Encouraging the Use of High Value Providers

Every year 210 million people visit a primary care doctor or other health professional, but only the tiniest portion of them have any idea what their visit costs or how well their doctor performs. As a result, we spend more per person on health care than any other country in the world, and our quality only ranks 37th among other industrialized nations. In every community across the US, it’s a coin toss whether you will receive the care that experts recommend for your condition.

The Maine Health Management Coalition currently measures and reports on the quality of care that Maine hospitals and clinicians provide to patients. Pathways to Excellence (PTE) is the name of the public reporting initiatives of the Maine Health Management Coalition (MHMC). The MHMC currently collects and publicly reports quality data for primary care practices, behavioral health practices, and hospitals at www.getbettermaine.org. MHMC strongly believes that Maine people need good reliable independent information to help them choose their health care providers, one of the most important decisions many of us need to make.

tieringPurchasers don’t want to keep paying for mediocre care, so they are starting to encourage their members to use known high-quality doctors and hospitals through benefit plan design. When members seek care from a high-quality provider or hospital (partly based on the quality rankings on GetBetterMaine), the plan will pay at a higher level of benefit. Some purchasers are starting to move towards a 3-tier benefit design where the third tier (paying the highest benefit) is based on quality and the next two tiers are in-line with the traditional in and out-of-network benefit design.

By offering people incentives to see high value doctors and hospitals, purchasers not only ensure that their members are receiving the best available care, but they also encourage lower quality healthcare to improve through competition.  Choosing high-quality care is in everyone’s best interest, and by choosing the doctors and hospitals that perform best we are improving care across the state.