| |
Summary
of Maine's State Health Plan
Last
updated on 5/26/04
(This is a summary of the Draft State Health Plan
released by the Governor's Office of Health Policy
and Finance on May 26, 2004. The summary was prepared
by Consumers for Affordable Health Care Foundation.)
Part 1: Introduction
Why a State Health Plan?
- The purpose of the State Health Plan is to strategically
improve the allocation and coordination of our health
care resources to help Mainers become the healthiest
people in the United States.
Statutory Requirements
- The Dirigo Health statute requires the Governor
to develop and issue a biennial State Health Plan
by May 2004 that "set[s] forth a comprehensive,
coordinated approach to the development of health
care facilities and resources in the State based
on statewide cost, quality and access goals and
strategies to ensure access to affordable health
care, maintain a rational system of health care
and promote the development of the health care workforce."
The Case for a One-Year State Health Plan
- The law requires that the State Health Plan be
a biennial plan, yet the first plan is due in May
2004, midway through the biennium. The Advisory
Council on Health Systems Development is now proposing
a one-year plan to allow it time to develop a biennial
plan, which would cover the period from July 1,
2005 to June 30, 2007.
Part 2: One-Year State Health Plan
Section 1: Maine's Major Health Issues
- Cancer - Maine ranks among the five states with
the highest rates of cancer mortality.
- Cardiovascular Disease - The leading cause of
death in Maine, it accounted for almost 39% of all
deaths in 1999.
- Lung Disease - Lung disease is the third leading
cause of death in Maine. Children in Maine exhibit
the highest rate of asthma in New England.
- Diabetes - In 2002, 68,000 Maine adults had diagnosed
diabetes. People with diabetes have an annual risk
of death that is twice that of people without diabetes
and suffer from a variety of related medical conditions.
- These chronic conditions can often be prevented,
and the Maine Bureau of Health has developed
comprehensive plans for addressing the challenges
of these conditions.
- Mental Illness - The State Health Plan expresses
concern about the number of inpatient discharges
(11,000 in 2002), the expense of providing services
under the court-ordered consent decree to former
residents of the Augusta Mental Health Institute,
the rapid growth in utilization of children's mental
health services, the use of hospital emergency departments,
and the need to address substance abuse and co-occurring
mental health disorders.
- Long Term Care - Maine has been successful in
offering care in the most appropriate setting. While
the growth in long term care spending has been 53%
nationally since 1995, the Department of Human Services
has experienced only a 17% increase in spending
for the same type of care over the same period.
The State Health Plan recognizes a need to eliminate
some outdated facilities and to study the need for
nursing and residential programs in undeserved regions.
- Caring for the Chronically Ill - At the heart
of the chronic care model is the notion that the
health care system is fully integrated into a community-based
model of care organization. Patients and their families
are supported to actively participate in an informed
manner in their own care and effectively self-manage
their conditions. They interact and are supported
by practice teams that represent the expertise required
to provide clinical and behavioral management. Practice
teams are supported by timely access to relevant
data about individuals as well as the population
of the community they serve. This practical approach
allows for the provision of proactive, evidence-based
productive interactions with connected patients
who are equipped to make informed decisions regarding
their care.
- Strategies
- Develop strategies to reduce the use of emergency
departments for Maine people experiencing a
psychiatric crisis
- Develop strategies to improve outcomes and
reduce costs of treatment of substance abuse
and co-occurring mental health disorders
- Convene a Governor's Working Group on the
Health System and Chronic Care
Section 2: Cost
- The good news is that the quality of care in
Maine is, for the most part, good. The bad news
is that people in this state are paying more for
that quality than people in states with similar
quality of care, and there is a wide body of research
suggesting that higher spending does not result
in commensurately better health outcomes.
- Health Care Cost Drivers
- A variety of measures suggest that the efficiency
of spending in Maine's hospitals has room for
improvement, that Maine's hospitals should be
able to provide the same quality of care at
a lower cost. Once hospital spending is adjusted
for differences associated with the severity
of illness and variances in the cost of labor,
Maine's hospitals had an average cost-per-discharge
26% higher than New Hampshire's and 39% higher
than the northeast region's.
- Maine's hospital utilization rates are higher
than the rest of New England, and only Massachusetts
exceeds Maine in rate of admissions.
- It is likely that Maine's high rate of hospital
utilization is driven at least in part by the
fact that the state has the most beds per 1,000
citizens in New England.
- In 2,000, Maine's rate of emergency room use
was 43% higher than the national average and
substantially higher than New Hampshire's or
Vermont's, which suggests that Maine people
use the emergency room to obtain primary care
services, which is not acceptable from the standpoint
of cost or quality.
- Maine ranks first in New England in the number
of uninsured citizens. The uninsured tend to
be more costly to the health care system because
they are less likely to receive preventive care
and more likely to be diagnosed at more advanced
stages of disease.
- In 2002, Maine's hospitals reported an estimated
$123 million in bad debt and $68 million in
free care costs that were then shifted to other
payers.
- Aging contributes relatively little to the
overall cost increases. When adjusted for case
mix - which reflects the contribution of age
as a complicating factor - and wage variation,
Maine's inpatient cost per discharge, adjusted
for differences in the wage index and case mix
($6,917) is significantly higher than both the
United States averages ($5,819), the Northeast
($4,759), New Hampshire ($5,483), or Massachusetts
($3,679).
- Personal lifestyle behaviors affect health
care costs.
- Objective: Provide Guidance for Determining
the Level of Future Investment in Health Care Services,
the Issuance of Certificates of Need and Related
Lending Decisions
- 2 M.R.S.A. § 103(4) specifies that the
State Health Plan be used to determine the level
of the Capital Investment Fund (CIF) in guiding
the issuance of Certificate of Need awards by
the state and the lending decisions of the Maine
Health and Higher Education Facilities Authority.
- The average age of hospital plant in Maine
in 2002 was 9.85 years. Of 43 states for which
data are available, Maine ranks 20th in terms
of age of plant. It has a lower average age
of plant than the states in the entire northeast
region and tracks the age of plant for both
rural hospitals and for all hospitals, as a
group.
- While capital costs per adjusted discharge
for the nation as a whole is steady, Maine has
caught up ($425.25 in 2001) and has now surpassed
the national performance standard ($423.28 in
2001).
- Maine's growth in per capita health care expenditures
between 1991 and 1998 (the latest year for which
state specific data are available) was over
7% per year, exceeding that of any other New
England state or for the United States as a
whole. In 1998, Maine's annual growth rate was
approximately 7.25%, compared to 5.5% in New
England and 4.25% nationwide. Clearly, Maine's
spending on health care is accelerating at a
rate that far outpaces our region and our nation.
- According to the United States Census Bureau,
the three-year average median household income
for 2000-2002 was $37,654 in Maine and ranked
43rd in the nation.
- Strategies - In evaluating and prioritizing
projects submitted in accordance with Maine's
CON statute, the Department of Health and Human
Services should be guided by these important
criteria. Insofar as 22 M.R.S.A. § 335(1)
directs the commissioner to approve an application
for a CON if the project is, among other things,
consistent with the State Health Plan, it is
important that this plan clearly lay out criteria
for projects.
- Objective: Strengthen Maine's Certificate of
Need Program by setting out criteria for prioritizing
projects that are submitted for review and approval
- A. Projects undertaken to protect and promote
public health and safety should be give highest
priority in an environment where there are limited
resources to invest in the health care system.
- B. Where Maine's level of spending on health
care is unsustainable given the state's economic
constraints, projects that truly will generate
cost savings either through increased operational
efficiencies or through strategies that will
lead to lower demand of high cost services in
the short and long run should be given very
high priority.
- C. In times of economic constraint, it is
important to be cognizant of the impact the
introduction of new services and/or technologies
will have on the cost of care in Maine.
- High priority will be assigned to applicants
demonstrating adequate evidence of good faith
efforts in meeting the voluntary price and cost
targets established by the Dirigo Health Reform
Act. Likewise, high priority will be assigned
to applicants demonstrating investment in and/or
use of an electronic medical records system
with an HL7 interface, allowing for exchange
of information.
- Objective: Establish Statewide Health Expenditure
Targets for Maine
- The proposal involves a more collaborative
structure that includes streamlining and standardizing
payment methods and reporting systems across
payers and that engages citizens and regional
workgroups in debating and deciding funding
priorities. The vision is one of health system
budgets developed by regions and that include
five key budget categories: institutional, ambulatory,
chronic care, community health and capital.
The statewide expenditure target could include
risk sharing or incentives to allow effective
and efficient providers to retain some or all
savings.
- Strategies - June 2004 to May 2005 Planning
Process
- Objective: Promote the Concept of Paying for
Performance to Public Purchasers
- It is rare that providers are paid for quality
improvement activities, and, when such activities
take time away from practice, such participation
can serve to decrease a provider's revenues.
- Strategies - The Governor's Office of Health
Policy and Finance will work with the Public Purchasers'
Steering Group to explore opportunities for building
pay for performance into health care purchased
with public funds.
Section 3: Quality
- The Institute of Medicine defines health care
quality as: "The degree to which health services
for individuals and populations increase the likelihood
of desired health outcomes and are consistent with
current professional knowledge."
- A 2003 report issued by the Centers for Medicare
and Medicaid Services ranked Maine hospitals third
in the nation - just behind New Hampshire and Vermont
- in 2000-2001 on 22 quality indicators for care
provided to Medicare patients.
- In 2003, Maine ranked eighth in the nation in
terms of overall health by the United Health Foundation,
working in partnership with the American Public
Health Association and the Partnership for Prevention.
- The state's three tertiary medical centers have
each voluntarily participated in the Leapfrog Group's
hospital patient safety survey, scoring well with
respect to high risk treatments/procedures; ICU
physician staffing (use of intensivists); and computer
physician order entry systems.
- Health care providers in different areas of the
state approach the treatment of the same condition
in what can be significantly different ways, exhibiting
a lack of consensus among providers about how best
to treat certain diseases and conditions. Such variations
are rarely attributable to differences among patients.
While they are influenced by capacity, they are
very influenced by local practice patterns and physician
decision-making.
- Objective: Improve Maine's Data and Information
Technology Systems to Facilitate Improvements in
Quality Care
- The Maine Health Data Organization reports
that the all payer database is expected to be
accessible for public use by February 2005.
- The Institute of Medicine and the National
Quality Forum recognize implementation of electronic
medical records and access to clinical information
among un-allied providers as the highest priority
goal in improving the quality of health care.
- The Bureau of Health is requesting proposals
for assistance in the development and implementation
of IPHIS - the Integrated Public Health Information
System - to implement a centralized Internet-driven
systems integration capability that enables
the timely, accurate and secure exchange of
public health information within the Bureau
and the state.
- Strategies - Timelines to Make MHDO All Payer
Data Set Available and to Implement IPHIS by
July 1, 2005
- Objective: Develop framework for comprehensive,
integrated, patient-level data system
- Strategies - Priority will be assigned to applicants
for Certificate of Need review and approval demonstrating
investment in and/or use of an electronic medical
records system with an HL7 interface, allowing
for exchange of information. The Governor's Office
of Health Policy and Finance will participate
in collaborative efforts to reduce the fragmentation
of health data via the integration of patient
health and administrative data through a secure,
patient controlled mechanism by June 2005.
Section 4: Access
- About 136,000 (17%) of non-elderly Maine people
spent part of 2002 uninsured. On any given day,
roughly one in eight non-elderly Maine people were
uninsured. Eighty percent of the uninsured work
- 73% are employed in a small business or are self-employed.
Of the uninsured, 52% have incomes below the Federal
Poverty Level (e.g., $30,500 per year for a family
of three).
- The uninsured tend to be more costly to the health
care system because they are less likely to receive
preventive care, are more likely to be diagnosed
at advanced stages of disease, and are more likely
to be hospitalized for preventable conditions like
pneumonia and uncontrolled diabetes.
- Death rates for uninsured women with breast cancer
are significantly higher than for insured women.
- Forty-two percent of families with uninsured children
report delaying needed care for their children due
to costs. This rate is seven times that reported
by insured families.
- In 2002, Maine's hospitals reported an estimated
$123 million in bad debt and $68 million in free
care costs that are then shifted to other payers,
causing the ranks of the uninsured to grow.
- Objective: Reduce the number of uninsured Maine
people by 31,000
- Strategies - Implement and market Dirigo Health
coverage beginning in summer 2004 and implement
expansions of MaineCare three months after Dirigo
Health coverage becomes available
- Objective: Preserve the fiscal and programmatic
integrity of MaineCare as a safety net to cover
Maine's lowest income people
- MaineCare provides coverage for about 250,000
Maine people; an additional 100,000 receive
assistance with prescription drug purchases.
- Strategies - Conduct monthly program oversight
meetings between the Governor's Office of Health
Policy and Management and the Department of
Health and Human Services to assure compliance
with budget and program goals; provide regular
updates on MaineCare enrollment service use
and costs; initiate limited MaineCare expansions
as part of and funded through Dirigo Health
three months following launch; the Governor's
Office of Health Policy and Management will
produce a "State of the MaineCare Program"
report
- Objective: Develop a resource inventory by
region documenting health, mental health, public
health and long term care resources and workforce
- The combination of financial barriers and
the mal-distribution of primary care providers
in the rural areas of Maine result in significant
barriers to appropriate care.
- Maine's aging population presents a need for
long-term care services.
- The Department of Health and Human Services
has expressed the need for a plan for mental
health services.
- Strategies - Review and analyze current data
bases, develop framework and work plan, work
with Regional Workgroups to complete inventory,
develop methods to put the inventory on-line
and maintain its currency
Part 3: Process for First Biennial State Health
Plan
The planning process will take place over the
next year and it will have five components:
- A baseline of credible, regionalized data on cost,
quality, access and health status
- A regional process through three regional workgroups
to bring all stakeholders together to examine data,
set regional goals and benchmarks
- A statewide campaign, "Tough Choices,"
to determine the public's priorities for health
and health care
- A statewide health expenditure target
- A state-level synthesis of regional and State
Health Plans
Return
to Coalition News
|
|
