An Open Letter to Maine's Congressional Delegation

An open letter to Maine 's Congressional Delegation:

As Maine's largest health care foundation focused on expanding health care access to people across our state who are uninsured and medically underserved, the Maine Health Access Foundation supports coverage expansions through national health reform as an essential step toward achieving our mission. We are committed to increasing access while reducing costs, improving quality and ensuring patient choice.

The current debate on national reform provides a rare opportunity to expand coverage and improve our broken health care system. The foundation would like to offer its experience, expertise, and capacity to serve as a nonpartisan convener to help inform the decisions you and your staff must make to ensure national reform meets the needs of Maine people.

Maine is fortunate that our congressional delegation is committed to reaching out and listening to their constituents regularly. Unlike provider organizations, insurers, professional associations or membership organizations, the Maine Health Access Foundation (MeHAF) has no financial stake in the outcome of reform. Our offer to bring fresh perspectives and voices to the national health reform discussion is prompted by the desire to share the valuable information we have gathered over the past seven years, and to advance our mission.

Since its inception, MeHAF has reached out to people across Maine for advice on how the foundation can advance access, improve health and bring down the soaring cost of care. In community after community, people have voiced their frustration at the current system, and have implored MeHAF to look beyond immediate needs to "fix the system." In response, we have invested $35 million over seven years to promote public policy, advocacy, research and grant-funded initiatives that expand access, improve quality, rein in costs and promote health in Maine.

Maine has been a leader in health reform, and as a state, we have fared well at preserving coverage over the last decade. But the continued pace of rising health care costs threatens to undermine these gains. MeHAF's work has helped identify opportunities to balance coverage expansions with carefully framed cost containment strategies, payment reform and expanded care management approaches. These are all necessary elements to insure coverage gains are sustainable. Many of the lessons learned from our grant initiatives to strengthen Maine's safety net, promote patient and family-centered care, and advance health reform can inform and guide the policies shaping national reform. A brief summary of some of the most relevant work is below.

MeHAF shares the national sense of urgency that we must move forward with national health reform, and we are gratified that this imperative reaches across the partisan divide.

As a nation we simply can't afford maintaining the status quo.

Please accept our thanks for your service to the people of Maine. We will be reaching out to see how the foundation might be of assistance to all the members of the delegation during these challenging deliberations.

MeHAF-Funded Work Relevant to National Health Reform

Expanding Coverage

• Better Insurance Benefit Design: With passage of the Dirigo Health Reform legislation, MeHAF provided funding to advocacy organizations, public health experts, and safety net providers to insure the development of this new insurance product would promote prevention, support evidence-based care, and meet the needs of its priority population. In the end, DirigoChoice adopted several innovations that can serve as a model for other insurance expansions, such as providing incentives at enrollment for a health risk appraisal and adding evidence-based preventive screening and mental health parity as part of the benefit package. This benefit structure promotes wellness, insures members have an established relationship with their primary care doctor, and acknowledges the critical need to include mental and behavioral health care as part of reform.

• Medicaid Citizen Verification: In response to the new federal requirement for Medicaid applicants to prove citizenship, MeHAF brought senior leaders from the Maine Department of Health and Human Services and advocates together to plan how Maine would meet this new requirement in a way that preserved coverage for low-income people. With MeHAF funding, these groups worked collaboratively to identify existing state data bases to verify identity and worked with people in their communities to secure documentation. As a result, Maine was one of the few states that largely preserved enrollment in the face of these new requirements. This experience demonstrates how the availability of coverage is necessary but insufficient to get people to enroll in public or subsidized programs. Any coverage expansions will require effective strategies and resources to help people enroll and stay in programs.

Lowering Costs While Improving Quality

• Better and Lower Cost Care for the Uninsured: Maine has been a leader in providing high quality and lower cost care for people who are uninsured through programs such as CarePartners (MaineHealth/Maine General), Franklin Health Access and York Hospital Community Caring Health Connection. With MeHAF funding, CarePartners evaluated the impact of receiving primary care and care management on cost and utilization for the uninsured people in their program. Using dummy claims data, they demonstrated that costs, service utilization, and ER use decreased for those who remained in the program more than one year. For patients enrolled for at least 18 months, per member/per month cost actually fell below the commercially-insured population. This data indicates better quality of care and cost savings can be achieved - even with challenging populations – when primary care and care management is patient-centered and locally provided, as opposed to payer-centered.

• Improving Pharmaceutical Management: The explosion of pharmaceuticals has expanded drug therapy for many chronic illnesses, yet it has also resulted in polypharmacy with many people taking multiple medications on a daily basis. For three years, MeHAF has supported a broad-based group of provider organizations to improve medication safety and management. Based on a well-framed evaluation of this work, researchers are finding that improving medication management can decrease adverse drug events that result in ER visits or hospitalizations. Programs such as these have significant potential to drive down health care costs.

• Promoting Cost Containment: Based on research MeHAF commissioned from the Urban Institute, in 2007 the foundation demonstrated that Maine had few public or private resources remaining to expand coverage. In fact, Maine's rapidly rising health care costs were threatening coverage gains in both the public and private markets. In response, MeHAF is supporting a wide range of organizations (Maine Health Management Coalition, Maine Equal Justice Partners, Prescription Policy Choices, Consumers for Affordable Health Care, and others) to frame achievable strategies to improve cost containment so access can be preserved. The results of this work should help inform and guide similar policy discussions at the national level.

• Advancing Health Information Technology to Improve Care and Lower Costs: MeHAF has been a conceptual leader and lead fiscal supporter for Maine's initiative to advance a state-wide health information exchange, called HealthInfoNet. The foundation's support for this innovative program was prompted by the acknowledgement that people who are uninsured faced the greatest barriers to receiving quality and affordable care, and until such a time that everyone has universal access to care, at least we could help develop a "virtual" universal system of care. Additionally, MeHAF has consistently advanced the rationale that improving health IT is the most proximate, achievable strategy to decrease health care costs. Our assertion is supported by recent research from the University of Massachusetts that demonstrated the successful implementation of HealthInfoNet could result in potential savings in Maine of $38 - 46 million per year, which frees resources for coverage expansions.