Close to 44,000 state employees and their family members covered by the state’s health plan are being encouraged to go to one of 13 so-called “preferred” hospitals in Maine with the promise that part of their $200 health insurance deductible could be waived.
The preferred list of 13 out of 39 hospitals in Maine was compiled by the State Employee Health Commission based on quality measurements, including voluntary surveys that some hospitals simply never filled out.
The list includes Bridgton Hospital; Cary Medical Center; Central Maine Medical Center; Eastern Maine Medical Center; Maine General Medical Center; Maine Medical Center; Mayo Regional Hospital; Mercy Hospital; Mid Coast Hospital; Miles Memorial Hospital; Southern Maine Medical Center; Stephens Memorial Hospital; and, York Hospital.
Other hospitals will have a chance to improve their ratings when a new list is issued in January, and there is talk that a few more hospitals will be added to the preferred list before the deductible incentive takes effect on July 1.
“Our goal is to have them all tier-one hospitals eventually,” said Brett Hoskins, the co-chairman of the State Employee Health Commission. The commission represents labor and management in decisions affecting health coverage for employees working in state government, the courts, the Community College System, the Turnpike Authority and even legislators. There are 44,000 people covered under the state plan, which includes employees, retirees and their families.
State employees are not mandated to go to “preferred” hospitals, Hoskins said, because state law “prevents us from saying you have to go to this hospital or that hospital or this doctor or that doctor.” And, procedures are covered at all Maine hospitals in the same way they were before.
While the law prohibits a financial penalty to force patient behavior, it does allow financial incentives, although in this case Hoskins said it won’t amount to much.
“In all of the meetings were having with folks, we’re downplaying the deductible piece,” Hoskins said, because it only applies to hospital visits. Most will end up paying it at their doctor’s office long before they get to the hospital.
“It’s a slight incentive in some cases where people might save a few dollars,” he said, but the real issue is an “awareness campaign.”
That awareness worries the Maine Hospital Association because the packets going home with state employees lists the so-called first-tier hospitals.
“It is certainly going to influence health care decision-making, and it certainly carries a stigma if you’re not one of the preferred hospitals,” said Mary Mayhew of the hospital association. “We have supported efforts to encourage quality,” she said, but “want to make sure it is done as thoughtfully as possible.”
Sen. Richard Nass, R-York County, said the deductible incentive was “pretty mild,” but he worried “this is the first step in more state control of the hospitals and control of their costs.”
The criteria used is a combination of measurements used by three groups: the Maine Health Management Coalition, which includes some large employers like the University System, BIW, Hannaford, and organizations representing state and local employees, along with some hospitals and insurers; The Leapfrog Group, which rates hospitals nationwide; and, the national Centers for Medicare and Medicaid.
The Maine Health Management Coalition rated hospitals based on their answers to a survey on the safe use of medicines; Leapfrog’s rating was based solely on whether the hospital completed a safe practices survey; and, CMS data was used on clinical outcomes for acute coronary syndrome, heart failure and pneumonia.
The voluntary Leapfrog survey is 100 pages long, Mayhew said, and according to information provided by the state employee commission, 18 hospitals simply didn’t complete it. Another six failed to fill out the health management coalition survey.
Meetings to explain the tiered hospital rating to health plan members started in April and are going on through May across the state.
Hoskins said the State Employee Health Commission has been working for three or four years to change the way health care is received. “What we want to pay for is quality of health care versus quantity,” he said.
Trish Riley, the head of the governor’s office of Health Policy and Finance, said the initiative did not come from the administration, but rather is part of a movement catching on nationwide to make employees smarter consumers of health care.
“It was a choice,” made by the commission that manages the state employee benefit plan, Riley said.
Frank Johnson, director of employee health and benefits for the state, said the initiative has its roots back in 2000 or 2001. “We changed the way we purchased health care,” he said, and “started looking beyond chasing discounts,” and instead at quality and value.
He said the State Employee Health Commission was the first Maine-based firm to join the Leapfrog initiative, which tracks hospital quality nationwide.
Johnson said he has heard from hospitals not on the preferred list and fully expects that list to double by January, now that administrators understand the importance of filling out the quality surveys.
He confirmed that several hospitals could be added to the list even before the benefit takes effect in July, based on some updated information from CMS.
“We would be pleased if virtually every hospital was on that list,” Johnson said, because the intent is to encourage quality.
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