PORTLAND — Congress passed national health care reform this year, but it will be up to Maine and the other states to figure out how to improve care and reduce costs.
That was the challenge presented to about 300 health care providers and experts who gathered Tuesday for a forum called “National Health Care Reform: Leveraging Opportunities for Maine.”
The Affordable Care Act remains the focus of a tug of war in Congress. Many in the newly elected Republican majority are working to repeal all or parts of the law, especially requirements that individuals buy health insurance or pay a fee.
Tuesday’s discussion, however, focused on more popular sections of the law that encourage innovation to drive down costs. Because Maine is already experimenting with new kinds of doctors’ offices and payment systems, national and state advocates said the state may play an important role in shaping the reforms.
“I’m very impressed by what’s going on here,” said Dr. Robert Berenson, a national expert on health care reform and a top adviser to the national Medicare system.
Maine, for example, is one of eight states chosen to lead a national experiment with payment systems that could reward hospitals and physicians for keeping people healthy and out of their emergency rooms and waiting rooms. The current system doesn’t pay well for preventive care, but instead rewards doctors and hospitals when they order expensive tests and treatments.
“I don’t think there’s a lot of controversy around the fact that we’ve got to move from volume-based payments to value-based payments,” Berenson said.
But such reforms won’t be fast or easy, said Berenson and the other experts. New systems of paying for medical care are at least five to 10 years away, although incentives could be added to the system in the meantime, Berenson said.
There is no doubt that better preventive care can reduce costs, said Lori Newcomb, supervisor of outpatient care at Eastern Maine Medical Center in Bangor, but the way hospitals and doctors are paid punishes such efforts.
Newcomb described how one elderly man with respiratory and other illnesses made 16 trips to the hospital’s emergency room in one year. The next year, after she began working closely with the patient and his primary care doctor to keep him healthy, he made just three trips to the emergency room. And after being admitted as a patient four times in the first year, he was admitted only once in the second year.
However, because insurance doesn’t typically pay for keeping patients healthy and at home, her success ended up costing the hospital a lot of money from services that were not provided.
The federal law doesn’t immediately change the way health care is paid for, but it encourages preventive care and competition and supports experimentation with new payment systems that could benefit Maine, the experts said.
“We are incredibly well positioned to take advantage of the Affordable Care Act,” said Elizabeth Mitchell, director of the Maine Health Management Coalition. “We should really be that community to show how this can be done.”
The conference at the Holiday Inn by the Bay was sponsored by Aligning Forces for Quality, a coalition led by Maine Quality Counts, the Maine Health Management Coalition and the Dirigo Health Agency’s Maine Quality Forum.
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