Maine Patient-Centered Medical Home Pilot

Program Location: 
Augusta, ME
Number of Practices: 
Payer Type: 
Partner Organizations: 
Maine Quality Forum
Maine Quality Counts
Maine Health Management Coalition
Anthem BlueCross Blue Shield
Harvard Pilgrim Health Care

The Maine Patient-Centered Medical Home Pilot was launched in January of 2010 and is led by the Dirigo Health Agency’s 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. The Pilot includes 26 primary care practices from around the state that are working to implement the PCMH model as a first step in ultimately achieving the goal of statewide implementation of a patient centered medical home model.  These Pilot sites include a diverse mix of 22 adult and 4 pediatric practices from around the state, that were selected for their demonstrated leadership for and commitment to the principles of the PCMH model; diversity of practice size, location, and ownership; and ability to link with and leverage existing improvement opportunities going on across the state. As part of their participation in the Pilot, practices are expected to implement a set of ten “Core Expectations” addressing key practice changes, and will be supported in their continued efforts to transform to a more patient centered model of care through participation in a PCMH Learning Collaborative. The ultimate goal of this effort is to sustain and revitalize primary care both to improve health outcomes for all Maine people and to reduce overall healthcare costs.

Maine’s Medicaid program, has been an active supporter of the Maine PCMH Pilot from the outset and currently participates as a payer in the Pilot, providing medical home payments to both Pilot practices and Community Care Teams. MaineCare is now broadening its support for practices that agree to meet medical home criteria and commit to the PCMH Pilot 2 Core Expectations through its new “Health Homes” initiative, an effort authorized by Section 2703 of the Affordable Care Act and a key component of the Maine Department of Health & Human Services’ “Value Based-Purchasing Strategy”. 

The Pilot has engaged the major private and public payers in the state to provide an alternative reimbursement model to participating practices that recognizes the infrastructure and system investments needed to deliver care in accordance with the PCMH model, and rewards practices for demonstrating high quality and efficient care, with participation by anthem BCBS, Aetna, Harvard Pilgrim Health Care and MaineCare. In 2012, due to Maine's selection for a CMS Multi-payer Advanced Primary Care Practice demonstration project, Medicare will join Medicaid and the commericial payers to participate in the project. 

The Multi-Payer Advanced Primary Care Practice (MAPCP), Medicare's major Patient Centered Medical Home (PCMH) demonstration project provides the PCMH Pilot in Maine, with an opportunity to introduce Community Care Teams (CCTs) as a new component of care for high-needs patients. Medicare is providing Maine PCMH Pilot practices with a new care management fee – estimated to a total up to $28 million over the next three years and must demonstrate improvements in clinical care and efficiency and specifically result in improved coordination of care; decreases in avoidable inpatient admissions and emergency department visits and in specialty consultations and imaging.

Community Care Teams (CCT's) recognize that many patients have needs and barriers to care that can reach beyond the capacity of even the most robust primary care physician practice.  CCTs are multi-disciplinary, community-based, practice-integrated care management teams that will work closely with the Patient Centered Medical Home (PCMH) Pilot practices to provide enhanced services for the most complex, most high needs patients in the practice.  

For a map of participating practices, click here.

Payment Model: 

The payers endorsed a three-component payment model that includes: (1) a new, up-front “per member, per month” care management fee paid to PCMH practices, (2) continued fee-for-service payments, and (3) payment that recognizes excellent performance by the practice, whenever possible.

In 2012, CMS began providing Medicare enhanced fees to Maine PCMH Pilot practices (MAPCP demonstration funding) –estimated to total up to $28 million over three years—for providing medical home services to their Medicare patients. 

As of January 2012, Medicare began paying a care management fee of $6.95 PMPM. Between January 1, 2012, and December 31, 2012 PCMH Pilot practices and CCTs received a total of $2,203,295 in payments from Medicare for beneficiaries assigned to their practices during the first year of the demonstration.

- RTI International Independent Evaluation of MAPCP Demonstration (year 1)

Other Outcomes: 

RTI International (January 2015) indepedent evaluation comparing data from the first demonstration year vs. baseline

Utilization results:

  • The rates of all-cause, acute-care hospitalizations, ER visits and unplanned readmissions during the first year of the MAPCP Demonstration did not change significantly for beneficiaries assigned to participating PCMH Pilot practices, relative to the comparison group (PCMH and non-PCMH). However, in the third and fourth quarters of 2012, higher rates of all-cause, acute care hospitalizations were observed among beneficiaries assigned to Maine PCMH Pilot practices relative to beneficiaries assigned to comparison PCMHs.

Cost Results:

  • The growth in expenditures for ER visits was less for beneficiaries assigned to participating practices than for beneficiaries assigned to comparison PCMHs. 
  • Between the baseline and fourth demonstration quarter, total expenditures increased more for beneficiaries assigned to participating practices than for beneficiaries assigned to comparison PCMHs
Last updated January 2016
Go to top