Dirigo Health plan’s promise

With the eyes of the nation watching, Maine now enters into the most difficult part of our journey to establish universal health care coverage. The enactment of the Dirigo Health plan will test the entire state as we seek to breathe life into the concepts of health reform embodied in this bold strategy.

In the face of this challenge, community health centers are mounting efforts to deliver the highest quality of primary care to tens of thousands of Mainers who otherwise could not access preventive care regardless of their coverage status. The recent announcement by the Maine Health Access Foundation to fund the Maine Collaborative Network – a comprehensive approach to improving health outcomes for those with chronic disease – will speed the work of our state’s health centers, helping to validate the promise of Dirigo Health and its “quality watch dog,” the Maine Quality Forum.

As Gov. Baldacci pointed out in his unveiling of Dirigo Health, three of the top four killers in Maine are chronic diseases. Maine’s death rate due to chronic disease was the fourth highest in the nation in 2001, and Maine leads the nation in the three risk factors that cause or exacerbate chronic disease: tobacco use, poor eating habits and physical inactivity.

This is the status quo and it is literally killing us. We must pull together as a state to improve our health status even as we as a state age more rapidly.

Our challenge is to build a system of care that engages each and every one of us in improving our health status. In doing so, we will also be able to take a swing at reducing our utilization of increasingly costly health care services.

How to do it? Maine’s community health centers are implementing a new model for delivering optimal primary care for chronic diseases, called the Chronic Care Model. Developed by the Institute for Healthcare Improvement, the Chronic Care Model emphasizes clinical information systems, decision support, community resources and patient self-management. The patient herself is an integral part of the health care team, for she is the one who can best execute the care plan, in concert with her clinical team members at the health center.

Community health centers are the place for these changes to take place; the National Academy of Sciences’ Institute of Medicine praises their “strong track record in chronic care management, electronic patient registries, and performance measurement” that contribute to better quality and lower the overall costs of care.

However, changing the status quo is not without costs, which are all the more difficult to sustain amidst a worsening economy. As reported earlier this year in the journal Health Affairs, health care financing and health care delivery in America are out of alignment. Our investments in quality improvement are often unsustainable because primary care practices bear many of the costs of changes and improvements, yet they reap relatively few of the material benefits.

To address this mismatch of costs and benefits, and to support the Chronic Care Model and related quality improvement work, the Maine Primary Care Association is launching its Maine Collaborative Network in September. Financed by the Maine Health Access Foundation, this project will promote the Chronic Care Model in 30 of the state’s medically underserved areas.

Focusing on three highly prevalent and debilitating illnesses – diabetes, depression and cardiovascular disease – this project seeks to improve health outcomes in the areas of greatest need across the state. Members of the collaborative network are all committed to the delivery of the Chronic Care Model for the benefit of their patients.

The potential rewards are inspiring. At Katahdin Valley Health Center, applying the Chronic Care Model to the care of 100 patients with diabetes has already led to $115,000 in savings in just eight months.

These savings were calculated by the costs of avoided referrals, procedures and hospitalizations prevented by the early and aggressive primary care at the health center. And these savings do not begin to consider the higher quality of life and immeasurable benefits of being able to live fully despite a chronic condition.

We should not look to Dirigo Health as a panacea. Rather, it is a structure within which we can accomplish the goals of meaningful health care coverage and access for every person in Maine.

As the governor stated upon enactment of Dirigo Health, “The only thing that will keep us from fulfilling the promise of Dirigo Health is ourselves. If we can come together to develop the program as we came together to pass this great new law we will truly realize Maine’s motto… Dirigo – to lead with and for the people of Maine.” The Maine Collaborative Network is one such effort to fulfill the exciting promise of Dirigo Health.

Kevin Lewis is executive director of the Maine Primary Care Association whose members provide access to comprehensive primary care in the state’s medically underserved areas.