May 26, 2018
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Don’t shy from chance to cover more people, reform care

By Amy Madden, Special to the BDN

I recently testified before the Maine Legislature in support of LD 1066, a bill that would cause Maine to accept federal funds to insure more than 69,000 low-income Mainers. I spoke as a family medicine physician and as a member of the Maine Medical Association. My practice is Belgrade Regional Health Center, a federally qualified health center. Like other federally qualified health centers, we strive to provide high-quality, affordable, patient-centered health care in medically underserved areas and to people who might otherwise have trouble accessing healthcare.

I support LD 1066 because I have seen people face incredible challenges when they need medical care but lack insurance or are underinsured. LD 1066 represents a unique opportunity to insure tens of thousands of Mainers, with the vast majority of the funding coming from the federal government — 100 percent for the first three years and no less than 90 percent thereafter.

I do not think that anyone wishes to limit Mainers’ access to health care for any reason other than concern for what health care is costing our state. We can all agree that as health care costs rise, we see economies of every sort struggling to figure out the balance. Whether you’re a large employer, a small employer, a town with a municipal budget, a school system or a family, the cost of meaningful health care coverage is causing turmoil.

What we know about health care, however, is that limiting access is not the answer to our financial difficulties. When we limit access — such as rejecting these expansion funds and continuing the status quo — we do not eliminate the need for healthcare. We only allow individuals and families to fall into debt and bankruptcy, and we continue to shift costs onto those who provide and have health insurance.

What matters most is the kind of health care system to which people have access. Reforms aimed at enhancing quality and containing costs must be made and are underway in Maine. In fact, Maine is recognized as a leader around the country for the changes that are happening to health care in our state.

The “Triple Aim” in health care is a concept developed by the Institute for Healthcare Improvement. It states that health care systems function optimally when they strive to achieve three principles — improve the patient experience of care including quality and satisfaction, improve the health of the population, and reduce the per capita cost of health care.

The kinds of efforts going on in our state as we work to achieve the “Triple Aim” are impressive. Accountable Care Organizations, such as those in which the State Employee Health Commission is engaged with local hospital systems, are being formed across the state. An expanded Patient Centered Medical Home pilot project, in which practices focus on reforming primary care to achieve the Triple Aim, now involves more than 70 primary care practices and represents more than 350,000 patients. MaineCare has developed the Health Homes initiative to better serve MaineCare recipients who have complex needs that result in high healthcare costs.

The Maine Health Management Coalition will soon be publicly reporting data that will allow us to compare hospitals and providers not only on quality and patient experience but also on the cost of care. This innovative and progressive work being done in your communities holds the promise to bend the cost curve of healthcare – not by limiting access or reducing services, but by rethinking and improving the systems by which we deliver care.

It is because of this united purpose of health care leaders in Maine that I am reassured that we, as Mainers, will succeed in meaningfully changing the face of healthcare. I believe that we will realize the goal of a healthcare system that delivers on the promise of quality and value. Now is not the time to shy away from opportunities to cover more people in our state. Instead, we should embrace it.

Amy Madden is a physician at Belgrade Regional Health Center.

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