Revolutionizing how Health Care is Delivered
Written by Barry Matulaitis, editor, Livermore Falls Advertiser
April 13, 2012
At a meeting at the Androscoggin Valley Medical Arts Center on April 6, health care officials discussed how health care needs to be made more sustainable, efficient, and affordable in western Maine and the rest of the state. Front, left to right, are Patrick Denning, Network Manager for Harvard Pilgrim Health Care in Maine, and Rebecca Ryder, President/CEO of Franklin Memorial Hospital and Franklin Community Health Network. Back, left to right, are Gerald Cayer, Executive Vice President of FMH/FCHN, Elizabeth Mitchell, CEO of the Maine Health Management Coalition, and Frank Johnson, Executive Director of the State Employee Health Commission.
Originally published in the Livermore Falls Advertiser on April 11, 2012.
Franklin Memorial Hospital/Franklin Community Health Network (FMH/FCHN), its state employee partners, Aetna, and Harvard Pilgrim Health Care are collaborating to make health care more affordable for citizens living in western Maine.
At a meeting with members of the press at the Androscoggin Valley Medical Arts Center (AVMAC) on April 6, FMH/FCHN Executive Vice President Gerald Cayer explained that FMH and its partners were committed to reshaping the health care delivery system to bring costs down and be sustainable on a Medicare level of payment for everyone while still providing the best possible service. A goal is to get the costs in the local health system below the state average and moving away from shifting costs, said Cayer.
He referred to a “Just Imagine” series of lectures given by Laurie Lachance, Chief Executive of the Maine Development Foundation. She challenged health care professionals and officials to imagine a state where:
-The people are creative and practical
-The companies are innovative and resourceful
-The culture honors the past, celebrates the present, and engages in shaping the future
Now, said Cayer, the hospital and its partners aren't just imagining. They are taking action, committing to a DRG, APC, and fee schedule model of payment effective July 1st.
“In year one, we expect to drive our costs down 4.7 percent for commercial and private payers, or $900,000,” said Cayer.
He said that this would be achieved by creating and finding efficiencies and continuing the hospital's efforts in the development of population-based health care delivery in the following ways:
-Access to primary care
-Rotating specialty clinics in more efficient buildings
-Best practice/evidence-based care pathways when considering high cost diagnostics procedures
-Refine care management for those with chronic illness
-Better understanding of end of life care management
-Allow and support uncomfortable dialogue about various health care issues
“This building, the AVMAC, is the model that will allow us to address the six areas of focus to bend the health care cost curve,” said Cayer. “This building represents a primary care centric model versus the traditional acute centric model, with behavioral health and care management embedded in the practice.”
The space, he pointed out, is multi-purpose by design. Administrative functions are centralized to serve primary care, specialty care, physical therapy, behavioral health, care management, an outpatient laboratory, and appropriate, basic imaging services. Also, said Cayer, the approach was in alignment with the IHI Triple Aim Principles.
“For this model to work, Franklin Memorial must find efficiencies and refine the delivery of care that is focused on the level of service to the general population, not units of service delivered to individuals,” said Cayer. “Payers must pay for a delivery of health care that supports prevention, screening, and linking people with the appropriate level of care at the appropriate time at a fair price. They must not frivolously deny claims, resulting in rework.
“In addition, state government must adhere to the same broad principles. Neither paying the true costs of care for Maine Care recipients nor paying claims in a timely manner will hamper the transformation of health care delivery in Franklin County and throughout our state.”
Frank Johnson, Executive Director of the State Employee Health Commission, said that in the budget the Maine Legislature enacted last year, the state employee health plan was funded at the same level it was during the previous fiscal year. In 2013, there is a projected $22 million reduction planned.
As a result of the fiscal challenges, said Johnson, the Commission started to reach out to community health care providers such as FMH last fall.
“We wanted to make sure we could partner with organizations that would redesign the delivery system,” he said. “We wanted to share with partners and invest in care and primary care infrastructure.”
A total of 650 individuals that are part of the state employee health plan live in the area serviced by FMH. The State Employee Health Commission has designated FMH a preferred hospital.
“We feel this is the beginning of a partnership,” said Johnson. “We can make adaptations as we need to.”
Harvard Pilgrim Health Care has also taken notice of FMH's efforts. Patrick Denning, Network Manager for Maine, said that different payment models have been presented as to how the cost of care could be reduced.
“We were looking for a rational payment system,” he said. “This is a rational payment system.”
Elizabeth Mitchell, CEO of the Maine Health Management Coalition, explained that the partnership between organizations will transform the way health care is delivered in the region, and beyond.
“This is national news,” she said. “It's so unusual to have a provider, an employer, and a health plan saying we're going to work together to bring down the cost of service. This is a really unique model for the country.”
She noted that reducing health care costs was a key to economic development in Maine.
FMH/FCHN President and CEO Rebecca Ryder addressed the national health care program that is being debated in the U.S. Supreme Court. Regardless of the outcome, she said, the way health care is delivered in the U.S. needs to change for the system to be sustainable.
With the fee for service model, a high level of the cost of care delivered to Medicare and MaineCare patients gets shifted to private insurers, noted Ryder. In order to achieve better efficiency, she said, providers such as FMH need to be smarter in terms of how they deliver care. Administrative waste also needs to be reduced, she added, barriers to health care need to be removed, and the overall focus needs to shift from an acute care-based network to primary care-based, she said.
Also, Ryder pointed out that health professionals need to utilize best practices, and recognize that the hospital is just one piece of community-based care.
Soon, she noted, HealthReach will be moving into the Lamb Block next door to the AVMAC.
“It's another partnership we have,” she said.
Moreover, there needs to be a cultural shift in the U.S. with a greater emphasis on better diets and exercise, said Ryder. While the technology is present to do an unbelievable variety of medical procedures, the causes of problems need to be addressed, she said.
“This country has not been focused on wellness and long term prevention.”
However, Ryder, added, “If everyone stays healthy, no one gets paid.” Mitchell pointed out that health care is a $2.5 trillion industry in the U.S.
Cayer emphasized stewardship as another motivation for the hospital's partnership with other organizations to change the health care delivery paradigm.
“That's what we're talking about. If you do it right, you're being good stewards,” he said. “Imagine being good stewards of health care.”
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