Frequently Asked Questions

1) What is the Maine Health Management Coalition?

a) A non-profit coalition of 50 employers that includes doctors, hospitals, insurers, and public and private employers. Approximately 200,000 employees and their dependents benefit from their employers' support of the Maine Health Management Coalition.

2) Why does the Maine Health Management Coalition exist?

a) Employers feel that healthcare costs are increasing at a rate that is unsustainable. The MHMC is committed to addressing the crisis of healthcare costs by improving the quality and value in the health care services they purchase for their members' employees and families.

b) Maine employers (in conjunction with National employers) believe that improving health care quality is good for employees and will save money. According to a recent report by the Juran Institute and the Midwest Business Group on Health, 30% of healthcare costs are the result of poor quality and inadequate systems. *(Reference: Reducing the Costs of Poor Quality Through Responsible Purchasing Leadership, Midwest Business Group on Health. www.mbgh.org)

3) What is the Pathways to Excellence - Primary Care Initiative?

a) The Pathways to Excellence - Primary Care Initiative initiative was designed to get information concerning the quality of care of primary care physician practices out to employees and reward those practices which can demonstrate high quality care. Similar approaches have been launched across the nation.* (Reference: www.bridgestoexcellence.org. Reference: Integrated Health Associates, California: www.iha.org)

b) The initiative, Pathways to Excellence - Primary Care is intended to measure, report and improve the quality and value of healthcare in Maine at the primary care level.

c) In 2002, a steering committee which included 12 physician practices, employers and health plans was formed to guide this initiative. The collaboration of all key stakeholders offers the opportunity to thoroughly discuss and understand all the issues and barriers from all perspectives to create a reasonable, viable solution acceptable to all. The steering committee members have invested a great deal of time to develop key metrics, consumer reports, and approaches to rewarding practices for high quality and value.

4) What is the Pathways to Excellence - Hospital Measurement and Reporting Initiative?

a) The Pathways to Excellence - Hospital Measurement and Reporting Initiative was designed to create a robust dashboard of measures comparing the performance of Maine hospitals with each other and, where available, with regional and national performance comparisons and to publicly report those measures to inform employer and employee healthcare decisions. Similar approaches have been launched across the nation.* (Reference: www.leapfroggroup.org; hospitalcompare.hhs.gov)

b) The initiative, Pathways to Excellence - Hospital Measurement and Reporting Initiative is intended to measure and report on the performance in Maine hospitals in the areas of patient satisfaction, patient safety and clinical quality.

c) In 2002, a steering committee which includes physicians, nurses, quality and safety experts, employers and health plans was formed to guide this initiative. The collaboration of all key stakeholders offers the opportunity to thoroughly discuss and understand the issues and barriers from the various perspectives in order to create a reasonable set of measures. 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 hospital performance.

Whenever possible, the hospital performance measures used are those that have been endorsed and are already being reported by leading national organizations such as the National Quality Forum, Leapfrog, and CMS. The Coalition's Medication Safety Spotlight Survey is the only exception. Each year, a Medication Spotlight Workgroup comprised of a group of dedicated pharmacists, nurses and quality experts from MHMC's member hospitals, convenes to oversee the process of administering the survey to all Maine hospitals. Pharmacists from hospitals across the state are engaged in efforts to improve medication ordering and administration in their facilities by promoting the utilization of tools such as automated dispensing machines, bedside medication verification, and planning and development for safe medication systems. This initiative communicates the results bi-annually.

5) Why does the Maine Health Management Coalition focus on engaging and informing consumers?

a) The MHMC conducted a series of focus groups over several years and learned that employees want their employers to guide them to good, unbiased health care information. (*Reference; www.mhmc.info ) They trust the integrity of the MHMC data since all the stakeholders endorse the information for employees and consumers.

b) National data shows that treatment patterns and quality vary across providers and across regions. The MHMC has studied the best national programs. Our mission is to produce good reports based on data and information available in Maine. The MHMC believes that it is critical for all Maine employees to become engaged and informed healthcare consumers. *Reference: Institute of medicine www.iom.org, www.leapfroggroup.org

c) It's the right thing to do.

6) Why does the Maine Health Management Coalition reward providers for high quality?

a) The MHMC believes that if you provide financial and non-financial rewards for practices demonstrating best quality, you begin to motivate and enable providers to change practice models and to make investments in improved systems.

b) The Pathways to Excellence - Primary Care Initiative is not about physician salaries. It is about recognition. It is about redesigning payment mechanisms to fund new services which enhance care, employ technology to bring up-to-date information into the physician/patient interaction, reduce administrative burden and that emphasize quality of care rather than visits.

c) Current systems of "paying" for health care not only fail to recognize high quality, but act as a barrier to quality improvement.

7.) Will the Maine Health Management Coalition reward hospitals for patient safety efforts as well?

a) A group of Maine healthcare leaders is currently working with the Coalition to reward hospitals on a number of quality, safety, and efficiency measures. Hospitals' efforts at improving their environment of safety will be a critically important measure in the process.

b) As with the Primary Care initiative, the patient safety effort is not about giving more money to hospitals. However, some of the patient safety steps that hospitals will need to take such as the introduction of sophisticated clinical computer systems, are extremely expensive and the Coalition wants to find ways to recognize hospitals that have made those investments and to help them find the dollars needed to continue.

8.) What will the Maine Health Management Coalition do with this data?

a) The Pathways to Excellence - Primary Care Initiative and Patient Safety Steering Committees are focused on developing credible and fair measures that are based on evidence based medicine, reflect best practice, and are under the control of the clinicians and organizational leaders. These measures are meant to be used to measure the safety practices in hospitals and the quality of primary care practices, recognize high quality practices and hospitals that have given patient safety a high priority, and as a basis for financial rewards from self-insured employers and health plans.

b) Outside this process, some individual MHMC members have plans to use the metrics developed by Pathways to Excellence in a number of ways. Some are using this information as a tool to create awareness among their employees that the quality of healthcare varies, in order to prepare them to be more informed consumers. Others will likely use the comparative ratings to create incentives for their employees to go to high quality practices and safety-focused hospitals through the use of variable co-insurance, co-pays and deductibles. Future applications may include tiered reimbursements to reward the best performing providers.

c) MHMC employers will work with participating hospitals and practices to provide guidance to these outside efforts and try to assure that the goals and methods of various employers across Maine are as uniform and compatible as possible so that our healthcare system can be as focused and effective as possible.

9) How did the Pathways to Excellence - Primary Care Initiative initiative choose metrics being used in the clinical outcomes reporting segment of the program?

a) The Pathways to Excellence Steering Committee created a Provider Subgroup to give input on these metrics.

b) Metrics were chosen to be consistent with current standards of care (e.g. % of patients with HbA1c<7%, LDL<100, BP<130/80). In addition, because of a desire to have comparability to existing quality programs such as the Bridges to Excellence and National Committee for Quality Assurance programs, and the American Diabetes Association and American Heart Association Provider Recognition programs, several additional metrics were included that reflect "older" standards of care (e.g. LDL<130, BP<140/90).

10) How do physicians benefit from the Pathways to Excellence - Primary Care Initiative?

a) Physicians benefit because physicians participate in the selection and design of metrics that they and the Maine Health Management Coalition agree are representative of good patient care and high quality.

b) Physicians can be recognized for the extra efforts being made in their practice for quality improvement. Financial and recognition rewards can help make these efforts economically feasible and sustainable for their practices.

c) Physicians are helping the Coalition to create consumer reports which are easily understood and also help in explaining what the limitations might be for the various reports on the public web site.

d) This initiative offers physicians confidential comparative data to allow them to compare themselves to other practices as well to learn from other practices in the state and around the country. It also suggests a focused set of improvement goals so they can prioritize the efforts of their busy practices.

11) What are the next steps for the Maine Health Management Coalition and the Pathways to Excellence initiatives?

a) We intend to continue Pathways to Excellence initiatives for primary care, hospitals, and specialty care.

b) We intend to continue to develop quality measures and reports and to work with employees to see what information is most helpful to them and their families.

c) We intend to accomplish our goal of, "Helping employees and their employer to choose safe, high quality Maine health care." *Reference (www.mhmc.info)

d) We will continue to work collaboratively with physicians, hospitals and provider organizations around the state. We will continue our outreach efforts to additional physicians and other providers to get involved in the Pathways to Excellence initiatives and other Maine Health Management Coalition projects.