Opioid Health Homes (OHH) Pay-for Performance (P4P) Benchmark Announcement

Jan 06, 2025

In August 2022, MaineCare introduced a P4P provision within the OHH model. The resulting performance measures represent core expectations of team-based, whole-person care for individuals with Opioid Use Disorder (OUD).

Core expectations of the OHH model:

• Continuity of Pharmacotherapy for OUD – Assesses gaps in pharmacotherapy treatment of OUD.
• Community Engagement – Assesses member engagement in employment, volunteering, education, parenting, etc. as a recovery support.
• Access to Preventive and Ambulatory Care – Assesses members utilization of primary care services.

The initial roll-out of P4P utilizes two benchmarks (see below) which represent the composite score of the above performance measures. These baseline benchmarks were based on data from OHH providers before the new P4P provision was effective. These benchmarks will be updated on June 1, 2025. [1]

Current benchmarking data shows considerable variability in performance by OHH provider organizations. The Department will provide regular data reports, collaborate with OHH providers, and utilize other data sources or evidence-based materials to support quality improvement and identify and address identified health disparities.

OHH Benchmarks:

1. The current “minimum performance threshold” is a composite score of 27% which will end May 31, 2025. The new “minimum performance threshold” as of June 1, 2025, will be a composite score of 37%. When an OHH provider meets this minimum, they will receive the balance of their full OHH reimbursement (the remaining 4% of the rate).

2.The current “excellence performance threshold” is a composite score of 34% which will end May 31, 2025. 

The new “excellence performance threshold” as of June 1, 2025, will be a composite score of 47%.  When an OHH provider meets this threshold, they are eligible to receive a bonus payment, when funding is available. Eligible funding is dependent on how many OHHs, if any, are below the minimum performance threshold thereby releasing funds for higher performers.

See MBM, Chapter III, Section 93, Opioid Health Home Services for a full description of the P4P measures and methodology, including how benchmarks are established.

If you have any questions, please contact Kaley Boucher, Program Coordinator.

[1] Using an assessment period of 1/1/2023-12/31/2023