June 23, 2018
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State health policies not producing good outcomes

By David S. Proffitt, Special to the BDN

A quote of significance for me always has been, “People who produce like to talk about outcomes. People who don’t produce like to talk about effort.” Do the state’s health care policies produce great results?

In the last month, CNN reported that Maine was the new heroin “mecca” in the U.S. and that one in three college-age people in Maine has used this dangerous substance. Reducing availability of services to combat this reality would not appear to be consistent with the best health interest of Maine or good health policy.

According to a major recent national study providing state-by-state analyses of substance abuse and mental illness patterns by the Substance Abuse and Mental Health Services Administration, Maine rates below average in many areas.

The national estimate of past month uses of illicit drugs other than marijuana among people age 18 and over is higher in Maine than the national average.

What about marijuana use? Use by Mainers 12 years old and older is estimated at 12.6 percent. That is more than an additional 2,000 people for every 100,000 in population than the national average.

So a quick review shows that Mainers are subject to dangerous behaviors that affect their health at a higher rate than most of the nation.

This same report indicates that Maine has a higher percentage of the population having been in need of drug treatment over the last year but not having received it than most other states; worse than West Virginia, Kentucky, and Nevada. Maine also ranks as 20th for suicide occurrences.

Serious psychological distress was present in Maine more frequently than in most states. For Mainers between 18 and 25 the occurrence is better then one in five, putting Maine in the unglamorous “top 10 occurrence states.” Additionally, incidences of major depressive episodes also rank Maine as a “top 10” status state. Not good.

What costs to lives, families and communities does accepting subpar performance on health outcomes have on all of us? Is reducing access really the best policy?

Much has been made of advocating for budget needs, purchasing services, consent decree requirements, judges’ rulings, court monitors and court receivers and MaineCare coverage. The issue at the heart of the debate should be on outcomes.

Recently Brenda Harvey, commissioner of the Department of Health and Human Services in Maine, wrote that the consent decree was “outdated.” She explained that Maine “must define core services, such as crisis response, medication, counseling and inpatient care, all coordinated with primary care.” She is right, in a way.

What was less directly addressed was that beyond focusing on what is provided, we must focus on what works. Focusing on outcomes will improve services, reduce costs, and make Maine a more healthful place.

DHHS is in a strong position to guide achievements. Setting health care policy and monitoring policy implementation is what ensures outcomes. Through defining outcomes and monitoring, the state can best lead toward a less costly but more effective mental health system. Such a strategy, absolutely proper, perhaps even essential, will make many, including providers, advocates and politicians apprehensive.

Claims of trying hard, generous spending and political spinning should never be allowed to replace health outcomes. Neither should the fact that it is difficult to guide the system to realizing results. Leon Gorman, past CEO of L.L. Bean, once stated, “If you can’t measure it, you can’t improve it.” The state has the needed measures. Now we must use them.

I hope we never allow anyone to rationalize that people of Maine should settle for less health. We should all be committed, especially those in public leadership or private health care, to doing all we can to be accountable to high levels of achievement. In this way we can help secure the highest quality of life for those who live, work, and play in the great state of Maine.

David S. Proffitt is president and CEO of The Acadia Hospital.

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