State Health Plan
Background: On November 7, the Governor's Office of Health Policy
& Finance released the draft 2006-2007 State Health Plan for public
comment. The State Health Plan is a key initiative of Dirigo Health
Reform and is the foundation upon which such things as Certificate of
Need decisions will be based. The draft plan is available at http://www.maine.gov/governor/baldacci/healthpolicy/Draft%2006-07%20State%20Health%20Plan%20-%2011-05.pdf.
Public comments will be received by the Governor's Office of Health
Policy and Finance until 5:00 p.m., Friday, December 2, 2005.
Public hearings will be held according to the following schedule:
- Lewiston, November 21, 11:00 a.m. to 2:00 p.m., Lewiston/Auburn
Campus of the University of Southern Maine, 51 Westminster St.
- Brewer, November 21, 4:00 p.m. to 7:00 p.m., Jeff's Catering, East
West Industrial Park, 5 Coffin Ave.
- Portland, November 22, 11:00 a.m. to 2:00 p.m., University of Southern
Maine's Portland Campus, Hannaford Hall in the Abramson Building
The final plan will be presented in December.
MHA Overview:
While MHA is extremely pleased with the emphasis on addressing some
chief drivers of medical spending related to chronic disease and the
establishment of a public health infrastructure as outlined in the draft
state health plan. MHA has concerns that the plan does not establish
clear goals and objectives to assure appropriate access to community-based
medical care delivery system and state-of-the-art medical care.
MHA's comments will underscore that Maine hospitals are cost-effective,
utilized effectively and efficiently and are providing high quality
care at time of increasing expectations.
The plan should recognize and address some of the existing barriers
and challenges affecting Maine's community hospitals in the pursuit
of their mission to provide high-quality, affordable care and to ensure
that the continuum of care is available within their communities.
The state's failure to pay its bills with hospitals, Medicaid reimbursement
policies that are eroding vital access to physicians and other health
care services, inadequate allocation of state resources for community
and hospital-based mental health services, and the consequences for
cost, quality and access.
The state health plan must address the importance of medical care and
the medical care delivery system so that these objectives are given
the necessary consideration, including as part of Certificate of Need
applications. The plan now has a narrow consideration, focused largely
on public health priorities.
Key Issues/Comments:
o Public Health
- We are supportive of the public health goals and the creation of
a public health infrastructure
- Hospitals currently play a significant role in public health
- Hospitals should be part of decision-making regarding local public
health priorities
- Do not agree with the draft plan's assumptions that there is adequate
money in the pipeline to accomplish public health goals
- Want to ensure that there is adequate funding for these public health
goals and initiatives to avoid critical resources being diverted away
from medical care services
o Lacks appropriate recognition of current and future needs of Maine's
medical care delivery system
o Plan needs to include more acknowledgment of health care workforce
challenges and recommendations
o Fails to acknowledge and address impact of the state Medicaid program
on access, cost, and quality
- Impact on hospitals
- Primary & specialty physicians
o CON
- 1% for public health
- Ignores work hospitals are already doing on public
health
- The 1% should not be CON specific & should look
more globally at the applicant
- Erroneously suggests that hospitals are not worrying
about preventing the underlying need
- The priorities identified in general
- CON applications should be evaluated on their own
merit regarding clinical need & cost effectiveness
- Concerned about weight of public health priorities
over medical care priorities.
- The proposed Memorandum of Understanding between the Maine Quality
Forum and the Department of Health and Human Services to inform CON
decision-making.
- MQF lacks adequate resources for this role
- Lacks transparency/accountability
o The proposal of yet another study of rural hospitals
- Disregards the just-finished Hospital Study Commission;
- Includes unsubstantiated claims not supported by the data
- Overhead
- Costs
- Lacks acknowledgement about the vital role hospitals play in ensuring
access to services across the continuum of care;
- Fails to address the primer drive of financial challenges for these
hospitals: the state Medicaid budget
o Data inaccuracies that inaccurately argue that Maine's infrastructure
is already excessive & expensive in order to restrict investments
through the CON and CIF
- hospital costs,
- impact of aging on health care spending,
- excess bed capacity
- # of beds
- national comparisons
- Flu season
- Surge capacity
- costs of empty bed
- Inpatient & outpatient utilization.
o The use of informal "working groups."
Goals:
- Establish Maine as the healthiest state in the country
- Establish Maine as the premiere high quality medical care delivery
system that ensures appropriate access to high quality medical care
throughout the state
- Increase the number of Mainers with comprehensive commercial health
insurance coverage
Objectives:
Improving the health of people in Maine.
- Assessing the medical care and public health needs in Maine and
the identification and implementation of efforts to improve the overall
health of Maine people.
- Focusing on strategies to improve health status with an emphasis
on the primary drivers of poor health and significant contributors
to increased health care spending in Maine;
- Balancing the goals of cost containment with improving access and
quality.
- Controlling costs in ways that do not jeopardize appropriate access
to high quality health care services and efforts to improve health
status of Maine citizens.
- Basing the analysis of health care expenditures on the needs of
Maine citizens, not on an arbitrary percentage of the Gross State
Product.
Medical Care Strategies:
- Recognize and financially support the expansive role of community
hospitals in ensuring access to health care services across the continuum
care.
- Recognize and financially support the role of community hospitals
in recruiting and retaining primary and specialty physicians.
- Promote appropriate access to community-based medical services and
technology
- Acknowledge and address the impact of poor and delayed payments
by Medicaid on cost, quality and access goals.
- Promote increased transparency and public accountability of health
care costs and quality;
- Support the rational development of expensive services and technology
through the Certificate of Need process;
- Re-evaluate the impact of the Capital Investment Fund on critical
investments for Maine's medical care infrastructure
- Develop state-wide plan for the implementation of evidence based
clinical protocols and disease-management protocols;
- Using the MHDO claims database, analyze the way care is accessed
in Maine to improve standardization of clinical care and better clinical
coordination. Seek agreement by the state and federal governments
to release Medicare and MaineCare claims data to this database.
- Establish support and financial assistance for the implementation
of electronic health information systems; and
- Continue to evaluate opportunity for state-wide health information
network.
Public Health Strategies:
- Build a more collaborative medical care/public health approach to
health care in Maine.
- Implement a multifaceted approach that includes the framework of
primary, secondary and tertiary prevention.
- Improve standardization of care through greater focus on community-based
health assessment and implementation of a chronic care delivery model.
- Implement evidence-based clinical guidelines.
- Identify incentives to improve individual behavior in managing one's
health and promote community-based health promotion, prevention and
disease management.
- Invest in health care information systems
- Use the state health plan to strengthen the Certificate of Need
process.
- Address barriers to access to primary care
o Insurance Coverage
o Poor Medicaid reimbursement for primary care physicians
o Underserved areas
