How Our Members Work Together to Achieve Better Health at a Lower Cost

“Because no single sector alone has the capability to successfully pursue improving the health of a population, the Triple Aim explicitly requires health care organizations, public health departments, social service entities, school systems, and employers to cooperate.  Fostering this cooperation requires an integrator that accepts responsibility for achieving the Triple Aim for the population.” 1

The Maine Health Management Coalition’s Triple Aim goals, though non-binding, are intended to align direction and effort among MHMC members and partners.  Members pursue the aims in ways that they consider most effective.  The Maine Health Management Coalition provides support and shares best practices among members as requested, and measures and reports on progress.  The Triple Aim goals also inform MHMC strategic planning to ensure that resources that support members to achieve the goals are prioritized.

To enable achievement of the Maine Health Management Coalition’s Triple Aim goals, members support the transition to shared risk through global payments and will work collaboratively to create global payments/budgets for coordinated systems of care for all patients, with the clear understanding that stakeholders may continue to use other payment reform and benefit design levers while progress is being made.  This transition is intended to provide meaningful and predictable savings for purchasers while removing payment and administrative barriers for clinicians to optimally redesign systems of care.  In addition, benefit designs are being established to encourage patient support of coordinated, efficient, quality care and patients will be encouraged to take greater responsibility for their health.  The exact details of the global payments/budgets are care delivery changes are individually negotiated and may vary across payers and providers.

Each Triple Aim goal requires changes from all stakeholders.  The population health goals require expanded use of health risk assessments and use of common functional status survey question(s).  Benefit design changes incent the use of preventive services and Patient-Centered Medical Homes.  Payment changes enable patient-centered, coordinated care and greater flexibility for providers seeking to manage population health and cost.  Good outcome, patient experience and cost measures will be required at the community level to monitor performance and support engagement and accountability.  Data to support change at the patient, provider, and community level must be available.  Aligned change may provide greater efficiency and impact and facilitate measurement of progress.

As part of the facilitation of stakeholder consensus on the path to cost reduction and quality improvement in Maine, the Maine Health Management Coalition claims database and analyses can serve as a common source of measurement and evaluation.  Claims-based data analyses from the Maine Health Management Coalition may be used to support the design and implementation of payment and delivery reforms.

1. Matthew Stiefel, MPH: Senior Director, Center for Population Health, Kaiser Permanente Care Management Institute; Fellow, IHI Kevin Nolan, MA: Senior Fellow, IHI, A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost, Institute for Healthcare Improvement, 2012.