April 24, 2018
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Maine health reform sets national example

By Anne Weiss, Special to the BDN

Everyone knows about the high cost of health care, because it affects all of us. But so, too, does a less visible problem with our health care system — poor quality. Few understand that America’s health care system too often delivers care that is mediocre at best and dangerous at worst.

Poor health care quality harms or even kills many more Americans each year than die in airplane crashes, yet far less attention is given to the safety of health care than to air travel. Studies show that you have about as good a chance of getting all the proven care needed for your condition as you do of getting heads when tossing a coin.

First, patients don’t get care we know is proved to work, such as immunizations or regular tests and checkups for people with diabetes. Second, many patients get care that is unsafe, such as being given the wrong medicine. Finally, many patients get care they don’t need, care that is wasteful and exposes them to harm, such as unnecessary tests.

Several major research reports have pegged wasted services at a whopping 30 percent of the $2.5 trillion the nation spends on health care.

This situation calls for urgent change. Not only because poor health care causes unnecessary harm and imposes a cost burden that is rapidly becoming intolerable but because getting people better-quality health care actually could save the nation money.

But while we as a nation struggle to lift quality and control costs, Mainers have made great progress toward improving their health care system. According to the Agency for Healthcare Research and Quality, Maine jumped from 12th to fourth place in categories such as cancer care, long-term care, maternal and child health, and patient safety.

It’s no accident that Maine has made such outstanding progress. I believe it is the result of the great work being done here in the state of Maine to bring together those who get, give and pay for care around a single goal of improving the performance of the health care system.

Maine is one of 17 regions from around the country working with the Robert Wood Johnson Foundation’s Aligning Forces for Quality program to improve health care quality. The Maine Alliance has three principal partners: Quality Counts, the Maine Health Management Coalition and Dirigo Health’s Maine Quality Forum. These organizations have a rich history of collaborating with employers, physicians, hospitals, insurers, consumers and the government to drive positive change for Maine’s health care.

For instance, the Alliance’s website, www.mhmc.info, which began by encouraging physicians to post their quality ratings on a voluntary basis, now is used by the State Employee Health Commission to steer patients to doctors with high ratings for delivering quality care. And as recently as Nov. 30, the Maine Alliance brought together more than 300 stakeholders from throughout Maine’s health system, including patients, physicians, employers, policy experts and insurers, to discuss the opportunities for Maine to capitalize on the new federal health reform law.

This is tough, complex and plain hard work. There are many steps that need to be taken, and no one single maneuver that will get us high-quality care. We will need to release public performance information on hospitals and doctors, support projects to help providers improve care, engage consumers in demanding better care, promote greater use of health information technology and more. Perhaps most important, we need to reform the way we pay for care so that both private health plans and government programs reward providers for good care, not simply for delivering more care. We have to push forward on all fronts, as Maine is doing.

But Maine has never been afraid of a challenge. And, not surprisingly to those who follow national reform efforts, Maine is once more in the forefront.

There are 26 primary care practices in Maine testing a new system of primary care delivery called the patient-centered medical home, with support from leading health plans. Recently, the federal government chose Maine as one of only eight states to test this model for Medicare enrollees.

There are also nascent efforts to create what are being called accountable care organizations — new ways to organize doctors and hospitals to better coordinate people’s care and pay for quality over quantity of medical services. These efforts to deliver the right care to people at the right time are designed not only to improve quality but also to lower health care costs as well.

In many communities across the U.S., national health reform will drive changes in the health care system for the better. Thanks to the work of the organizations in Maine’s Aligning Forces for Quality Alliance and their many partners, the state is setting an example for the rest of the nation to follow, providing models for others to adopt. Maine’s efforts prove that with good information and solid collaboration, we can make sound decisions about our health care to improve quality and slow growth in costs.

The poor quality and high cost of health care are national problems, but if we are to solve them, it will happen one community, one region, one state at a time. Maine is leading the way.

Anne Weiss is the director of the Quality-Equality Health Care Team and a senior program officer with the Robert Wood Johnson Foundation.

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