Maine Development Foundation

Leadership Maine

Theta Class

 

Searching for a Healthy Maine

 

As reported by:

Jim Amaral

Spike Enck

Brenda Harvey

Tracy Hawkins

Roy Hitchings

Gary Knight

Larry LaPlante

Bill Schneider

 

Searching for a Healthy Maine

 

The “Health care Crisis” is with us again. The financial difficulties plaguing the major health providers, rapidly rising health insurance costs, the chronic problem of the uninsured, and drug prices have all come back as major public issues. Commissions have been established, laws passed, and concern expressed by all leaders, but does anyone have a clear sense of what needs to be done to provide a “healthy Maine?” If so, who has such a vision? Are there competing visions? How do the competing visions differ, and what are the implications of such competing visions for the possibility of leadership to address the health care crisis? What kind of leadership will be needed in order to address these issues? Wrestling with the answers, state and federal governments, providers, payers, businesses, and consumers have not as yet provided the leadership or the vision to provide solutions to the issues at hand.

 

However, all is not lost, since out of the talent and leadership in the Theta class, there is a cross section of professionals who welcomed the challenge “Searching for a Healthy Maine”. Jim Amaral, Spike Enck, Tracy Hawkins, Brenda Harvey, Roy Hitchings, Gary Knight, Larry LaPlante, and Bill Schneider accepted the task at hand. After all, if a hospital CEO, CFO, past and present Trustees, a business leader, banker specializing in health care, Department of Mental Health Director, and renowned State Representative, who else could.

 

Being a task-oriented group, our first challenge was to develop a team charter. We agreed to assign a facilitator for each of our sessions, treat each other with respect, listen, accommodate to the extent possible, limitations created by time and extended geography, allowing flexibility in meeting goals but hold each other accountable, and having fun (eat good bread) in the words of Jim.

 

In November, the report of the “Year 2000 Blue Ribbon Commission on Health Care” was completed. Knowing that timing is everything, our team chose to use this report as the centerpiece of our report. It was agreed that our project would not focus on specific solutions to the health care issues, but understand the players in the process in order to recommend the next steps for using the report. Smart move on our part considering specific solutions still elude the greatest minds in our country.

We established the following goal for the project:

 

To recommend to key stakeholders (users, payers, and providers) the next steps for using the Blue Ribbon Task Force report as a catalyst for change and improvement, leading to accessible and affordable health care for all Mainers.

 

Our next step was to select key players in the Blue Ribbon Commission process to interview. The list was expanded to include legislators, insurance executives, and business leaders. The questions focused on the strengths and limitations of the report and the process of creating it, how the report can be used to foster more accessible and affordable health care, and what are the major issues.

 

As we looked back on the process using plus Delta, it was very apparent that our team kept to our original charter of treating each other with respect and accommodating to the extent possible, knowing our limitations created by time and extended geography. We did have fun and ate good bread thanks to our fellow team member Jim. On the Delta side, we looked back at the process and realized we had spent too much time on the report itself rather than what should have been the use of the report. The impact on our real lives to get the project done may be reflective of why solutions to the health care crisis have not been forthcoming. Collectively, we feel that there has been no effective mechanism to bring the stakeholders together.   

 

It is the top of the hour and I ask you to listen to Bill and Jim, AKA, Ree and Co, Maines Peripatetic Reporters, bring you some things reconsidered or is it all things preconsidered. Well, I will let you decide for yourself.

MPR

(Maine’s Peripatetic Reporters)

 

Bring You

 

All Things Preconsidered

 

 

Ree:  Hi this is Ree Porter,

 

Co:  And I am Co Host.

 

Co:  And welcome to All Things Preconsidered, an occasional presentation of news and commentary, brought to you by MPR, that’s “Maine’s Peripatetic Reporters” of the Leadership Maine Theta Class.

 

Ree:  We have a great newscast for you folks today.

 

Co:  Do you realize, Ree, that there is absolutely no news today!

 

Ree:   That’s amazing, Co.   You know what they say, though: “no news is good news!”  Co, though our viewers may not realize it, you and I have been participating in the Leadership Maine Program for the past year, and today we are going to bring our audience a special investigative report on “The Year 2000 Blue Ribbon Commission on Health Care,” and the healthcare landscape in Maine after the Commission’s report.

 

Co:  Today’s report is brought to you by a crack team of “Leadership Maine” reporters who, though they lack any significant newsgathering experience to speak of, and go by names like “Spike” and “Steg,” have traveled far and wide to bring you this story.

 

Ree:  We employed the Governor’s “Report of the Year 2000 Blue Ribbon Commission on Health Care” as a lens to examine the “leadership landscape” in Maine with respect to health care issues.  That lens, sometimes telescopic, sometimes microscopic, was brought into focus through a number of interviews conducted by our intrepid team.  First, let’s turn to the geography of the health care crisis.  It is as daunting and dramatic a place as our fellow explorers Peary and MacMillan ever cast their eyes upon. 

 

Co:  Fortunately our fellow team members were able to call on the map reading and orienteering skills acquired at Outward Bound in the fall of 2000 to navigate this treacherous topography.

 

Ree:  While the scope of this report is neither technical nor exhaustive in nature, we offer a few facts and observations from the “Year 2000 Blue Ribbon Commission on Health Care” to illustrate the lay of the land.

 

 

 

Co:   Health Care may be the most complex and pervasive domestic issue that faces Maine and the country as a whole.  In an era of increasing financial pressures on the health care systems in the state, the Governor appointed a panel of people who had few preconceptions about Maine’s health care systems to look at the approaches to providing and paying for heath care services in the state.  This was the Blue Ribbon Commission.  They held public hearings to receive input from many of the players, and produced a report.

 

Ree:  Maine spends a large amount of money on health care.  Mainers’ personal health care expenditures in 1999 were estimated at 4.7 billion dollars.  In 2010 that figure is expected to reach 9 billion dollars.  To put those numbers in perspective, Maine’s entire general fund budget expenditure is now about 2.5 billion dollars a year.  These facts play an enormous role in how health care is provided and financed.  Federal Medicare and Medicaid coverage provide health care insurance for nearly one in three Maine residents. That population accounted for more than one-half of the 1999 health care expenditures in Maine.

 

Ree:   Much of the difficulty our health care system faces is reflected in the uninsured population.  Maine has the highest percentage of uninsured people in New England.  Health insurance is also getting more difficult to find, even for willing payers, as several major insurers have pulled out of the Maine market.  One of the primary sources of insurance for Mainers, and indeed for people across the nation, is through their employers. 

 

Co:  The employer-based system of health care insurance is under tremendous pressure and may be at risk of failing.  Employers have seen their health insurance costs increase by 20%, 30%, or 40% per year for the last several years, with no letup in sight.  Nearly 60% of Mainers have some or all of their personal health expenditures covered through an employer-based insurance program.

 

Ree:  As our team traipsed the length and breadth of Maine researching and developing this story, we noted four distinct ecological niches into which the participants in Maine’s health care crisis fell:

 

Consumers of Health Care

 

Health Care Providers

 

Financers of Health Care

 

Policy Makers

Co:  Given the size of annual health care expenditures in Maine, it came as no surprise that there has evolved a complex web of competing constituencies in the field that even Darwin would have found fascinating.  Team members observed the following populations within each niche:

 

Within Consumers of Health Care are:

                        Individuals             

                        Employers (including local and state governments)

 

Among Health Care providers:

                        Independent Medical Practitioners (traditional and non-traditional)

                        Hospitals

                        Long Term Care Facilities

                        Mental Health Facilities      

                        HMO’s

 

Within the category of Financers of Health Care are included:

 

                        Individuals

                        Employers

                        Insurance Companies

                        Federal Government

                        State Government

                        Taxpayers

                        HMO’s

 

Policy Makers include:

Officials of the Federal Government

Members of the Executive Branch of State Government (including the Governor)

State legislators

                        Policy Think Tanks

                        Advocacy groups and Coalitions

                        Lobbyists

 

Ree:  These populations co-exist within a complex web of relationships, and members of one population often belong to one or more of the other populations in other niches.

 

Co:  Our interviews with members of these populations focused on their perceptions and responses to the Governor’s “Year 2000 Blue Ribbon Commission on Health Care.”

Team members interviewed the following individuals, chosen for interviews because of their potential to offer us insights on the Commission’s work and the health care landscape in Maine: 

 

Andy Coburn USM, Muskie School of Public Policy

Catherine Longley     Commissioner, Dept. of Professional & Financial regulation

Steve Michaud           President, Maine Hospital Association

Dana Connors            President, Maine Chamber & Business Alliance

Joe Ditre                    Executive Director, Maine Consumers for Affordable Healthcare

Craig Freshley           Maine Development Foundation

Dan Fishbein              General Manager, Aetna-US Healthcare General Manager

Richard Bennett         Senator, Maine Senate President Pro Temp

Jud Dolphin                State Director, Maine Chapter AARP

Joe Bruno                   Representative, Maine House Republican Leader

Gordon Smith, Esq.   Executive Vice President, Maine Medical Association

Sharon Roberts          Vice President for Membership, Anthem Blue Cross

Brian Bowman           Owner, Bowman Brothers, Theta Class, Leadership Maine

 

Ree:  There were a number of general observations about the Governor’s “Year 2000 Blue Ribbon Commission on Health Care.”  Comments included the following:

 

“Seemed to cover all the bases”

“Does assist in focusing the debate”

 “Was a good first step”

“Offered some suggestions but no clear directions”

“Comprehensive and a good starting point”

“Good start - cost profiling should be done on an annual basis.”

 

Co:  And now for the weather . . .

 

Co:  We have a live report available to us now from crack reporter Jimmy Olson.  He’s somewhere in a small town in Maine listening to an important conversation.  Jimmy, are you there?

Scene: Mary (M) and Bart (B) live with their four children in their small home in Anytown, Maine. Bart has two part-time jobs in the “mill”, which provides health care coverage for him, and the “ store”, with no benefits.

 

            The children are covered under Medicaid’s Cub Care program, and are healthy due to Mary’s diligence.

            Mary was employed part-time (fifteen hours a week) as a school secretary, until last year. Mary is not insured and does not qualify for Medicaid coverage.  About a year ago after experiencing chest pains, Mary finally scheduled an appointment with her doctor, who prescribed heart and thyroid medication costing  $50 per month. With Mary not working and with the new prescription, the family budget is extremely tight. There is no excess funds for unanticipated expenditures. Recently, her Doctor confirmed Mary’s worst fears that she has a lump in one breast. In discussing options with Mary, her doctor estimated the cost to remove this lump at about $8,000-10,000 through outpatient surgery, but this cost would increase if the mass become larger and may require a hospital stay. Her doctor prescribed a follow-up mammogram, which Mary has delayed since the children needed new spring jackets. This morning, while doing self-examination of her other breast, Mary felt a mass that is similar to the mass in the first breast. All day, Mary has worried about this latest discovery and several times thought about calling her doctor, but worried about the cost of another visit and the unpaid bills at the doctor’s office and the hospital.

         It is now 9 PM and the kids are in bed, and Mary waits for Bart to return from his shift at the store. With the kids home from school, Mary has kept busy with their stories of the day and homemaker chores. As she waits for her tired husband to return from his twelve-hour workday, her fears return. Bart walks in the room and finds a tense Mary sitting in a chair.

 

B:  Hi Dear! What’ wrong?

M:  Nothing! How was your day?

B:  I know something is wrong. Are the kids OK?

 

M:  The kids are all fine and had a wonderful day at school. I think I have another lump in my other breast and I am really afraid.

 

B:  Oh No! I thought you were going to have that checked.

 

M:  That was my other breast and I have not been able to schedule the mammogram.

 

B:  I thought we talked about that, and you promised me that you were going to have that done as soon as possible. What happened?

 

M:  Bart, we do not have the money. We still owe $1,000 in doctor and hospital bills and every month it is harder and harder to find the $50 for my medicine.

 

B:  But Mary, it’s your health. How much did your Doctor say it would cost for the removal of the lump?

 

M:  About $8-10,000, but where are we going to find the money?

 

B:  We will find away!  If the car hadn’t died two years ago, you could have been covered under my plan!

 

M:  At the time, I was feeling fine and our old car was costing so much to operate. You know we couldn’t afford the car payment and the  $100 monthly insurance payment.

 

B:  Yes, but the plan would have covered the cost of these procedures and regular physicals. Until you had your chest pains, how long had it been since you saw your doctor for a physical?

 

M:  About three years.

 

B:  The plan covers physicals. Remember, the family nurse practitioner that did my physical was concerned about my blood pressure and I cut back on salt, quit smoking and exercised more. It did make a difference.

 

M:  Thank goodness, the kids and you have coverage. Can I join the plan now?

 

B:  I checked on that at the mill.  Since you have not been covered and have medical problems now, these so-called preexisting conditions are not covered in the first year. I don’t think we can wait a year. The person I talked asked about Medicaid coverage.  I told her that we checked on that as well and you are not eligible.

 

M:  I am so worried! All of the time on TV, you hear about all the great medical advances saving peoples’ lives. I guess you can get this care if you have insurance or can afford it. The other day when I was in my Doctor’s office, I was talking to a lady who recently had surgery to remove lumps from her breast. She mentioned a Bear Care program. What are we going to do?

 

B:  Tomorrow, I want you to call the doctor and schedule an appointment. We need to take care of these problems and soon. In the mean time, I am going to call the hospital and see if we can work out some payment terms. I’ll ask about this Bear Care program. One of the customers at the store told me about his nephew who broke his leg and couldn’t pay.  A hospital worker met with him and told him he qualified for charity care and would not have to pay. I need to ask about the qualifications for charity care. I am also going to call my cousin.

 

M:  We have never asked for help before. Are you calling your cousin, the LAWYER?

 

B:  Yes, the lawyer. He may be able to suggest some other options. We may have to consider bankruptcy.

 

M:  Not that. We have talked about that. What will our parents think? Our friends and neighbors?

 

B:  We have worked hard and done our best, but we have to take care of your health problems. I know in the past we both have been too proud to look at this, but if we have to file, we have to.  The kids and I need you healthy and happy.

 

M:  I am really scared that it’s too late.

 

B:  I know! Let’s hope for the best.

 

Co:  Thanks, Jimmy; that was quite a sobering report.  Where does that leave us, Ree?

 

Ree:  Well, Co, that leaves us in a position to draw some conclusions.

 

First, we can draw some conclusions about our Leadership Maine group’s performance in completing this project.  The GRPI model, with which we may assess our Goals, Roles, Procedures, and Interpersonal interactions, would serve us well in this regard.  Our goals underwent some necessary evolution as we progressed through the project.  Some of the evolution of our goals was necessitated by time constraints on our members, and some was the product of the information we gathered through our research.  Our roles were fairly well-designed and equally distributed, in that each member of our group had an important part to play, in fact, sometimes we all had the same part to play, at each stage of the project.  Our procedures had definite strengths and weaknesses.  We did a fairly good job of staying in communication with each other despite geographic and time constraints.  We did not do as well at meeting our own deadlines for project work.  Whether the problem was with the deadlines themselves or our difficulty in meeting them, that is certainly something to remember.  As far as interpersonal interactions are concerned, that was probably the high point of our project team’s performance.  We set a realistic team charter at our first meeting, and we stuck with it.  I can honestly say, Co, that working with the other members of our project team has been the real highlight of the entire Leadership Maine program, don’t you agree?

 

Co:  I certainly do, Ree!  I suspect that I’ve made a new group of lifelong friends among our project team!  Now, what conclusions did we reach regarding the process that will be necessary for solving Maine’s health care dilemma?

 

Co:  And now it is time to hear the weather report from Stormy Hitchings.

 

 

 

 

 

 

 

 

            Thanks, Ree and Co.  This is Stormy Hitchings, your politically incorrect weatherman.

The weather forecast for the state of Maine is certainly uncertain based on our tracking of national and state patterns.  Things could either be stormy, foggy or even sunny depending upon the leadership shown by various constituencies in the state.

 

            As you know, weather forecasts are hard, complicated and complex.  They are based on everything from “how’s my arthritic knee feeling?” to sophisticated computer modelings.  However, we all know that in order to make an accurate forecast you need a clear vision.  So, with that in mind, here’s our vision of what’s needed for an improved healthcare system in Maine.  It would have the following components:

1.      Universal coverage.  Everyone’s covered, but not necessarily by just one payer. Universal coverage is a combination of employment-based and government programs.  All citizens are provided a basic minimum level of health insurance with the ability to buy up if they so chose.

2.      Relatively stable costs.  Healthcare inflation equal to the general CPI.

3.      Healthcare system that is easy to access and simpler to navigate for the patient/consumer.

4.      Medical decisions are need and clinically driven, not financially driven.

5.      “Evidence-based medicine” is utilized throughout Maine.  It’s the most effective medicine; it’s widely accepted and uniformly provided.

6.      Maine has a statewide health policy council that:  develops a statewide health plan and policies for legislative funding; allocates technology and resources based on population needs (not market needs); and advocates increased funding for prevention and wellness.

These, then, are the elements of a vision for improved healthcare.  My hope is that the weather is sunny and clear, and that leaders in Maine can use this vision to create a better healthcare system for all Mainers.

 

Co and Ree, I would like to close with a quote from one of my heroes, C. Everett Koop, M.D., former Surgeon General of the Unites States.  Dr. Koop said a number of years ago, and I quote, “What all Americans want from their healthcare system is immediate access to high quality care at a reasonable cost.  And the problem is you can only get two out of three.”

 

That’s it from the weather desk.  Back to you, Co and Ree.

 

 

Ree:  From our fairly brief involvement in this project, we have determined that efficiently providing access to affordable, high-quality health care for every person in Maine is one of the most difficult and important issues facing our society today.  Each participant in the health care issue (consumers, providers, financers, and policy makers) plays a major role in both creating the issues and eventually solving them.  One of our main conclusions is that there does not seem to be a single individual or organization that has both a clear vision of the solution to the health care problem, and the ability to provide significant leadership in implementing that solution.  There is something of a leadership vacuum in Maine’s health care arena, and the existence of that vacuum was not ameliorated, it was made more obvious by the report of the “Blue Ribbon Commission.”  The Commission report was well done in some respects, and not so well done in others.  It did a tremendous job of assembling data and information that had been completely unavailable until the Commission’s work.  It seems clear that the eventual solution of the Health Care problem in Maine will rely significantly on good data and information, and its efficient dissemination to a wide audience.  The report’s weaknesses were largely in its inability to settle on a clear vision for the future. 

 

One interesting consideration we have noted is that which sector of the interested parties provides leadership on the issue will be important to the eventual solution to the problem.  There is considerable disagreement about whether the greatest changes in the area of health care will be required of the government, providers of health care, financers, or even consumers of health care.  It is likely that the segment of the population that is providing leadership on the issue will have a profound effect on the type of solution that will take effect.

 

The issue is so large and intractable that it seems unlikely that any single individual can provide the necessary leadership towards the eventual goal.  That kind of vision and leadership will come from experts in the many fields intertwined in this issue.  It will be important that they are able to “think outside the box,” and are relatively unconstrained.  They must be able to float an idea, and then go back to the drawing board, undeterred, if it sinks, and be prepared to do that time after time until one rises to the top.  It cannot be an overly exclusive group, either, because it will be essential that all of the parties affected be taken into consideration.  These men and women will be the architects and engineers of the solution to Maine’s health care crisis.  This is the leadership landscape in the wake of the “Year 2000 Blue Ribbon Commission on Health Care,” and it is certainly a hopeful one.  I am hopeful that a solution will be crafted. 

 

Well, Co, do you have any other good news for us tonight?

 

Co:  We are happy to conclude this report with the good news that none of the team’s members were injured nor suffered any negative health consequences from their efforts to compile this report and did not in so doing, in any way, contribute to the ongoing health care crisis.  On behalf of all of us here at MPR’s All Things Preconsidered, we wish you good health and a good night!  Good night, Ree.

Ree:  Good night, Co.