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MHMC Wikipedia Page – Revised Initial Post THE MAINE HEALTH MANAGEMENT COALITION Established in 1993, the Maine Health Management Coalition (MHMC) is a statewide, multi-stakeholder coalition with a membership that includes doctors, hospitals, health plans (insurance), and public and private employer sponsors of health care. http://bangordailynews.com/2012/10/03/health/five-groups-join-maine-health-management-coalition/

The MHMC’s mission is to bring together disparate stakeholders to improve the delivery and financing of health care services by facilitating collaboration. This coordinated group effort reflects the culture of Maine, where there is a strong sense of community, as well as its geography, which is predominantly rural. Source: http://content.healthaffairs.org/content/26/3/817.full#sec-2 Those inquiries helped spur decades of cooperation among Maine businesses, health insurance companies, hospitals and physicians. The 21-year-old Maine Health Management Coalition now publishes detailed score cards on physicians and hospitals, tracking more than 100 variables. The state's largest employers, health systems and insurers take part. That, in turn, has helped change the way patients are treated.

http://www.latimes.com/nation/la-na-healthcare-collaboration-20140319-dto,0,2911326.htmlstory#ixzz2xXTPAEYB

LEADERSHIP The MHMC was founded by John Benoit, president of Employee Benefits Solutions, along with a number of progressive Maine businesses. Source: http://www.holdenagency.com/employee-benefits/maine-insurance-agents/john-benoit Benoit appointed Doug Libby as the first full-time executive director of the MHMC in 1995. Libby served until 2009, when J. Elizabeth Mitchell was named CEO. Source: http://www.mainebiz.biz/article/20130909/NEWS0101/130909968 Mitchell held the position until 2013, when she became CEO of the Network for Regional Healthcare Improvement. Source: http://bangordailynews.com/2013/03/07/health/health-coalitions-ceo-to-lead-national-nonprofit/ Andrew Webber, who succeeded Mitchell as CEO, previously served as president and CEO of the National Business Coalition on Health in Washington, DC. Webber is also a board member of the Patient Centered Primary Care Collaborative, the Health Care Incentives Improvement Institute and the Center for Advancing Health. Source: http://www.mainebiz.biz/article/20130909/NEWS0101/130909968

The MHMC is governed by a Board of Directors comprised of leaders from its statewide, multi-stakeholder membership. Source: http://www.mehmc.org/about-us/who-we-are/governance/

KEY PROGRAMS State Innovation Model Initiative (SIM) The State of Maine will receive up to $33,068,334 to implement and test its State Health Care Innovation Plan. (A State Health Care Innovation Plan is a proposal that describes a state’s strategy to use all of the levers available to it to transform its health care delivery system through multi-payer payment reform and other state-led initiatives.) Source: http://innovation.cms.gov/initiatives/state-innovations-model-testing/ The federal funding comes from the Centers for Medicare and Medicaid Services (CMS) Innovation Center. Source: http://innovation.cms.gov/index.html The funding is being made available to help Maine find new ways of paying for and delivering health care that could ultimately lower costs of government-run health services, while improving the health of the programs’ beneficiaries. The Maine State Innovation Model (SIM) will test a plan to make better use of health data for more transparent and detailed reporting of costs and quality. Source: http://bangordailynews.com/2013/02/21/health/maine-wins-33-million-to-test-health-care-innovations/?ref=inline

The key strategies being pursued to achieve the Maine SIM objectives are payment reform, delivery system reform, data analytics and reporting, health information technology, and consumer engagement. Source: http://www.maine.gov/dhhs/sim/strategies/index.shtml

The MHMC serves as the lead implementation partner with the State of Maine for SIM. As such the MHMC will play a leadership role in a number of key areas, including: Payment and Delivery System Reform: The MHMC convenes the Accountable Care Implementation (ACI) Workgroup meetings to identify Accountable Care Organization (ACO) metrics to be used in public reporting, contracting, and performance measurement in order to develop uniformity in the way quality is measured.

Payment Reform: The MHMC promotes value-based insurance design (VBID) through the VBID Workgroup’s examination of examples from around the country and identification of best practices. Source: http://www.maine.gov/dhhs/sim/strategies/payment-reform.shtml

VBID endeavors to increase health care quality and decrease costs by designing health plans that reduce barriers to maintaining and improving health. Source: http://www.ncsl.org/research/health/value-based-insurance-design.aspx

The VBID Workgroup will also create a means to rank insurance plans according to adopted VBID metrics, and encourages Maine businesses to adopt the new benefit model because of its potential to both increase quality and decrease cost. In addition, the MHMC convenes the Health Care Cost Workgroup (HCCW) to provide CEOs and healthcare decision makers in Maine with the tools needed to exercise influence on the marketplace. The HCCW will track the cost of care in Maine and identify opportunities to bring costs down – including the costs of behavioral health. Source: http://www.maine.gov/dhhs/sim/strategies/payment-reform.shtml

Delivery System Reform: The MHMC facilitates the work of the Behavioral Health Workgroup, which is part of the larger Pathways to Excellence (PTE) Physician Workgroup, a body of providers, employers and insurers charged with measuring and reporting quality data on Maine physicians and hospitals. The Behavioral Health Workgroup will identify viable performance measures for behavioral health integration and work to decide how to report practices’ behavioral health scores on the MHMC’s public reporting website: www.getbettermaine.org.

Source: http://www.maine.gov/dhhs/sim/strategies/delivery.shtml

Data Analytics and Reporting: The MHMC collects data through its all-payer claims database. The database aggregates information from MaineCare (Medicaid in Maine), Medicare, and all of Maine’s commercial payers into software that is able to generate meaningful information. In addition, the MHMC is building secure portals for providers to log in and examine claims data. This data will allow providers to better allocate resources at their practice and identify patients who may need additional support. The MHMC is also developing practice reports to present providers with information about key cost and quality metrics. The reports give providers insight into areas in which they are performing well and areas in which improvement is needed. Source: http://www.maine.gov/dhhs/sim/strategies/data.shtml

Consumer Engagement: The MHMC is substantially increasing the number of metrics for reporting quality and cost information on its consumer website, www.getbettermaine.org. New measures, which are being developed by the Pathways to Excellence Steering Committees, will include Patient Experience Scores, Behavioral Health Integration, Advanced Primary Care, and Total Cost of Care. In addition, the MHMC is reaching out to consumers to educate them by producing a video on how VBID works and what the benefits of a VBID plan are. The MHMC will also provide free training on VBID to advocates, Area Agency on Aging advisors, navigators, free care providers, brokers, human resource specialists, and Maine payer staff. http://www.maine.gov/dhhs/sim/strategies/engagement.shtml

Programs for Employers Value Based Insurance Design (VBID): The MHMC promotes VBID, because VBID endeavors to increase health care quality and decrease costs by designing health plans that reduce barriers to maintaining and improving health. By covering preventive care, wellness visits, and treatments for chronic conditions at low to no cost, health plans may save money by reducing future expensive medical procedures.” Source: http://www.ncsl.org/research/health/value-based-insurance-design.aspx

VBID places an emphasis on evidence-based care. It also encourages the use of services when the benefits exceed the costs, and discourages the use of services when the benefits do not justify the cost. In this way, VBID moves away from the fee-for-service payment model. Source: http://content.healthaffairs.org/content/26/2/w195.abstract

Buying Value: The MHMC supports Buying Value, an initiative of private health care purchasers that seeks to achieve better care and lower health costs by replacing the volume-based purchasing model in health care with one based on quality and patient safety. Source: http://www.buyingvalue.org/

Wellness: The MHMC encourages employers to improve the health of their employees by creating an employee-centered wellness culture that provides healthy, safe environments and access and opportunities for employees to engage in a variety of workplace health programs. Source: http://www.cdc.gov/workplacehealthpromotion/businesscase/index.html

CEO Champions: The MHMC sponsors CEO Champions, a competitive wellness program that uses a top-down approach. Set up as a team competition, leaders from local organizations work with employees and community members to create the healthiest and most wellness friendly workplace. Source: http://forces4quality.org/ceo-champions-wellness-program-winning-over-maine?term_id=147 Using the Health Enhancement Research Organization (HERO) Scorecard evaluation, the CEO Champions are judged on the how much improvement their organizations achieve over the course of a year. They'll also get points for assisting each other. Each competitor has agreed to institute a wellness program at their place of business, find and mentor another leader in the second year of the program and provide financial assistance to a school's wellness program. Source: http://www.healthcarefinancenews.com/news/disruptive-innovators-ceo-champions?page=0

Choosing Wisely®: The MHMC promotes Choosing Wisely®, which encourages conversations between physicians and patients by helping patients choose care that is supported by evidence; not duplicative of other tests or procedures already received; free from harm; and truly necessary. National organizations representing medical specialists have been asked to “choose wisely” by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting lists of “Five Things Physicians and Patients Should Question” spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments. Source: http://www.choosingwisely.org/

Programs for Health Care Providers Pathways to Excellence Public Reporting Initiatives: The MHMC collects and then disseminates information on the quality of care reported by physicians and hospitals on the public reporting website www.getbetterme.org. Source: http://qid.mainequalitycounts.org/project/pathways-to-excellence--get-better-me More than half of Maine’s 400-plus primary care practices participate in Pathways to Excellence (PTE), a voluntary system for reporting on health care quality. The MHMC developed the PTE reports and has publicly posted them on its website since 2004. The system is designed to promote value-based health care purchasing and spur providers to improve the quality of care. Source: http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/05/studying-maine-s-pathways-to-excellence-program-.html

Data The MHMC is a Qualified Entity (QE) in the Medicare Data Sharing for Performance Measurement Program of the Centers for Medicare and Medicaid Services. As such, the MHMC receives feeds of Medicare claims information from the federal government, which may be used for the purpose of evaluating the performance of providers and suppliers, and to generate public reports regarding such performance. Source: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/QEMedicareData/index.html In addition to Medicare and Medicaid data, the MHMC also aggregates claims data from the Maine Health Data Organization (MHDO) and all commercial insurers in Maine. This data is kept in Maine’s only all-payer claims database, and is used to inform and track cost and quality efforts around the state. Source: https://mhdo.maine.gov/_externalReports/OnpointHospitalCostReportJan2013.pdf, https://mhdo.maine.gov/datarequest.aspx

EXTERNAL LINKS MHMC Official Website: Get Better Maine Public Reporting Website: