Consider

• The top insurance companies in Maine are developing programs that provide incentives for quality care.
• In various congressional hearings, a consistent message is being heard that the health care system must change. One of the integral components: the system must provide rewards for the provision of quality care.
• Maine employers are getting involved in quality health care. Besides initiatives at their place of business, they have formed the Maine Health Management Coalition and are beginning to reward providers who can prove that they are providing quality care and posting this data on their internet site.
• A material component of the new Dirigo Health Plan involves quality review and collection of quality data. These actions suggest an increased focus on quality and eventually weighted payment.
• We spend more of our Gross Domestic Product on Health Care than any other nation in the world and yet we cannot prove our quality is any better and some would argue that it is even worse than these other countries.
• How organized is your Quality Effort?

While today the above incentives make up a small percentage of overall reimbursement, if the development pace of these incentives continues it will become difficult for health care providers to compete if they can't manage their data and prove their quality. Proof of quality processes and outcomes will be required for reimbursement, regulatory and community relations goals. Delaying preparations will place practices at a disadvantage.

Healthcare providers must have a plan for:

• Quality Improvement - How will your health care system document outcomes that payers want to see?
• Disease Management - How will you manage your common chronic diseases?
• Data management - Health care providers are deluged with lab tests, reports, and general information. Making sure this information is used to the maximum extent possible is difficult even with an electronic medical record. What is your plan for data management?

Maine Network for Health has invested in solutions to these issues and are committed to helping prepare for future through:

• Quality Improvement Collaboratives based on the Institute for Healthcare Improvement's model
• Negotiated Payer Incentives
• Assist in Data Collection and Analysis for Disease Management
• Development of Communications Infrastructure for Quality Topics and Forum Discussions
• Monitoring and Report on Business Groups Quality Activities such as Maine Health Management Coalition

Collaboratives

By harnessing the collective wisdom of participants and an advisory panel of experts, a Collaborative provides the necessary clinical, technical, and social support needed to help a health care organization make dramatic improvements. Organizations that enroll in a Collaborative must commit to work together intensively during the one year period. This process was developed by the Institute for Healthcare Improvement and is used internationally develop quality changes in health care.

Expert Panels

Prominent clinical leaders serve on an expert panel for review of evidence-based guidelines and to establish goals for the Collaborative. This Collaborative contained experts in Endocrinology, Family Medicine, Diabetes Education, and Employer Health Benefits to list a few. Maine Network for Health staff and other specialists in improvement and organizational change also were available to provide as-needed assistance throughout the Collaborative.

Learning Sessions

Teams attend three Learning Sessions that provide instruction in the theory and practice of improving performance in the specific clinical or operational area of focus. Again, it is a collective team approach where everyone teaches, and everyone learns. Learning Sessions also function as milestones along an organization's path to improvement: At each session, each team reports on its activities, methods, and results surrounding improvement efforts. This sharing provides powerful social support and encouragement for making further changes.

Action Periods

Following each Learning Session, team members implement concepts and ideas acquired at the Learning Session. Action periods are where the real work of the Collaborative is accomplished: Participants face and conquer the tough realities of making change happen. Action Periods are supplemented with frequent conference calls, e-mail "listserv" communications among member organizations, and consultations with experts and colleagues to troubleshoot barriers and suggest ways to overcome them.

For more information about the Collaborative process, contact the Institute for Healthcare Improvement at http://www.ihi.org/collaboratives/

A corner stone in the development of "change options" is based off the Chronic Care Model. More information on this topic can be reached at http://www.improvingchroniccare.org/.

Disease Management

The Maine Network for Health employs nurse care managers who have experience in managing patients from a clinician to patient perspective through to a disease population perspective. Maine Network for Health's nurses are available to assess your patient population and craft interventions that may allow you to improve the statistics that third parties may use to assess your performance (e.g., HEDIS measures).

Quality Initiatives

Maine Network for Health is developing a number of initiatives to help practices meet their quality management goals. These products include:

• Web-Based Disease Registry
• Web available tools and resources
• Discussion Forums on disease specific topics
• Chart review for determination of care pathway characteristics
• Disease and/or topic specific collaboratives
• Monitoring of quality related activities by payor sources
• Support for practice specific quality improvement programs