​​MaineCare Issuing First Hospital Value-Based Purchasing (VBP) Supplemental Payments​

Jun 02, 2023

MaineCare recently implemented its new VBP supplemental sub-pool payments, totaling $600,000, which the Department will distribute each year to eligible hospitals based on performance on one or more quality measures. This sub-pool helps align incentives across the health care system to drive desired outcomes. The 2022 and 2023 distribution of these funds will focus on primary care access among MaineCare members within designated Hospital Service Areas (HSAs).  

Eligible hospitals must: 

• Be an Acute Care Non-Critical Access Hospital, Acute Care Critical Access Hospital, or a Hospital Reclassified to a Wage Area Outside of Maine, and 

• Participate in the MaineCare Accountable Communities (AC) Initiative, which includes Beacon Health, LLC (Beacon),  Community Care Partnership of Maine, LLC (CCPM), Kennebec Region Health Alliance (KRHA), and MaineHealth Accountable Care Organization (MHACO). 

Annually, the Office of MaineCare Services works with the MaineCare AC Lead Entities to identify eligible hospitals and completes the data analysis required for each performance period. For a full description of the payment methodology please review MaineCare Benefits Manual, Chapter III, Section 45, Hospital Services (Section 45.07).  

The Department is issuing inaugural payments this week to hospitals that are in the top performing HSAs in regard to the percentage of MaineCare members in the HSA who accessed primary care services in Calendar Year (CY) 2021. We congratulate these hospitals, listed in the table below, their AC entities, and their community partners who are working to connect MaineCare members to primary care services.   

 

AC	Hospital	Percentage of MaineCare Members in the HSA with a Primary Care Visit  (CY 2021)
Community Care Partnership of Maine	Millinocket Regional. Hospital.	74%
MaineHealth ACO	MaineHealth – Southern Maine Health Care	71%
MaineHealth ACO	MaineHealth – Franklin Memorial Hospital	70%
MaineHealth ACO	St. Mary's Regional Medical Center	70%
Beacon Health	Northern Light Inland	69%
Kennebec Region Health Alliance	MaineGeneral Medical. Center’s Alfond Center for Health	68%
Community Care Partnership of Maine / Beacon Health	St. Joseph Hospital​ / Northern Light Eastern Maine Medical Center	68%
MaineHealth ACO	MaineHealth – LincolnHealth	66%

 

For hospitals that are awarded these funds, the invoice type should display on any paper Remittance Advice (RA) and be listed as “OTHER.” The invoice number should display on any electronic 835 with a prefix of “VBPS.” 

There will be a second payment in June 2023 for State Fiscal Year 2023. Once these initial two payments are issued, awarded hospitals should anticipate an annual May delivery date of these notices and the associated payments.  

 

Please contact Tiffany Norton, Provider Relations Specialist, with any questions.