MHMC’s Payment Reform Goals

MHMC Members’ Vision Leads to Payment Reform Initiative

In the summer of 2008, the Maine Health Management Coalition held a series of strategic planning retreats to determine its future course.  It was agreed that health system redesign was a shared goal, but the vision for what a redesigned system would look like was unclear.  MaineHealth and Hannaford Brothers initiated the Health Action Collaborative (HAC) to bring together diverse stakeholders to identify the attributes of an 'idealized' reformed health system.

1. Provides transparent cost and quality information
2. Promotes accountability for cost and quality at the patient, provider, and community levels
3. Supports a viable and sustainable primary care foundation for the healthcare system that provides integrated, patient-centered care
4. Aligns payment with desired outcomes and eliminates waste
5. Supports a public that is informed and engaged
6. Supports integrated health information technology (IT) infrastructure that promotes patient-centered coordination of care across settings

Health Payment and Health System Reform are Both Necessary

There was consensus among HAC participants that in addition to the Coalition’s on-going efforts to improve quality, that healthcare cost containment is also an increasingly urgent priority as demographic demands and economic conditions necessitate a more affordable healthcare system for purchasers. 

Collaborative Work Yields Results

Key Elements in the Coalition’s Payment Reform Work  

Creation of the MHMC Payment Reform Model  The MHMC-F received a grant from the Maine Health Access Foundation (MeHAF) to begin its work evaluating, vetting, and piloting a reformed payment model in Maine.  The Coalition has engaged consumers, payors, employers, and providers in developing a proposed Value-Based Payment Model, detailed below.  

Payment Model Research and Pilot   After examining many payment models including but not limited to Prometheus, capitation, Accountable Care Organizations and episode payments, the HAC developed a combined model that is based on our knowledge of unwarranted variation of utilization and cost of healthcare within Maine.  The Value Based Payment Model matches reimbursement and benefit design to the different service categories from the Dartmouth Atlas.

Central to the Coalition’s reform initiative is our partnership with the MQF and Health Dialog.  In collaboration with Health Dialog, and building on research and analysis done on behalf of the MQF, we will analyze outcomes data in 3 categories - preference sensitive care, supply sensitive care, and effective care - in three Maine communities: Portland, Lewiston, and Bangor.  Health Dialog will provide data in each area identifying outcome and utilization variations.  Once areas of under use and overuse are identified, we will work with providers, payers, and employers to advance payment reform and benefit design changes to incent appropriate utilization.   In August 2009, MHMC-F applied for a grant through Aligning Forces for Quality (AF4Q) and the Robert Wood Johnson Foundation to further develop and pilot an incentive based reimbursement model to reduce unwarranted variation in the service categories identified in the Dartmouth Atlas.  We will learn by October if MHMC-F has been awarded the grant.   

Employee Activation  Currently, payment reform is largely being discussed among purchasers and providers, but if there is one lesson to keep in mind from previous reform initiatives it is that consumers and patients must be involved in the solution.  The MHMC’s Employee Activation program has demonstrated that it is possible to engage consumers in the issue of health quality.  Now the initiative has begun to prioritize communications about ‘choosing value’ to introduce consumers to the concepts of unwarranted variation, their role in payment reform, and shared decision making.  MHMC is working with its AF4Q and PCMH partners to further promote these messages.   

Shared Decision Making  Effective Shared Decision Making (SDM) has the impact of empowering patients to participate with their providers in treatment-related decisions, improving outcomes, and increasing patient satisfaction with treatment decisions.  It is suggested that SDM may also help reduce small area practice pattern variations and potentially help contain costs.  The Maine legislature also passed legislation requiring an analysis of SDM.  Recently, the MHMC completed a white paper on the opportunities for Shared Decision Making (SDM) which provides a roadmap for integrating SDM into the provider and patient relationship.  As a key component of our payment model, and as a strategy that spans all of our areas of work, MHMC will include SDM work in the 2010 strategic plan.   

PCMH and Other Pilots  The Maine Patient Centered Medical Home (PCMH) Pilot is an effort to strengthen primary care services in Maine.  The Maine PCMH Pilot is outlined by its mission, vision, and guiding principles that build off of national principles for the medical home model, and also reflect the needs of Maine people and providers.  Maine’s pilot is also distinguished by the participation of all payers in the state, both public and private.  The Maine pilot currently includes 26 primary care practices working together over a 3-year period.  Participating practices commit to achieving national recognition standards for medical home, and work to meet a set of 10 "Core Expectations" to continue their efforts to move towards a more patient-centered model of care.  For more information, please visit Quality Counts.  

Symposium 2009  Entitled "Payment Reform for a Reformed System: Better Health for Our Healthcare Dollar", the 2009 fall symposium featured Peter Lee, Harold Miller, David Wennberg, Bruce Hamory, Murray Ross, and a panel of Maine experts - Trish Riley, Frank McGinty, Chris McCarthy, and Mike Hudson.  The Symposium attracted over 200 people to learn about various Payment Models and the reason for their importance in the overall pursuit of Healthcare Reform.