	CMS Pioneer ACO
Central Maine ACO	Medicare	Central and Western Maine	Medicare Shared Savings Program
CMS State Innovation Model Testing Award - Maine	Grant	Statewide	CMS State Innovation Model (SIM)
Improving Health Outcomes for Children - Maine	Grant	Maine, Vermont	CHIPRA Quality Demonstration Grant
Maine Community ACO	Medicare	Augusta area	Medicare Shared Savings Program
MaineCare's Health Homes Initiative	Medicaid	Statewide	ACA Section 2703 Health Homes
MaineHealth ACO	Medicare	Southern Maine	Medicare Shared Savings Program
PTN - Maine Quality Counts, Northern New England Practice Transformation Network	Grant	Maine, New Hampshire, Vermont	Transforming Clinical Practices Initiative (TCPI)

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
Aetna Accountable Care - Maine	Commercial	Portland, Augusta
Cigna Collaborative Accountable Care ACO - Beacon Health	Commercial	Eastern Maine	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care ACO - Central and Western Maine Regional PHO	Commercial	Central and Western Maine	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care ACO - Kennebec Region Health Alliance	Commercial	Augusta and Waterville	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care ACO - Martin’s Point Health Care and Mercy Health System	Commercial	Portland and Bangor areas	Cigna Collaborative Care Program
Enhanced Personal Health Care Program - Maine	Commercial	Statewide	Anthem - Enhanced Personal Health Care

State Legislation

Legislation	Status	Year
Appropriation for patient-centered medical home pilot In the FY2010 budget, the Maine legislature appropriated $500,000 to partially fund a PCMH pilot in partnership with Maine Quality Forum (MQF), Maine Quality Counts, and the Maine Health Management Coalition with additional funding from an RWJ Foundation Aligning Forces for Quality grant.	Enacted	2010
SP 421: An Act To Establish Transparency in Primary Health Care Spending This bill requires insurers to report primary care expenditures to the Maine Health Data Organization and for the Maine Quality Forum to use this data to report annually to the Department of Health and Human Services and the Legislature the percentage of total medical expenditures paid for primary care by commercial insurers, the MaineCare program, Medicare, the organization that administers health insurance for state employees and the Maine Education Association benefits trust respectively, the average of the percentage of total medical expenses paid for primary care across all organizations and the methods used by these organizations to pay for primary care. This bill also requires the Maine Quality Forum to conduct a study on best practices in health care spending reporting and submit its findings to the Department of Health and Human Services and the Joint Standing Committee on Health and Human Services.	Enacted	2019
SP 421 - LD 1353 Defines primary care and details how primary care spending report will transpire in Maine moving forward.	Enacted	2019
LD 1196 Sets targets for investment in primary and behavioral healthcare.	Enacted	2022