Health Policy Commons^™

Rural Working-Age Adults Report More Cost Barriers To Health Care, Erika C. Ziller Phd, Carly Milkowski Mph, Amanda Burgess Mppm, Mph

Access / Insurance

Using the 2019-2020 National Health Insurance Survey, researchers at the Maine Rural Health Research Center examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults. Rural adults (18-64) were more likely than their urban counterparts to report problems paying, or being unable to pay, their medical bills. They were also more likely to delay or go without needed care because of the cost. Compared with urban adults, those in rural areas were more likely to engage in prescription drug cost-saving measures such as skipping doses, delaying refills, or taking less medication than prescribed. For all affordability measures, …

Local Community-Based Workforce To Increase Covid-19 Vaccine Access: Deliverables Summary Binder, Mary Lindsey Smith Phd, Evelyn Ali Bs, Katie Rosingana Ba, Tyler Egeland Ba, Katharine Freund Mph

Substance Use Research & Evaluation

Public health evaluators from the Catherine E. Cutler Institute at the University of Southern Maine worked with Healthy Community Coalition and the Hometowns Partnership to provide evaluation services of the Health and Resources Services Administration (HRSA) grant to address vaccination hesitancy and access for the Western Public Health District. This grant program ran from June 2021 to January 2023. The primary goals of the evaluation were to: (1) document implementation strategies and identify barriers and facilitators to implementation, (2) evaluate the efficacy of the education activities at reducing vaccine hesitancy and improving vaccination rates in Western Maine, and (3) assess …

Rural Health Action Network Enhanced Outreach Initiative. Year One Final Report, Mary Lindsey Smith Phd, Karen Pearson Mlis, Ma, Evelyn Ali Bs

Substance Use Research & Evaluation

Healthy Community Coalition (HCC), in coordination with the Rural Health Action Network (RHAN) of greater Franklin County, is implementing a multi-faceted outreach program to improve health outcomes among the rural poor living with chronic conditions in greater Franklin County, Maine.

The goals of the Franklin County Rural Health Action Network Enhanced Outreach Initiative (RHAN-EOI) include:

• Expand access to quality services;
• Expand training for community health extenders;
• Decrease hospital admissions, emergency department use, and costs; and
• Improve communication and care coordination across project partners

This report highlights the implementation and progress of HCC RHAN in Year 1. For more information, please …

Healthy Acadia Downeast Community Opioid Response Program: Year 1 Summary, Mary Lindsey Smith Phd, Evelyn Ali Bs, Tyler Egeland Ba, Katie Rosingana Ba

Substance Use Research & Evaluation

The Downeast Substance Treatment Network is a group of diverse organizations working to improve integration and access to treatments and services for people with substance use disorder. The consortium’s Rural Communities Opioid Response Program grant project aims to: (1) expand the reach of their treatment network, (2) increase awareness and practice of harm reduction, and (3) facilitate transitions of care to improve partner efficacy. This project included a mixed-methods evaluation led by Catherine E. Cutler Institute’s Substance Use Research and Evaluation Team (SURE). This year 1 summary presentation includes feedback from program partners and key informants, in addition to HRSA-required …

Medication Assisted Treatment: Prescription Drug And Opioid Addiction Expansion Project, Mary Lindsey Smith Phd, Katharine Knight Mph, Mark Richards Bs, Tyler Egeland Ba, Evelyn Ali Bs

Substance Use Research & Evaluation

Greater Portland Health (GPH) in collaboration with Preble Street Resource Center was awarded a Medication Assisted Treatment: Prescription Drug & Opioid Addiction (MOUD-PDOA) grant from SAMHSA. The GPH MOUD-PDOA project will include a mixed-methods evaluation led by Catherine E. Cutler Institute. The evaluation team will build knowledge and provide feedback to inform the implementation and refinement of the GPH MOUD-PDOA Program.

Evaluation Goals:

• Document program strategies and identify barriers and facilitators to implementation
• Examine the efficacy of using a continuum of treatment services to increase access to MOUD among vulnerable populations in underserved communities
• Assess the impact of the intervention …

Patterns Of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 And Older, 2010-2017, Yvonne Jonk Phd, Heidi O'Connor Ms, Amanda Burgess Mppm, Carly Milkowski Mph

Access / Insurance

The purpose of this study was to examine rural-urban differences in health care use among Medicare beneficiaries age 85+. Understanding these differences, and the socioeconomic characteristics that contribute to them, can have important implications for Medicare policies aimed at serving the age 85+ population. Using the Medicare Current Beneficiary Survey 2010-13 Cost and Use and 2015-17 Cost Supplement Files, we examined whether and how rural and urban Medicare beneficiaries age 85+ differ in terms of their:

1. socioeconomic and health characteristics that may inform health care use;
2. trends in health care use, including use of inpatient and emergency department (ED) care; …

Mainegeneral Hrsa Rcorp Grant Summary, Mary Lindsey Smith Phd, Evelyn Ali Bs, Katharine Knight, Tyler Egeland Ba

Substance Use Research & Evaluation

MaineGeneral received a Rural Communities Opioid Response Program (RCORP) Implementation grant to further the work of the Substance Use Prevention Expanded Recovery (SUPER) Consortium. Over the course of the three-year grant, the SUPER Consortium: (1) expanded harm reduction work, including naloxone distribution, and (2) increased organizational capacity to treat and prevent SUD through education efforts in healthcare organizations, first responder organizations, community organizations, and schools. The Substance Use Research and Evaluation team at the University of Southern Maine’s Catherine Cutler Institute was contracted to evaluate MaineGeneral’s RCORP grant. This grant summary presentation includes data from community outreach and training grant …

Adult Day Services In Maine: Benefits, Challenges, And Opportunities, Elizabeth Gattine Jd, Eileen Griffin Jd, Kimberly I. Snow Mhsa, Ba

Disability & Aging

In Maine and nationally, adult day services tend to be underfunded and underutilized compared to other types of long term services and supports (LTSS). In part, investment in adult day services is hampered by a lack of standardized data collection and limited research on issues of accessibility, cost-effectiveness, and the impact of adult day services on the broader health system. Lack of uniformity in state regulatory frameworks for licensing, program design, service delivery, and other administrative requirements further complicates cross-state comparisons. Considering these limitations, a key goal of this report is to provide a more detailed and comprehensive understanding of …

Evaluation Of The Time To Ask Program At St. Croix Regional Family Health Center, Mary Lindsey Smith Phd, Evelyn Ali Bs, Tyler Egeland Ba

Substance Use Research & Evaluation

The goals of the Time to Ask (TTA) education and quality improvement program are to increase the capacity of the interprofessional care team to effectively, efficiently and compassionately discuss alcohol use with their patients through screening, brief intervention, and referral (SBIRT) as well as to expand regular screening and monitoring of unhealthy alcohol use at the practices. This infographic is a summary of a participant feedback following the TTA program at St. Croix Regional Family Health Center. For more information, please contact Lindsey Smith at [email protected]

Experiences Seeking Meaningful Employment For Individuals With Substance Use Disorder In York County Maine, Tyler Egeland Ba, Mark Richards Bs Bs, Evelyn Ali Bs, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

Two focus groups and one interview conducted in November 2021 collected information from a total of six respondents regarding theiremployment experiences in York County as individuals receiving treatment for substance use disorder. The guided discussion coveredtopics related to resources and services for finding employment opportunities, experiences obtaining meaningful employment, andpotential barriers and facilitators to maintaining employment. The interview and focus groups were facilitated and analyzed byexperienced researchers from the Catherine Cutler Institute at the University of Southern Maine. For more information, please contact Lindsey Smith at [email protected]

Nh Delivery System Reform Incentive Payment Program (Dsrip): Key Findings From The Summative Evaluation Report, Mary Lindsey Smith Phd, Deborah Thayer Mba, Katie Rosingana Ba, Rachel M. Gallo Mph, Catherine Mcguire Bs, Evelyn Ali Mph, Katharine Knight Mph, Chinonye Anumaka, Tyler Egeland Ba, Mark Richards Bs, Karen Pearson Mlis

Substance Use Research & Evaluation

Delivery System Reform Incentive Payment (DSRIP) programs are part of the broader Center for Medicare & Medicaid Services (CMS) Section 1115 Waiver programs and provide states with significant funding to support system transformation efforts. CMS approved New Hampshire’s five-year Building Capacity for Transformation Section 1115(a) Medicaid Demonstration Waiver in 2015. The overall goal of the DSRIP Demonstration is to improve the care for New Hampshire’s Medicaid Beneficiaries with behavioral health disorders by addressing workforce and infrastructure shortages, improving care transitions, and integrating physical and behavioral health. This condensed report highlights key findings from the NH DSRIP summative evaluation report. For …

Summative Evaluation Report By The Independent Evaluator For The New Hampshire Delivery System Reform Incentive Payment (Dsrip) Program, Mary Lindsey Smith Phd, Deborah Thayer Mba, Katie Rosingano Ba, Rachel M. Gallo Mph, Catherine Mcguire Bs, Evelyn Ali Mph, Katharine Knight Mph, Chinonye Anumaka Od, Mph, Tyler Egelund Ba, Mark Richards Bs, Karen Pearson Mlis, Ma

Substance Use Research & Evaluation

Delivery System Reform Incentive Payment (DSRIP) programs are part of the broader Center for Medicare & Medicaid Services (CMS) Section 1115 Waiver programs and provide states with significant funding to support system transformation efforts. CMS approved New Hampshire’s five-year Building Capacity for Transformation Section 1115(a) Medicaid Demonstration Waiver in 2015. The overall goal of the DSRIP Demonstration is to improve the care for New Hampshire’s Medicaid Beneficiaries with behavioral health disorders by addressing workforce and infrastructure shortages, improving care transitions, and integrating physical and behavioral health. This report is the final summative evaluation report on New Hampshire's DSRIP program. For …

Greater Portland Health Medication Assisted Treatment: Prescription Drug And Opioid Addiction Expansion Project: Biannual Summary, Mary Lindsey Smith Phd, Katharine Knight, Mark Richards Bs, Tyler Egeland Ba, Evelyn Ali Bs

Substance Use Research & Evaluation

Greater Portland Health (GPH) in collaboration with Preble Street Resource Center was awarded a Medication Assisted Treatment: Prescription Drug & Opioid Addiction (MOUD-PDOA) grant from SAMHSA. The GPH MOUD-PDOA project included a mixed-methods evaluation led by Catherine E. Cutler Institute’s Substance Use Research and Evaluation Team (SURE). The aims of the evaluation are to build knowledge, document lessons learned, and provide feedback to inform the implementation and refinement of the GPH MOUD-PDOA Program. This summary presentation is a biannual summary of the GPH MOUD-PDOA Project. For more information, please contact Lindsey Smith at [email protected]

Community Characteristics And Financial And Operational Performance Of Rural Health Clinics In The United States: A Chartbook, John Gale Ms, Zachariah Croll Mph, Jamar Croom Ms, Louisa Munk Mph, Yvonne Jonk Phd

Rural Health Clinics

This chartbook provides an overview of Rural Health Clinic (RHC) characteristics and issues using data from CMS’s Provider of Services file, Medicare Cost Reports, and the Robert Wood Johnson Foundation’s’ County Health Ranking and will be useful to policymakers and others interested in the performance of RHCs nationally. It can also be useful to RHC administrators to benchmark staffing patterns, productivity, and efficiency. Finally, it provides a discussion of the challenges related to collection and reporting of RHC quality data.

For more information, please contact John Gale, [email protected]

Vermont: A Health-Focused Landscape Analysis, Katherine Ahrens Phd, Amanda Burgess Mppm, Mph, Carly Milkowski Mph, Louisa Munk Mph, Yvonne Jonk Phd, Erika C. Ziller Phd

Population Health

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the Northern …

New Hampshire: A Health-Focused Landscape Analysis, Katherine Ahrens Phd, Amanda Burgess Mppm, Mph, Carly Milkowski Mph, Louisa Munk Mph, Yvonne Jonk Phd, Erika C. Ziller Phd

Population Health

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the …

Maine: A Health-Focused Landscape Analysis, Katherine Ahrens Phd, Amanda Burgess Mppm, Mph, Carly Milkowski Mph, Yvonne Jonk Phd, Louisa Munk Mph, Erika Ziller Phd

Population Health

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the …

The Northern Border Region: A Health-Focused Landscape Analysis, Katherine Ahrens Phd, Amanda Burgess Mppm, Mph, Carly Milkowski Mph, Louisa Munk Mph, Yvonne Jonk Phd, Erika Ziller Phd

Population Health

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the Northern …

New York: A Health-Focused Landscape Analysis, Katherine Ahrens Phd, Amanda Burgess Mppm, Mph, Carly Milkowski Mph, Louisa Munk Mph, Yvonne Jonk Phd, Erika Ziller Phd

Population Health

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the Northern …

House: Homeless Opioid User Service Engagement Program. Year 1 Report, Mary Lindsey Smith Phd, Katharine Knight Mph, Evelyn Ali Bs, Thomas Chalmers Mclaughlin Msw, Phd, Katie Rosingana Ba, Tyler Egeland Ba, Mark Richards Bs, Karen Pearson Mlis, Ma

Substance Use Research & Evaluation

Homelessness and lack of stable housing is often a barrier to achieving stability for individuals who are experiencing homelessness (IWAEH) with an OUD. In order to meet the complex needs of IWAEH with OUD, the Department of Health and Human Services funded a pilot program in 2021, the Homeless Opioid Users Service Engagement (HOUSE) Program; clinicians at Greater Portland Health provide clients with low-barrier Medication Assisted Treatment (MAT), while staff at Preble Street provide casework support and rapid housing assistance to individuals who have been identified as being at high risk of overdose, are experiencing homelessness, and are diagnosed with …

R.A.C.E. To Recovery Year 1 Evaluation Summary Report, Katie Rosingana Ba, Evelyn Ali Bs, Tyler Egeland Ba, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

Through a collaborative effort led by the Healthy Community Coalition, the multi-sector Rural Addiction Care Expansion (R.A.C.E.) to Recovery initiative consortium is utilizing evidence-based, community-wide response to impact and reduce the effects of the opioid epidemic in the Western Maine Public Health District/ Greater Franklin County. To assess and evaluate the implementation, successes, and challenges of the RACE to Recovery project, the Cutler Institute is collecting and analyzing data for both process and outcomes of the initiative.

In the first year of the initiative, the Cutler evaluation team utilized both primary and secondary data to assess RACE to Recovery program …

Support For Me Needs Assessment Summary., Mary Lindsey Smith Phd, Katie Rosingana Ba, Evelyn Ali Bs, Karen Pearson Mlis, Ma, Mark Richards Bs, Katharine Knight Mph, Tyler Egeland Ba, Olivia Dooley Mpa

Substance Use Research & Evaluation

Maine Department of Health and Human Services contracted with the Catherine Cutler Institute at the University of Southern Maine to conduct a baseline needs assessment. The overall goal was to better understand the current capacity to address substance use in Maine; find barriers to receiving and utilizing SUD treatment and recovery services; and identify any gaps in SUD-related services in the state. The Cutler team conducted interviews, surveys, community listening sessions and focus groups with healthcare key informants (leadership from health systems, residential care, recovery housing, behavioral health agencies), providers (medical, behavioral health, first responders, residential treatment, law enforcement, opioid …

Time To Ask Program At Greater Portland Health [Infographic], Evelyn Ali Bs, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

The goals of the Time to Ask education and quality improvement program of the Lunder Dineen include increasing the capacity of interprofessional care teams in discussing alcohol use with the patients through the screening, brief intervention, and referral (SBIRT) process, and expanding providers' use of screening and monitoring unhealthy alcohol use of their patients.

This evaluation infographic visualizes the impact of Greater Portland Health's use of this program.

For more information about Time to Ask, visit https://lunderdineen.org/program/alcohol-use-time-to-ask/

For more information about the evaluation, please contact M. Lindsey Smith, PhD, [email protected]

Support For Me: Substance Use Disorder Prevalence And Treatment Capacity Assessment, Rachel T. Gallo Mph, Katharine Knight Mph, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

The aim of this report was to understand the sociodemographic and geographic distribution of substance use disorder (SUD) prevalence in Maine, through a claims-based analysis which assessed current statewide capacity to address SUD by examining current SUD treatment and recovery infrastructure, service utilization patterns, and geographic distribution of services and usage throughout the state to identify any gaps in treatment and recovery capacity.

The authors would like to note that this report was completed during the planning phase of the SUPPORT for ME project, which was funded by the Centers for Medicare & Medicaid Services (CMS) via the SUPPORT Act …

Support For Me: Provider Focus Group Summary, Mary Lindsey Smith Phd, Katie Rosingana Ba, Evelyn Ali Bs, Tyler Egeland Ba, Karen Pearson Mlis, Ma, Mark Richards Bs

Substance Use Research & Evaluation

This summary highlights feedback from focus groups with providers across Maine who currently address the needs of persons with substance use disorder (SUD). These providers represent individuals working in the following organizations: Health Systems, Behavioral Health Agencies, Residential Treatment, Community Recovery Programs, Opioid Treatment Programs (OTP), Emergency Medical Services (EMS), First Responders (EMT, fire, police), and law enforcement (e.g., Sheriff’s Office, Corrections). This summary report is designed to provide feedback to the Office of MaineCare Services to help inform their strategic planning process to increase statewide capacity for SUD treatment and recovery service capacity to better meet the needs of …

Use Of Electronic Health Records To Manage Tobacco Screening And Treatment In Rural Primary Care, Jean A. Talbot Phd, Erica C. Ziller Phd, Carly Milkowski Mph

Mental Health / Substance Use Disorders

Researchers at the Maine Rural Health Research Center, University of Southern Maine examined whether the use of electronic health records by rural primary care physicians facilitates their use of best practices in addressing tobacco dependence. The study used the National Ambulatory Medicare Care Survey (2012-2015) to explore how rurality and use of tobacco-related electronic health record functions were related to smoking status documentation and cessation treatment at adult primary care visits. Rural-urban comparisons were also examined.

The authors conclude that rural primary care physicians were at least as successful as their urban counterparts in leveraging electronic health records to enhance …

Support For Me Assessment Of Substance Use Treatment And Recovery Services Current Infrastructure And Future Needs: Summary Of Feedback From The Support For Me Community Focus Groups (Condensed), Katie Rosingana Ba, Mary Lindsey Smith Phd, Evelyn Ali Bs, Karen Pearson Mlos, Ma, Tyler Egeland Ba, Mark Richards Bs

Substance Use Research & Evaluation

In 2019, Maine’s Department of Health & Human Services received a $2.1 million grant from the Centers for Medicare and Medicaid Services (CMS) SUPPORT Act, establishing the SUPPORT for ME initiative within the Office of MaineCare Services. The primary goal of this planning grant is to increase MaineCare providers’ capacity to deliver Substance Use Disorder (SUD) treatment and recovery services for Medicaid beneficiaries. In collaboration with Maine DHHS, the Cutler Institute conducted a series of virtual focus groups in Maine as part of a needs assessment for the SUPPORT for ME initative. These focus groups were conducted regionally by Public …

Support For Me Assessment Of Substance Use Treatment And Recovery Services Current Infrastructure And Future Needs: Findings From The Support For Me Youth Survey (Condensed), Evelyn Ali Bs, Katie Rosingana Ba, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

In 2019, Maine’s Department of Health & Human Services received a $2.1 million grant from the Centers for Medicare and Medicaid Services (CMS) SUPPORT Act, establishing the SUPPORT for ME initiative within the Office of MaineCare Services. The primary goal of this planning grant is to increase MaineCare providers’ capacity to deliver Substance Use Disorder (SUD) treatment and recovery services for Medicaid beneficiaries. In collaboration with Maine DHHS, the Cutler Institute conducted a survey for youth and young adults in Maine as part of a needs assessment for the SUPPORT for ME initative. The data collection goals of the survey …

Support For Me: Key Stakeholder Interview Summary, Katie Rosingana Ba, Mary Lindsey Smith Phd, Karen Pearson Mlis, Ma, Evelyn Ali Bs, Tyler Egeland Ba, Mark Richards Bs

Substance Use Research & Evaluation

This summary feedback report is organized to inform the Office of MaineCare Services goal of addressing barriers and finding new and/or improved ways to increase capacity in Maine for people who seek treatment and recovery services for substance use disorder. Interview protocols were designed to assess critical domains of interest for the state, which include: current and potential provider capacity, access to care & service delivery provider willingness, and financial/ administrative policies.

Key Highlights from the stakeholder interviews indicated that:

• While there have been improvements in the integration of care for persons with behavioral health (BH) diagnoses, this integration has …

Promising Flex Program Initiatives To Support Critical Access Hospitals During The Covid-19 Pandemic, Celia Jewell Rn, Mph, Sara Kahn-Troster Mph, John Gale Ms

Rural Hospitals (Flex Program)

This brief reports on promising State Flex Program (SFP) strategies to support Critical Access Hospitals during the COVID-19 pandemic. SFPs adapted existing initiatives and implemented new activities to address the emerging needs of CAHs during the pandemic. With approval from the Federal Office of Rural Health, the SFPs redirected funds and activities to address the evolving COVID-19 needs of CAHs while maintaining fidelity to Flex Program goals. Based on qualitative interviews with seven SFPs, the authors, members of the Flex Monitoring Team, discuss initiatives such as resiliency training for frontline staff; packaging and dissemination of COVID-19 information; public health messaging; …