Frequently Asked Questions

1) What is the Maine Health Management Coalition (MHMC)?

The MHMC is non-profit coalition of 60+ employers that includes doctors, hospitals, insurers, and public and private employers. Approximately 250,000 employees and their dependents benefit from their employers’ support of the Maine Health Management Coalition.

2) Why does the Maine Health Management Coalition exist?

Employers feel that healthcare quality for their employees and dependents needs to be improved and that costs are increasing at a rate that is unsustainable. MHMC is committed to bringing the purchaser and provider communities together in a partnership to measure and report on the value of healthcare services. This informs employer and employee decisions and facilitates the use of performance information by employers and employees.

3) What is the Pathways to Excellence ?

Pathways to Excellence (PTE) is the name of performance measurement and public reporting initiatives of the Maine Health Management Coalition (MHMC). MHMC currently publicly reports quality data on primary care practices and hospitals in Maine and major surgeries in New England at www.mhmc.info.

Since 2002, steering committees that include physicians, nurses, employers, hospitals, 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 and ratings 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, and displaying it in a way that is useful to consumers.

4) What is the Pathways to Excellence – Hospital Reporting Initiative?

The Pathways to Excellence – Hospital 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)

The initiative, Pathways to Excellence Initiative is intended to report on the performance in Maine hospitals in the areas of patient experience, patient safety and select clinical quality.

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, CMS and The Joint Commission. 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?

After the Pathways to Excellence initiatives began publicly reporting quality data, MHMC started the Employee Activation Initiative to help member organizations communicate about quality healthcare to their employees. The MHMC members want to engage their employees and dependents to make informed choices about their own health and healthcare. Research has shown that employees want their employers to guide them to good, unbiased healthcare information. (Reference: www.mhmc.info ) They trust the integrity of the MHMC data since all the stakeholders endorse the information for employees and consumers.

National and state data show that treatment patterns and quality vary across providers and across regions. The MHMC has studied the best national programs. We work collaboratively to produce good reports based on data and information available in Maine that are usable for consumers and healthcare purchasers. 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)

It is the right thing to do.

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

The MHMC believes that if you provide recognition for hospitals and practices demonstrating best quality, you begin to motivate and enable providers to change practice models and to make investments in improved systems.

The Pathways to Excellence – Primary Care and Hospital Tripartite Steering Committees are focused on reporting 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 and quality of care in hospitals and the quality of primary care practices; recognize high quality practices and hospitals that have given patient safety a high priority; and serve as a basis for financial rewards from self-insured employers and health plans.

Outside of the 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 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.

7) How did Pathways to Excellence choose metrics being used in the reporting segment of the program?

The Pathways to Excellence Hospital and Primary Care Steering Committees review and endorse these metrics. Its intent is to <!–[endif]–>utilize all available performance measures endorsed by the National Quality Forum, AQA Alliance, Leapfrog, CMS and other expert entities unless there is a technical or compelling reason to reject an individual measure. Where possible, MHMC will recognize the differences among measures that measure high performance and those that measure basic competency or minimum thresholds of performance.

8) How do physicians and hospitals benefit from the Pathways to Excellence – Primary Care Initiative?

Physicians and hospitals benefit because both 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.

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

The providers 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.

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

We intend to continue Pathways to Excellence initiatives for primary care, hospitals, and specialty care, as well as the Employee Activation initiative.

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

We intend to continue “Helping employees and their employers to choose safe, high quality Maine healthcare.”

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.

Receiving recognition from a national entity such as BTE or NCQA will be the only way to achieve a blue ribbon for PTE in 2009. Because of the considerable momentum nationally for comprehensive metrics and performance measures, the MHMC Board decided that the Coalition should be taking advantage of the national measures and reducing the reliance on “home-grown” metrics. Whereas the Coalition started from scratch several years ago with the primary care measures, more universally accepted measures are being introduced by national organizations. Moving to national metrics is particularly appealing to multi-state employers and payors and will give physician practices an advantage in the market. Moving to national measures will also give practices an opportunity to submit for recognition on an ongoing basis rather than just once a year. We predict that adopting national measures will ultimately reduce duplicative reporting efforts and improve the standardization and efficiency of clinical performance measurement and public reporting efforts across the state.

PTE is also utlizing green ribbons for “Maine based recogntion” for those practice not able to particiapte in the national recognition efforts.

10) Does this mean that PTE is going away?

PTE is not going away but it will no longer be in the main business of data collection or scoring.  It will assign blue ribbons based on a practice’s national recognition status, and provide opportunities for recognition for practices where national recognition is not available.

11) Where can I find more information about MHMC as an organization, or where do I learn about joining?

Please visit www.mehmc.org to learn more about MHMC, our mission and key strategies, value based purchasing and membership.