With one of the most robust statewide health information exchanges in the country, Maine healthcare stakeholders are experimenting with medical home policies, trying to spread them statewide without a regulatory hand.

Along with Arkansas, Massachusetts, Minnesota, Oregon and Vermont, Maine is receiving a $33 million federal innovation grant authorized by the Affordable Care Act, born out of a realization that, with healthcare spending rising, “we can’t keep going in this direction,” as Randal Chenard, innovation model director at the Maine Department of Health and Human Services, said at the Maine Health Management Coalition’s annual conference.

[See also: All Maine hospitals commit to HIE.]

With $33 million available through 2016, including for behavioral health providers to acquire EHRs and connect to the HIE, the program is aiming to align many of the goals of national health reform on a statewide-level with locally-developed solutions — providers using coordination and data analysis tools to offer more integrated care, and Medicare, Medicaid and commercial payers using consistent quality indicators to track progress.

The state innovation model program will test policies at different levels, some already in place. “One of the reasons Maine was selected was that it is already far down the road,” said Chenard, a former business architecture VP at the insurance company Unum.

The goal is essentially to build on the current use of medical home care models, which have shown some promise. In an analysis of commercial claims from multiple payers representing 30 employers, the Maine Health Management Coalition found PCMH pilots were associated with a 20 percent reduction in admissions for patients with chronic conditions.

Chenard, Maine DHHS and other health organizations say there are more primary care improvements and outpatient and speciality care savings to be had by integrating behavioral health to PCMH models.

[See also: How to get 3 steps closer to PCMH.]

Part of that challenge in integrating behavioral and physical health — including some HIPAA navigation — rests with Maine HealthInfoNet, the statewide HIE. In addition to bringing Medicaid care managers automated notifications of beneficiary hospitalizations, offering patients their records for download, and supporting ongoing quality reporting, Maine HealthInfoNet will be helping behavioral health providers adopt EHR systems and connect with the HIE.

The Maine legislature recently enabled behavioral health patients to opt into the HIE, a first step in integration, but patient data related to drug and alcohol use still cannot be shared.

“There’s a lot of legal issues,” said HealthInfoNet program director Katie Sendze. “We still face barriers with substance abuse data.”

The larger challenge stemming behavioral health integration is “how do we get clinical data to talk across the state,” said Sendze, a former care coordinator at the Dana-Farber Cancer Institute in Boston.

For instance, HealthInfoNet is operating a clinical dashboard based on HIE data available for state Medicaid managers. “It’s a test: is that useful, how is that useful, how can MaineCare use that to improve care management?”

And as Maine DHHS officials said in a presentation to the state legislature, longer-term analytics will offer "a statewide analysis of all payers that will allow us to see how a change in one area of the system impacts the system as a whole."

Another pilot with one provider will test what will be the first patient-portal in the country with a clinical care summary from the HIE.

Maine HealthInfoNet’s clinical data repository, with records on 1.2 million patients and 4.5 million yearly provider encounters, and its claims data warehouse are serving as the basis for evolving analytics applications, in areas such as provider market share, clinical performance and patient risk prediction.