The state has mandated data collection, eased into quality measurement, and made everything public.
Sparsely populated and not far from the medical mecca of Massachusetts, Maine is faced with many of the same health delivery challenges as other states. It is home to urban health systems and remote rural hospitals, all adapting to the value-based payment era.
The political battle over expanding Medicaid is raging, and so is the fight against the deadly opioid epidemic.
Yet according to the Leapfrog Group, a good percentage of the state's hospitals earn an "A" for quality—enough to make Maine the top state in the Leapfrog Group's hospital quality rankings this year.
Does the Pine Tree State have a quality blueprint it can share with other states? Not exactly. The well-established Leapfrog Group is just one many health quality measures, and no two states or ranking systems are alike.
For example, while still above the national average, Maine dropped from the No. 9 spot to No.15 in The Commonwealth Fund's 2017 "Scorecard on State Health System Performance."
Still Maine seems to have made some moves over the years that allowed it to ease into in the era of mega-measurement.
For one thing, the state began wrestling with quality measures more than a decade ago. In 2005, the state employee health plan began rewarding high quality hospitals by offering incentives to patients who used them. In order to do that, Maine had to put a system in place to measure quality.
Michael DeLorenzo is the chief operating office of the Maine Health Management Coalition (MHMC), an employer-led group. The organization was able to do that by deliberately engaging both providers and purchasers in the identification and development of quality measures.
"We don't think it is more complex than that," he said.
Other players include Maine Quality Forum, a state agency, and Maine Quality Counts, a non-profit that works to "implement practical health care quality solutions."
The National Academy for State Health Policy, in a 2010 report, identified five "key components" of successful state plans to improve quality. Here's how Mainers have put them in action.
1. Data Collection and Aggregation
Since 2003, the Maine Health Data Organization, a state agency, has collected claims data from commercial insurance carriers, third party administrators, pharmacy benefit managers, dental benefit administrators, Medicaid and Medicare.
The all-payer data is available to the public with the goal of providing a "useful, objective, reliable, and comprehensive health information database that is used to improve the health of Maine citizens."
The agency's website includes a long list of studies generated with the data. One recent analysis found "mixed results" in terms of cost, quality and utilization for the first two years of the state's medical homes program.
2. Public Reporting
The "Get Better Maine" website invites patients to "Learn which hospitals have the highest quality of care" through a patient portal sponsored by the Maine Health Management Coalition's Pathways to Excellence reporting program.
A state-mandated site called "Compare Maine" allows patients to compare the cost and quality of procedures at different facilities. Users can compare the average cost of more than 240 procedures at 150 healthcare facilities, along with a few quality data points.
For example, an entry on a screening colonoscopy shows an average cost of $3,800 in one hospital and $850 in another.
3. Payment Reform
The Commonwealth Fund, among others, cites the changes at the Maine Employee Health & Benefits program as one of the state's successful quality innovation.
In 2005, the insurer for 40,000 state employees and dependents began work on tiered provider networks and tiered benefits that adjust payments based on the quality and efficiency of care."
In addition, the state was part of the Patient-Centered Medical Home Pilot in 2010 and providers across the state have formed affordable care organizations.
4. Consumer Engagement
While policy makers and providers have been promoting the use of health data by consumers, Maine activists are also involved in promoting the expansion and quality of care.
More that 64,000 of them signed a petition that will put Medicaid expansion on the ballot in November. Maine's governor has repeatedly vetoed legislation supporting the added benefits.
In addition to Mainers for Health Care, Consumers for Affordable Health Care runs a hot-line to help people find coverage and a website with quality links. The Get Better Maine site includes a page with resources: "What to Do If You Have a Concern about Quality in a Maine Hospital."
5. Provider Engagement
The PTE (Pathways to Excellence) Steering Committees convened by the MHMC offers a forum for providers to help with the formation and refinement of the state's set of quality measures, CEO DeLorenzo said.
The group includes "leading primary care and specialty clinicians, quality improvement professionals, employers/purchasers, health plan and consumers," according to the MHMC site. When the group was unable to find the appropriate measures from national programs, it developed their own.
In its 2015 report on transforming health care, the Maine Hospital Association cited several other factors in the effort to improve care, including Maine Health Infonet, the statewide medical records system, and the formation of ACOs.
The MHA also convenes its own "Quality Council," a panel of 20 member hospitals that "analyze healthcare quality and patient safety issues."
Tinker Ready is a contributing writer at HealthLeaders Media.