State employees can now choose from more than 30 hospitals in Maine to get a financial break on their health care.
Workers covered by the state health insurance plan are encouraged to visit “preferred hospitals” for their treatment as part of an effort launched in 2006 to improve care and cut costs. State employees pay less out of pocket for services delivered at hospitals that are deemed top performers on quality and price by a group called the Maine State Employee Health Commission.
Treatment at a hospital that doesn’t make the grade, for example, might ring up at a $1,000 deductible and a $50 co-pay. The same procedure at a preferred hospital might come with no deductible and a $20 co-pay. State workers can go anywhere they like for medical care, but the choice could cost them.
Last week, the commission updated this year’s preferred list, first issued in July, to include six additional hospitals that negotiated for a spot on the rankings. At its Sept. 13 meeting, the commission awarded “tier one” status to Calais Regional Hospital, Down East Community Hospital in Machias, Mount Desert Island Hospital in Bar Harbor, Cary Medical Center in Caribou, York Hospital in York and Northern Maine Medical Center in Fort Kent.
Maine Senate President Kevin Raye, who lives in Washington County, said he and other members of the county’s legislative delegation were “troubled” by what Raye described as “the seemingly arbitrary exclusion of certain hospitals, resulting in state employees in the same health care plan having widely varying deductibles.”
Raye and other delegation members stepped in on behalf of the Calais and Machias hospitals. The commission agreed to reopen the application process and allow hospitals to submit new applications for the September meeting.
“Both of our community hospitals immediately began working with the [commission] to find a solution and it was gratifying on Sept. 13 to see both of our hospitals awarded preferred status,” Down East Community CEO Doug Jones said in a statement.
Effective Oct. 1, state employees who seek treatment in Washington County will see their deductible drop to $300 from $1,500 and their co-pay decrease from 20 to 5 percent, according to the statement.
Already included on the original preferred hospital list were about 30 other hospitals across the state, including facilities that consistently make the cut, such as Mercy Hospital in Portland, Eastern Maine Medical Center in Bangor, Mid Coast Hospital in Brunswick, Miles Memorial Hospital in Damariscotta, and Mayo Regional Hospital in Dover-Foxcroft.
During the first six years, the number of preferred hospitals has ranged from 14 to 29.
Today, nearly every hospital in Maine is now on the preferred list. The commission hasn’t lowered its quality or cost standards, but did work with some hospitals to devise ways to lower prices, according to Laurie Williamson, executive director of the Maine Office of Employee Health and Benefits.
In some cases, hospitals asked the commission to review more recent quality data than was available during the initial evaluations, she said.
“Hospitals are doing better and some of them who didn’t make the preferred tier came to us with specific proposals to lower costs or prove that they had the requisite quality,” she said.
With roughly 35,000 employees, their dependents, and retirees, the state of Maine represents one of the largest purchasers of health care in the state. Hospitals that make the preferred list not only see state workers steered to their doors, but also get paid better by the state’s private insurance plan than they do by Medicare or Medicaid, which typically pay less than what it costs hospitals to provide care.
Hospitals are assigned points based on a range of industry data, including their performance in clinical care, patient safety, infection prevention and the prices of common procedures. The commission’s goals in creating the list are to improve the quality of care — not just for state workers but for all Mainers — lower costs to the state’s insurance plan, and boost the transparency of hospital quality information.
The list of preferred hospitals is updated each year based on health data compiled by the Portland-based nonprofit Maine Health Management Coalition.
Elizabeth Mitchell, executive director of the coalition, said the State Employee Health Commission has continued to raise the bar on health care safety, quality and cost, and Maine hospitals have risen to the occasion.
“There have been gains in quality and safety and I think providers should be recognized for that,” she said.
Funding for the state health insurance plan was held flat from fiscal year 2011, Williamson said. With more preferred hospitals on the list, state employees have more choices about where to get treatment, she said.
“The burden that the employees pay went up because we’re flat funded,” she said. “The fact that we have more hospitals reduces the burden for the employee to some extent.”
As for employers, the state of Maine isn’t the only one getting into the hospital-grading game. The University of Maine System, grocery chain Hannaford Bros. Co., and other large employers are evaluating health care data in pursuit of better care and lower costs, Mitchell said.
“We just can’t ignore the cost of health care and how hard that is for employers to bear,” she said.
BDN writer Tom Walsh contributed to this report.