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Advancing Health Care Reform in Maine: Why, What, & How?. Aging Advocacy Summit November 2012 Lisa M. Letourneau MD, MPH. Objectives. Identify factors contributing to the urgent case for transforming US health care system Introduce key components of Maine’s emerging model for change
Aging Advocacy Summit
Lisa M. Letourneau MD, MPH
Healthy, productive, connected people & families
…receiving healthcare from a highly functioning “accountable care organization”
… supported by a robust & well-supported system of primary care providers
The 15 minute visit!
Employers & payers unwilling to pay for desired services unless providers demonstrate value AND show potential to save money
Providers unable to transform practice without viable & sustainable payment for desired services
Maine Quality Counts
DHA’s Maine Quality Forum
Maine Health Management Coalition
Employers & payers pay for desired services if providers can demonstrate value AND reduce spending
= Payment Reform
Providers change practice, create value with viable & sustainable payment for desired services
= Delivery System Change
“A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.”
American Academy Pediatrics
Behav. Health & Sub Abuse
~ 540 Maine Primary Care Practices
~130+ MaineCare HH Practices?
100+ NCQA PCMH Recognized Practices
14 FQHCs CMS APC Demo
26 Maine PCMH Pilot Practices
50PilotPhase 2 Practices
“Accountable Care Organizations (ACOs) will constitute groups of providers - physicians, other clinicians, hospitals or other providers - that together provide care and share accountability for the cost and quality of care for a population of patients”
T. Lake et al, “Lessons from the Field: Making Accountable Care Organizations Real “, NIHCR Research Brief, Jan 2011
Consumer Engagement Campaign
Focus on reducing costs
PCP at full financial risk
PCP as gatekeeper
Very limited information and tools
vs. PCMH + ACOs
Focus on demonstrating value
New care management fees (plus performance payments?)
Limited financial risk to PCP
Primary care team coordinates care & supports patient needs across “med neighborhood”
Improved information and tools (EMR, registries)Managed Care All Over Again?