Cooperative Health Care

Whatever type of health-care system Maine eventually adopts, it would benefit from a couple of ideas presented this week by Anthem officials visiting Bangor. The insurance giant’s interest in holding down costs is clear enough; what’s interesting is when the means for achieving that interest overlaps with sound medical practice and well-designed state policy.

Dr. Sam Nussbaum, the chief medical officer at Anthem, is a former Harvard professor and chair of the Washington-based National Committee for Quality Health Care. His primary message that insurers, doctors and hospitals administrators need to collaborate much more to create a comprehensive health system, reduce medical errors and lower costs might be a surprise to many in the general public who assume that these professionals already cooperate. To an extent, they do, but not nearly enough to craft broad policies and standards that would, for instance, lessen paperwork by doctors while providing more information to hospitals or expand best practices without trying to dictate care.

One area these groups should come together, Dr. Nussbaum suggests, is over evidence-based medicine, a subject explored in more depth by Washington Post medical writer David Brown on today’s OpEd page. In brief, evidence-based medicine holds that practices be backed by accepted studies and recognized standards within professional groups. Doctors are not simply guessing now, of course, but they might be able to combine their training, skill and experience with more rigorously tested treatments to improve the care they provide their patients. Ultimately, improved care should help people become healthier, reducing both pain and the need for care.

Dr. Karen Bell, Anthem’s medical director in Maine, suggests that the state needs an overseeing board to assure quality and affordability in health care. Such a group would need the resources to look at use patterns in Maine and the effectiveness of treatment. Perhaps it should be given authority for a tougher certificate-of-need process. Now that the Maine Medical Assessment Foundation has closed for lack of funding, the state needs an independent research entity making sure the decisions made in health care are smart ones.

Anthem is acutely aware that Maine, perhaps more than most states, is on the verge of huge overhaul of its too-expensive, too-limiting health-care system. As the largest private insurer here it wants to influence the direction of the reform. And while its campaign last year to keep Portland from supporting single-payer was a flop, its more thoughtful observations this week add considerably to the discussion.