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Maine School-Based Health Center Evaluation (2 of 2)Project


Collaboration and Integration

The Maine School-Based Health Care Access Project is a collaborative effort among a wide variety of child serving agencies in the state of Maine. The Maine Children's Alliance, a long time leading advocacy organization, provides the leadership and administrative infrastructure. It also serves as the fiduciary agent. Other participants include:


  • Nine school-based health centers serving high schools in the following cities and towns: Auburn, Dover-Foxcroft, Lewiston, Newcastle, Portland (2 high schools), Readfield, Rumford, and South Paris. These schools represent Maine's urban centers (Portland, Lewiston, and Auburn), semi-rural areas (Newcastle, Readfield, and Rumford) and rural areas (Dover-Foxcroft and South Paris). Each school-based health center offers direct health care services and has agreed to provide the data required for the evaluation. In addition, the SBHCs are receiving technical assistance from the commercial insurers on issues such as, credentialing, billing, and accreditation.

  • The Maine Assembly on School-Based Health Care (the local chapter of the National Assembly on School-Based Health Care – NASBHC). The Councils – at both the local and national level – provide networking, advocacy, and technical assistance to the SBHCs and to the Maine School-Based Health Care Access Project. For example, the Maine Assembly has been active in raising awareness of the need for expanded health care options for adolescents through their participation in Healthy Maine Partnership activities, and facilitating the sharing of best practices in adolescent health care.

  • The Bureau of Health. They fund and support school-based health centers in Maine. The Bureau, through its performance-based contracts, requires and monitors the effectiveness of services, with an emphasis on preventive care, risk assessments, and follow-up. The Bureau has participated in the evaluation design and in securing support from the local SBHCs.

  • The Maine Department of Health and Human Services, Bureau of Medical Services. MaineCare (Medicaid and Cub Care) representatives have participated in the evaluation design and have agreed to provide crucial claims and utilization data for analysis. In 1999, the Bureau of Medical Services developed policies for school-sponsored SBHCs that provided for reimbursement of SBHCs without prior authorization and eliminated this key barrier to access in SBHCs. They also provide technical assistance and training for SBHCs on MaineCare enrollment and billing.

  • The four primary commercial insurers: Aetna Health Inc., Anthem Blue Cross and Blue Shield in Maine, CIGNA HealthCare of Maine, Inc., and Harvard Pilgrim Health Care. The commercial insurers are collaborating in significant ways: a) from the inception of MSBHCAP, they participated in the research design of the evaluation; b) they will be providing the claims and utilization data via the Maine Health Care Claims Data Bank; c) they agreed to reimburse SBHC services, consistent with their contracts; d) they are providing technical assistance to school-based health centers which will lead to greater financial viability and a stronger infrastructure.

  • The Maine Association of Health Plans. This non-profit trade association represents the four commercial heath insurers listed above and works to educate the public about the benefits of health, wellness, and coordinated care. Katherine Pelletreau, Executive Director of the Association, represents and involves the insurers in a wide variety of projects. Her role in this project has been to organize and facilitate the Health Plans' communication with the other stakeholders in the project. She has also served as a representative of the insurers on small committees when individual representatives from each company would have been unwieldy.

  • The Maine-Dartmouth Family Practice Residency. Daniel Meyer, PhD, Director of Research at Maine-Dartmouth Family Practice Residency and Associate Professor of Community and Family Medicine at Dartmouth Medical School, will conduct the evaluation. He will have access to the resources and facilities of both organizations, including computers, analytic/statistical programs, libraries, research capabilities, and peer/collegial support and feedback.

  • The Maine Health Information Center. William Perry, M.A., Vice President for Research at MHIC, will represent MHIC in this project, providing claims data processing expertise. He will also assist in all aspects of the project's design and analysis. See biographical sketch below.




The collaborative efforts of the Maine School-Based Health Care Access Project will lead to two major accomplishments. The first – the stated purpose of this proposal – is to conduct a rigorous evaluation of the impact of reimbursement on quality health care outcomes. If the evaluation demonstrates that outcomes improve while maintaining cost neutrality, then it could have profound implications for the way in which health care is delivered to children throughout Maine and indeed the country. The system of care will be impacted in a truly significant way because funders and providers will be able to join together to provide high quality health care to all children without incurring additional costs. Second, by participating in this project, the school-based health centers will receive the technical assistance necessary for them to become financially viable. Their administrative systems, such as billing and credentialing, will improve leading to greater efficiencies. By maximizing collections, they ensure their survival. And in so doing, they can continue to provide health care to all children, including the uninsured, the underinsured, the disadvantaged, and the underserved.

Sustainability

The evaluation of the Maine School-Based Health Care Access Project is a discrete project, which can be time-limited requiring no further funding. Should the results be sufficiently compelling, leading to system and structural change, further data collection and analysis may not be required. At the same time, the participants in the Project – the Bureau of Health, Medicaid, and the commercial insurers – might be interested in obtaining data on an ongoing basis. This could result in a long-term study stretching out over many years. No doubt, a longitudinal study such as this would be increasingly rigorous with added power and influence.





1 A comprehensive bibliography on adolescent utilization, health risks, outcomes and prevention interventions is on the Health-in-Schools website: http://www.healthinschools.org/sbhc25th/researchers.pdf
2 Key, J.D. Reduced emergency department utilization associated with school-based clinic enrollment. Journal of Adolescent Health, 2002, 30(4):273-8.
3 Webber MP, Carpiniello KE, Oruwariye T, Lo Y, Burton QWB, Appel DK: Burden of Asthma in inner-city elementary schoolchildren. Archives of Pediatric and Adolescent Medicine, 2003, 157L125-129.



Updated: Jun 28th, 2010 - 12:08:36
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