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V O L . X X I N O. X V I I I H E A LT H Y B U S I N E S S 18 Other stakeholders play a role, too Dr. Mark Fourre, chief medical offi cer at Lincoln County Health, a member of the MaineHealth system, says providers embrace the transformation of Maine's health care system and are doing their share to advance it. In addition to his role at Lincoln County Health, Fourre also is president of Community Physicians of Maine and the Maine Medical Center Physician- Hospital Organization, a network of 1,300 physicians. One MaineHealth initiative with an impressive track record going back several years, he says, is the AH! (Asthma Health) Program, which uses hospi- tal-based educators to support providers in helping asthma patients manage their chronic illness better, including complying with medications and controlling environmental factors (such as household dust) that can aggravate symptoms. e program has dramati- cally reduced asthma-related emergency department visits for both children and adults, improved medi- cation compliance and increased awareness among school nurses, community health workers and other providers about best practices for managing asthma. "It's a wonderful program and it's quite mature," Fourre says. "It delivers all the things you're looking for in the 'Triple Aim' goals of health care." Even more importantly, he says, MaineHealth is following a similar model of using data to shape strategies for improving the health of targeted popu- lation on several other fronts, resulting in measurable improvements. Other initiatives highlighted in its 2014 Health Index report include: ¡ Decreasing preventable hospitalizations by focus- ing on high-quality community-based primary care to manage chronic illnesses such as diabetes, hypertension and angina. ¡ Decreasing obesity by partnering with Harvard Pilgrim Health Care Foundation to expand the Let's Go program promoting healthy eating in schools and other child-care programs. Its two-year HOMEtowns program reached more than 300,000 people in seven rural counties in Maine, likewise promoting healthy eating and physical activity. ¡ Decreasing tobacco use by providing bedside counseling at MaineHealth member hospitals to patients hospitalized with smoking-related illnesses, which resulted in increased referrals to the Maine Tobacco HelpLine. MaineHealth and its partners also expanded community programs to deter young people from smoking as well as smoking cessation programs. Of the latter initiative, Fourre says as an emergency room physician he's learned that the "You should stop smoking" advice he might have given an emphysema patient a few years ago didn't go far enough. Now, recognizing that many smokers need help in quitting, he refers those patients to such programs and follows up with the primary care doctor to make sure there's additional support on that front as well. Shifting to 'value-based insurance design' Nancy Morris, MHMC's director of communi- cations and member services, says MHMC was founded on the premise that in order to have a real impact on health care costs, you needed to align the care providers, the payers and patients in a health care system that makes sure everyone is getting "the right care at the right cost." e challenge in trying to gauge the impact of coalition's work is that the vari- ous stakeholders are in "various degrees of change … [and] not everyone is doing it the same way." MHMC's publication since 2007 of data on quality outcomes, Morris says, has helped to greatly improve the quality of health care in Maine: In the 2014 National Healthcare Quality Report, Maine ranked fourth behind Minnesota, Massachusetts and Wisconsin in the "eff ectiveness, safety, timeliness, patient centeredness, care coordination, effi ciency and adequacy of health system infrastructure." Maine hospitals consistently are ranked the best in the nation for patient safety and quality of care. e coalition's current focus involves what Morris describes as "most comprehensive eff ort in the coun- try" to transform Maine's health care system into a "value-based insurance design" model. With other stakeholders in the Maine State Innovation Model initiative, MHMC is working to shift the incentives in the market away from a "fee-for-service" system based on high-volume, high-cost care to a health benefi t design that provides incentives to consumers who opt for care that is both high quality and low cost. It also creates incentives for health care providers to choose lower-cost care options when a range of equally eff ec- tive approaches to care are available for a given patient. Morris says the goal is to build one standard health plan design, so that whether it's Anthem, Aetna, Cigna, Harvard Pilgrim or Community Health Options pro- viding the coverage, an employer and its employees will "know the rules will be the same." "We need the benefi ts plan to help people pick what's right for them," she says, adding that in some cases it would address "under-use of the right service" and in others "over-use of the wrong service." Kevin Lewis, CEO of the Lewiston-based Community Health Options, welcomes that change. e VBID model is at the core of his nonprofi t health insurance cooperative's approach, refl ected by its reduced out-of-pocket costs to make offi ce visits, medications and equipment less costly and more likely to be used by its insured members with asthma, chronic obstructive pulmonary disease, diabetes and hypertension. It also is supporting tobacco treatment programs at no cost to members when prescribed and works with providers to ensure patients fully under- stand their treatment options, including available lower-cost options of equal or higher quality value. "We're only just beginning in terms of what we can do with the model," Lewis says. "It absolutely is the right way to go." JameS McCartHY, Mainebiz senior writer, can be reached at JmccartHY @ mainebiz.biz and @ JameSMainebiz » C O N T I N U E D F RO M PA G E 1 7 C A S E S T U DY 3 : T H E I N S U R E R Community Health Options PROBLEM: Patients with chronic illnesses such as asthma and diabetes do not always take the medica- tions that can help them achieve optimum health, due to cost barriers for prescriptions. Or they fail to follow the recommendations to better manage or even improve their chronic illness symptoms. Maine has some of the highest rates of asthma in the country, with 10% of Maine adults having asthma (compared to the 7.8% nationally) and 10.7% of chil- dren (compared to 8.9% nationally), according to Maine Center for Disease Control and Prevention. Asthma is the fourth leading cause of missing work. Diabetes is a major cause of heart disease and stroke and is the seventh leading cause of death in Maine. The center estimates that 11.4% of Maine adults have diabetes, with an estimated 3.1% not knowing they have it. Complications can be prevented or reduced for both chronic illnesses through self-management education programs and adherence to prescribed medications. SOLUTION: Community Health Options designed its benefi t plans at all levels to remove cost and self-management barriers for asthma, diabetes and other chronic illnesses such as chronic obstructive pulmonary disease. Preventive care and disease management are at the core of CHO's benefit designs, says CEO Kevin Lewis. Accordingly, medications used to treat asthma, diabetes and COPD that are on the insurer's list of medicines covered under all CHO plans and approved by the FDA are available at $0 cost-sharing for generics and 50% reduction in cost-sharing for preferred brands. To help prevent certain chronic conditions and illnesses from getting worse, CHO also offers a "preventive drug benefi t" that's designed to reduce high costs associated with treating long-term chronic conditions. CHO makes selected preventive drugs available to eligible members without fi rst having to meet plan deductibles for prescriptions. Asthma/COPD-related services that are covered with $0 cost sharing when performed by a plan pro- vider include offi ce visits to a primary care physician for routine management of the illness and a yearly pulmonary function test. Diabetes benefi ts include nutritional counseling, education, behavioral modifi - cation counseling and an annual diabetic eye exam with a plan provider with $0 cost sharing. BENEFIT: Improved patient self-management skills through education and consultations with provid- ers, as well as improved adherence to prescribed medications. Since CHO is only in its second year of provid- ing health insurance coverage through Maine's Affordable Care Act Marketplace, the insurer doesn't have comparative data to demonstrate the effec- tiveness of its initiatives compared to pre-coverage statistics for its customers. Anecdotally, however, Lewis says numerous customers have expressed thanks for being able to better manage their chronic illnesses without worrying about the cost. 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