Just what the doc ordered

Throughout Maine, people are talking about the Dirigo health plan that seeks to address issues of healthcare cost, quality and access in our state. Much of the discussion has centered on how the plan will be financed and how costs can be controlled. Lost in the shuffle is the recognition of programs already in place that are saving the state money while improving the quality of healthcare that Maine residents deserve.

One such program is Maine Cares (ME Cares), a groundbreaking program comprised of a coalition of 32 Maine hospitals that offer community-based care management programs for patients with heart failure (HF) and coronary heart disease (CHD). Medical Care Development, an Augusta-based non-profit organization I represent, serves as the facilitating organization for this innovative program, which has been shown to improve clinical and behavioral outcomes for patients with heart disease. These promising outcomes will lead to fewer costly hospitalizations, lower overall health care costs, and improved quality of life for heart disease patients in Maine.

Every year, nearly 30,000 hospitalizations in Maine are caused by heart disease, at a cost of more than $400 million. ME Cares was formed to enable every patient with heart disease in Maine whether living in an urban or rural setting, to have access care support services once they leave the hospital setting. ME Cares nurses, employed by the hospitals and working closely with physicians, provide patients with knowledge, tools, and encouragement that lead to better health and improved quality of life.

Using care management software technology developed by Pfizer Health Solutions, ME Cares nurses provide services telephonically to heart disease patients throughout the state, even in the most remote areas. The program has been a remarkable success. More than 1,500 patients have enrolled in the HF and CHD programs combined. Recently, the program received national recognition when the Centers for Medicare and Medicaid Services (Medicare) selected ME Cares as one of 16 sites nationally taking part in a five-year trial to measure the health and financial benefits of proactive care management.

As a result of ME Cares, more patients with heart disease are complying with their recommended treatments, such as following restricted diets, exercising more, and taking prescribed medications. When patients take a more active role in managing their chronic conditions, it can only serve to benefit their overall health and reduce unnecessary medical costs.

If we hope to control healthcare costs, we need to find ways to keep people healthy and to prevent disease progression. Programs like ME Cares do just that. For the most part the 32 ME Cares hospitals are providing care support services, emphasizing prevention and informed self-management, without reimbursement. Why? Because it’s the right thing to do. However, reimbursement for services that move people toward health through active disease management and prevention can benefit us all and should be a covered benefit for all Maine citizens. These community-based services build healthy communities and help control overall healthcare costs. Healthcare reform should guarantee this for all Maine citizens. That is true Dirigo – the kind of leadership Maine should be known for.

Dr. Richard Wexler has served as medical director for Medical Care Development for the past two and a half years.