Paying for performance in Maine: How one state significantly increased access to treatment without increased funding

In July 2007 the Maine Office of Substance Abuse instituted access and retention contract performance measures for all block grant contracted outpatient and intensive outpatient services. Contracted agencies receive quarterly payments based on meeting or exceeding measures on five measures: units of service, time from first call to first face to face, time to first treatment session, and two retention measures specific to the level of care (outpatient or intensive outpatient). Payments are based on data performance for these measures and agencies can receive an incentive payment, a baseline payment, or a penalty payment of plus or minus 9% of their quarterly base payment. Preliminary results indicate that agencies participating in the Maine process improvement grant learning collaborative who are receiving coaching in process improvement methods are more likely to achieve or exceed the access and retention measures and receive baseline or incentive contract payments.

This presentation will review performance results of the first five years of the Maine DHHS Office of Substance Abuse using this new approach. It will also discuss how Maine has applied the NIATx process improvement model to increase access to treatment services and improve quality and performance at both the state and agency level. An overview of how the OSA as the Maine Single State Authority (SSA) initiated application of the process improvement model to significantly increase admissions to treatment will be provided; the SSA's progress in supporting diffusion and spread of the model to all purchased services will be reviewed and discussed.