GRANT-FUNDED INITIATIVES BY THE NUMBERS

MPCA holds an HCCN contract to strengthen and leverage health information technology to improve health outcomes at primary care practices across the state. CCPM partners with MPCA by participating on the Statewide EHR workgroup, sharing quarterly collaborative discussions on remote patient engagement methods and effectiveness, and quarterly data sharing on clinical quality measures and digital/remote health tool engagement.

MPCA holds a WIN contract to strengthen workforce development of Medical Assistants (MA), Dental Assistants (DA), and Community Health Workers (CHW). CCPM partners with MPCA by participating on the Statewide WIN consortium, and creation of 3 MA Enhanced Skill toolkits. Toolkits aim to be completed by the end of 2023 and will be focused on the following topics: Quality, Population Health, and Supervisory Leadership.

Hometown Health Center partnered with Community Care Partnership of Maine (CCPM) and three other FQHCs to implement the Pre-Visit Planning Model Project. The project employed a centralized Medical Assistant (MA) through CCPM to conduct thorough pre-visit planning for annual visits for Harvard Pilgrim Health Care (HPHC) adult patients. The MA reviewed patient records to assess chronic disease management health indicators and the need for up-to-date preventative screenings, including SDOH screenings, and disseminated patient data to PCPs and MAs prior to patient visits. Pre-visit planning improved whole patient care and increased the efficiency of patient visits, especially for complex patients, and will be replicable across all 18 members of the CCPM ACO.

CCPM was funded to partner with the Schmidt Institute and PCHC’s Pharmacy Department to develop educational tools for providers and patients focused on chronic pain and controlled substance treatment management. This project team assessed providers and patient needs for evidence-based information about controlled substance prescriptions for chronic pain management, and mental health and trauma co-morbidities. Educational tools were developed to ensure literacy and language needs met the patient population and National Library of Medicine resources were utilized for development.

CCPM’s clinical and quality team partnered with 9 participating member organizations to implement quality improvement and referral procedures to prevent and treat cardiovascular disease and diabetes. Key focus areas included resources for disease management for patients with uncontrolled hypertension, prediabetes, and diabetes, support for care teams at organization sites to manage cardiovascular and diabetes disease patient care most effectively, and increased patient access to diabetes prevention resources, such as the National Diabetes Prevention Program (NDPP). A major strategy utilized by CCPM quality staff in accomplishing grant project focus areas is to implement pre-visit planning MA services with member organizations.

CCPM received funding to enhance the Theresa Bray Knowles Gaps in Care Fund to include Helping Hands for Health (HHH) mini-grants. The goal of the HHH Mini-Grant project was to reduce the financial barriers that exist for patients to access healthcare-related items through increasing the capacity of primary care health centers across the state to provide critical basic need resources on-site. All CCPM member organizations were eligible to apply for a mini-grant up to $2,500 to be used for items or services that support patients’ basic needs. Unique from the general Theresa Fund, items purchased under HHH were to be available to any patient at their facility, rather than for a specific individual request. Nine member organizations received mini-grant funding in 2022. The remainder of the $25,000 grant was dispersed into the general Theresa Fund.

The Lung Cancer Prevention and Early Detection Project (LCP Project) created numerous opportunities for CCPM, 4 member organization partners, and external resource organizations to review procedures, identify problems, and innovate solutions. Project deliverables included standardizing and improving lung cancer screening curriculum and standing orders, integrating lung cancer screening recommendations as part of CCPM’s pre-visit planning services, increasing connection to care management services for patients with COPD, and connecting member organizations to Lung Cancer resources in Maine.