The Maine Department of Health and Human Services (DHHS) and the Office of MaineCare Services (OMS) are committed to improving health care access and health outcomes for MaineCare members, demonstrating cost-effective use of resources, and creating an environment where providers can innovate and collaborate in delivering high-quality care. To ensure we continue moving toward this goal, DHHS and OMS set a goal to have at least 40 percent of MaineCare payments paid through Alternative Payment Models (APMs) by the end of 2022 [Specifically, APMs that meet the criteria for Category 2C “Pay for Performance” or higher of the HCPLAN framework].
An APM is a health care payment method that uses financial incentives to raise the quality of care, improve health outcomes, and lower costs for patients, purchasers, payers, and providers. In concert with other strategies, APMs are key tools to advance policies that improve the quality and value of health care.
Maine is utilizing the Health Care Payment Learning & Action Network (HCPLAN) framework for assessing progress toward this goal. HCPLAN is a national organization comprised of public and private health care leaders which maintains the most commonly used framework for aligning APM design and classification. To learn more about APMs, please visit the Health Care Payment Learning & Action Network at https://hcp-lan.org/.
Example Initiatives
MaineCare’s delivery system reform initiatives include, but are not limited to:
- Accountable Communities
- Behavioral Health Homes
- Certified Community Behavioral Health Clinics
- Community Care Teams
- MaineMOM
- Opioid Health Homes
- Primary Care Plus
For questions, please contact HH-BHH-Services.DHHS@maine.gov
Performance Measures
- Accountable Communities
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Quality Measures
- Behavioral Health Homes
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Pay-for-Performance
In April 2018, the Department implemented a Pay-for-Performance (P4P) provision for Behavioral Health Home (BHH) providers, placing 1% of total BHH payments at risk pending performance on a quality measure.
On January 30, 2026, MaineCare adopted a new BHH rule with an update for a P4P provision. Through this rule, the Department will withhold 4% of Per Member Per Month (PMPM) payments upon setting applicable performance thresholds. We will pay the remaining 4% of the rate to BHH providers every three (3) months if they satisfy the Minimum Performance Threshold. Subject to the availability of appropriations, the Department will reimburse BHH providers that meet the Excellence Performance Threshold an additional 1% of the total PMPM payments every three (3) months.
BHH P4P Measures
- Quality of Life/Patient Experience - Accesses patient experience data
- Access to Preventive and Ambulatory Care - Assesses members’ utilization of primary care services
The Department set the performance thresholds for the two measures included in the updated BHH rule and will begin withholding the 4% of monthly payment on May 21, 2027. The prior baseline benchmarks did not include Acentra data from the Quality-of-Life measure.
The Department will send regular data reports, collaborate with BHH providers, and utilize other data sources or evidence-based materials to support quality improvement.
P4P utilizes two benchmarks (see below) which represent the composite score of the above performance measures.
The "minimum performance threshold" as of 5/21/27 is a composite score of 65%.-
When an BHH provider meets this minimum, they will receive the balance of their full BHH reimbursement (the remaining 4% of the rate).
The “excellence performance threshold” as of 5/21/2027 is a composite score of 78%.
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Subject to the availability of appropriations, when a BHH provider meets this threshold, they are eligible to receive a 1% bonus payment
See MBM, Chapter II, Section 92, Behavioral Health Home Services for a full description of the pay-for-performance measures and methodology, including how benchmarks are established.
- MaineMOM
- Nursing Facilities
- Opioid Health Homes (OHH)
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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 are based on data from OHH providers before the new P4P provision are effective. These benchmarks 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 health disparities.
OHH Benchmarks:
- The current "minimum performance threshold" is a composite score of 27% which ended May 31, 2025. The new "minimum performance threshold" as of June 1, 2025, is a composite score of 37%. When an OHH provider meets this minimum, they receive the balance of their full OHH reimbursement (the remaining 4% of the rate).
- The current "excellence performance threshold" is a composite score of 34% which ended May 31, 2025.
- The new "excellence performance threshold" as of June 1, 2025, is 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
- Primary Care Plus
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- Calculating Performance Based Adjustment (PDF)
- PCPlus Quality Measures (PDF)
- Primary Care Service Codes (PDF)
- PCPlus Peer Groups, Program Year 2 (SFY 2024)
- PCPlus Peer Groups, Program Year 3 (SFY 2025)
- PCPlus Peer Groups, Program Year 4 (SFY 2026)
- PCPlus Peer Groups, Program Year 5 (SFY 2027)
- PCPlus Quality Measure Percentiles (PDF)
- Value-Based Purchasing Supplemental Pool – Hospitals
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Proposed Performance Measures for Value-Based Purchasing Supplemental Pool (PDF)