This study, conducted on behalf of the Emergency Department Use Work Group of the Maine Advisory Council on Health System Development provides an analysis of visits to hospital emergency departments in Maine that took place in 2006. The study relied on two sources of data: a comprehensive file of hospital discharge records provided by the Maine Health Data Organization; and comprehensive claims records for most privately insured residents in Maine and most MaineCare members. The 2006 data used for this analysis pre-dated some of the initiatives undertaken by the Department of Human Services to improve access to primary care and reduce emergency department use among MaineCare members.
Key findings with regard to emergency department (ED) use:
Maine's emergency department use in 2006 was, in aggregate, about 30% higher than the national average.
Maine's rate of use in every age cohort was higher than the national average for the same age cohort.
The highest prevalence of frequent ED users (4 or more visits in a year) is found among infants, and 19 to 24 year olds.
Use of emergency department care for outpatient care by MaineCare members is more than three times as high (918 outpatient visits per 1000) as rates of use by privately insured residents (284 per 1000).
The uninsured are responsible for 9 percent of emergency department visits. ED visits by uninsured patients are concentrated among young adults. Between the ages of 15 and 44, 15 percent of emergency department visits are generated by the uninsured.
Rate of emergency department use varies substantially by health service area; Geographic variation in emergency department use rates is seen among both privately insured and MaineCare members with substantial overlap of high and low use areas for these two populations, suggesting that use rates are affected by area-specific health system factors that affect the total population.
A review of diagnoses frequently seen in emergency departments in Maine suggests that a substantial number of visits are made for conditions that could be appropriately treated in office or clinic settings.
Following up on the Environmental Scan report (http://muskie.usm.maine.edu/Publications/rural/Barriers-to-Integration-E...), the authors interviewed representatives from Maine's business community, payers, purchasers, professional associations, state legislators, advocacy organizations, state government, and provider organizations. The interviews provided a context to understand the barriers to integration in Maine and develop recommendations to overcome them. This Final Report presents key findings from the study, recommendations for addressing barriers, and next steps for moving forward. This study recognizes the need for integration of behavioral and physical health services in all settings. Although most discussions of integration focus on the development of behavioral health services in primary care settings, this study acknowledges the challenges faced by individuals with chronic and/or severe behavioral health problems in obtaining vital physical and primary health care.
Presenting numbers and patterns is a critical component of data analysis. Once analyses have been completed, the next step involves sharing key findings with staff and stakeholders and using findings as a basis for decision-making. There are a number of ways to present data and the challenge is in constructing an effective visual. This paper provides an overview of the most frequently used formats and includes tips on how to select among the different types.
This report describes the results of a telephone survey of enrollees in the MaineCare Option for Workers with Disabilities (MaineCare is Maine's Medicaid program, the Workers Option is one of a growing number of state initiatives across the country that are referred to as Medicaid Buy-In programs).The Workers Option is a MaineCare eligibility category that provides full MaineCare coverage for working people with disabilities who have countable income up to 250% of the Federal Poverty Level (FPL) and who do not have unearned income above 100% FPL. The purpose of the Workers Option is to encourage people with disabilities to increase their job earnings without fear of losing health coverage. It is authorized under the federal Balanced Budget Act of 1997, one of two ways that states can develop Medicaid-related work incentives of this type. Maine's Bureau of Elder and Adult Services (BEAS), Maine Department of Human Services, commissioned the survey to find out more about the people who were or ever had been enrolled in the Workers Option. BEAS wanted to know about their work experience, their support services needs (particularly their use of personal assistant services), and their opinions and concerns about receiving health coverage under the Workers Option.
This paper outlines some of the factors program managers may need to consider in identifying strategies for integrating information to support their quality improvement activities. The focus of this paper primarily is on synthesizing information from different data sources and integrating two or more files. For the more technically minded, the Appendix provides examples of states system integration efforts.
The purpose of this analysis was to identify opportunities for eliminating unnecessary inconsistency and increasing consumer choice and control across Maine's personal assistance services (PAS) programs. Thirteen recommendations were made based on the findings which indicated that Maine PAS programs vary in the level of support they offer but the difference in support cannot necessarily be explained by differences in the level of need. Additionally, Maine PAS programs have been and are currently working toward increasing opportunities for expanding consumer choice and control over services.
In 2007, the Maine Department of Health and Human Services, Office of Child and Family Services, established a high-fidelity, community-based wraparound initiative to improve the lives of children and families in Maine. The project, commonly referred to as
This briefing paper examines the project activities proposed by states in their Fiscal Year 2004 Flex Program grant applications (September 2004-August 2005) and highlights recent trends in State Flex Program planning, development, and implementation.
Of the forty-five state grant applications reviewed, funding requests were greatest for activities related to network development (18%), quality improvement (21%), and supporting existing CAHs (22%). Some states provided funding directly to CAHs under state administered mini-grant programs to support hospital specific activities while others chose to use funds to support more statewide and/or regional activities to address the needs of CAHs through conferences and meetings, training and education initiatives, technical assistance services, recruitment and retention initiatives, operational assessments, and community needs assessments among others.
What applications can states use to measure home and community based services? The purpose of this report is to outline the key components of performance measurement and to discuss their relevance and potential use in HCBS. The paper also offers practical approaches for states to gradually build a HCBS performance measurement set to serve as the foundation for their quality management activities and CMS required reporting.
Research staff at the Muskie School of Public Service, USM were requested to evaluate the effectiveness of the revised HCBS waiver application process from the perspective of states. This report summarizes the purpose, scope, approach and findings of the evaluation. The evaluation was designed to provide qualitative information on states' experience using the new HCBS waiver application for initial and renewal waiver applications. The evaluation examined four major issues: Clarity/Consistency: Are the waiver application components (Application, Technical Guide, Review Criteria) clearly understood and do they promote consistent interpretation? Relevancy/Adequacy: Do the application components address the range of waivers and options available to states and are they useful in clarifying the design of the state's waiver program? Burden: Do the application components and processes promote efficiency of state effort? Impact: Do the waiver application components strengthen the waiver program? States identified four primary areas of benefit from the new waiver application process.
Overall Benefits States identified four primary areas of benefit from the new waiver application process. They found that the waiver application:
Facilitated communication and coordination within the State and with CMS;
Clarified the expectations of CMS regarding roles and responsibilities;
Improved the overall consistency and accuracy of the waiver application;
Improved and strengthened the organization and design of the waiver programs