Pathways to Excellence (PTE) is the name of each of the public reporting initiatives of the Maine Health Management Coalition (MHMC).  MHMC currently measures and publicly reports quality data on primary care practices and hospitals at www.mhmc.info.  Efforts to measure and publicly report quality data on specialists are currently underway.

Since 2002, steering committees that include physicians, nurses, employers, quality and safety experts, and health plans have guided the PTE initiatives.  The collaboration of all key stakeholders offers the opportunity to thoroughly discuss and understand issues and barriers from all perspectives to create a reasonable set of measures acceptable to all.  The steering committee members invest a great deal of time to make certain the MHMC is using the most accurate and reliable data available to measure doctor and hospital performance.  The steering committee also develops key metrics where necessary, consumer reports, and approaches to rewarding practices for high quality and value.

Introducing MHMC's newest PTE initiative:

Pathways to Excellence - Cost and Value Committee

The Maine Health Management Coalition, in order to fulfill its mission of improving the value of healthcare services, launched the Pathways to Excellence Cost and Value Committee in April, 2009.

Goal:  To review, select, interpret, and distribute to PCP practices and MHMC members the best available cost and value information that, along with quality information, can be used to make better decisions. There are multiple aims of the committee including evaluating and selecting national measures (as they become available) for use in Maine; developing credible comparative cost metrics with multi-stakeholder input so that ‘value' represents cost and clinical outcomes and to process all available cost information to arrive at a collective method to facilitate similar methodologies among employers and other users.  Initial users of the information will be:

• PCP practices involved in the Patient Centered Medical Home pilot, BIW Primary Care Demonstration Project, and other similar initiatives
• State Employee Health Commission
• BIW Joint Committee on Health Care
• Other member employers

In the first year the primary focus of the PTE C&V work is on improving overall usability of information/reports that currently exist among health plans, data organizations, state government, employers, brokers, etc. which could be used by PCP practices and MHMC members with proper vetting and interpretation.

In time the PTE Cost and Value Committee will likely seek to develop or select (when available) publicly reportable comparative cost metrics for MHMC members and the public.

Rationale:

• As a first step to improve healthcare value, the MHMC has been seeking to measure healthcare costs with minimal success since its founding in 1994.
• Over the past 7 years MHMC has made great progress in measuring primary care and hospital quality, but not costs.
• There have been multiple cost reporting initiatives that have been conducted (e.g. MHIC, Prof Soft), but none have been endorsed for public reporting.
• Given current economic conditions, there is much greater pressure from the public and purchasers to produce and use better cost information.
• Employer members of MHMC have indicated that they will be increasing their focus on cost in their purchasing decisions.  We assert that the system would benefit from a shared understanding of costs based on shared information to avoid further market fragmentation.
• Although there is not agreement that existing cost information is ready to be publicly reported, Coalition members, with help from the PTE C&V Committee, have the background and judgment to use existing cost and value information responsibly.
• In the PCMH and BIW initiatives, primary care practices will be held responsible for their own as well as downstream physician and hospital costs.  They need to have the best available information to be fair to them and to help make the initiative successful. 
• The PTE process is an established and successful consensus forum.
• It is widely expected that cost measures will be created at the national level within 1-3 years. The PTE C&V committee will be a forum to evaluate and select measures most appropriate for Maine.

Composition:  The PTE Cost and Value Committee will be made up of employers, employees, clinicians and others with financial expertise from organizations participating in the PTE process. 

Process:  The PTEC&V will meet 5 times a year, from 11 am to 1 pm, on the same days as the PTE Physicians and Hospital Committees.

Staff:  Ted Rooney, Elizabeth Mitchell, Lisa Letourneau, and Bill Perry will be primary staff to the committee.

Pathways to Excellence – Physicians Initiative

The Pathways to Excellence - Physicians Initiative measures, reports, and improves the quality and value of healthcare in Maine at the adult and pediatric primary care level.
MHMC designed the Pathways to Excellence - Physicians Initiative project to:

• Get information concerning the quality of care of primary care physician practices out to employees, their families, and other healthcare consumers
• Reward practices that demonstrate high quality care

Over the last several years, efforts have been underway to develop measures for select specialty areas.

Similar approaches exist across the nation, including Bridges to Excellence, Massachusetts Health Quality Partners, Integrated Healthcare Association, and others.

Pathways to Excellence - Hospital Measurement and Reporting Initiative

• Create a robust dashboard of measures comparing the performance of Maine hospitals with each other and, where available, with regional and national performance comparisons
• Publicly report those measures to inform employer and employee healthcare decisions, and provide information to consumers around the state