Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s signature effort to lift the quality of health care in 16 diverse communities, reduce racial and ethnic disparities, and provide models for national reform. AF4Q brings together people who get care, give care, and pay for care to work together toward the shared goal of better health and health care.

Today's issue of Spotlight features the work of AF4Q's Maine Alliance.

Although health care providers have long recognized that many of their patients have both behavioral and physical health needs, there has been a complete disconnect between how this comprehensive care is provided and how it is paid for. Data from the National Comorbidity Survey Replication indicated that 34 million American adults, or 17 percent of the adult population, had comorbid mental and medical conditions within a 12-month period. Now, with health reform, millions of uninsured patients with mental health disorders are transitioning to the formal health system, in particular the Medicaid program, making efforts to improve quality of care for this population an even higher priority.

Addressing this priority, Aligning Forces for Quality (AF4Q) partner Maine Quality Counts(QC), funded by MaineCare’s State Innovation Model, is supporting the implementation of Behavioral Health Homes (BHH) by coordinating the Behavorial Health Homes Learning Collaborative.

“This is an exciting time to bring mental health issues to the table, and we are very hopeful that this collaborative will help BHHs improve the health status of our entire community and serve as a beacon to other communities looking to implement similar programming,” said Anne Conners, program director of the BHH Learning Collaborative. 

Across Maine, patient-centered medical homes and their community care teams are improving quality and patient outcomes while reducing overall health care costs. Funded in part by RWJF’s Aligning Forces for Quality (AF4Q) initiative, Maine’s Patient-Centered Medical Home Pilot has a broad reach—not only coordinating patients’ care and serving as a reliable resource, but also linking patients to services like food banks and mental health case workers. Results from the medical home initiative include a 40 percent reduction in readmissions at one participating hospital. 

One percent of Americans account for 20 percent of the nation’s health care costs; five percent account for 50 percent. Who are these patients? They are known as “super-utilizers”—patients who make frequent trips to the emergency room and have many hospital admissions. Often they are alone and need help determining where to go and how to get healthier.

Suzanne Cole, nurse care manager for the Maine site, says it’s important to make sure the goals for the patient and for the project are in tandem. The Maine team maps out a patient’s discharge plan from the beginning. “If you don’t have a good reason to admit somebody, there’s not going to be a good reason to discharge them,” she said.