🔒As access to health care becomes more limited, collaboration is key

Maine, with its far-flung largely rural population and the challenges that brings, has always had a tradition of collaboration when it comes to health care services.

But changes in the economy, health care policy, care reimbursement, combined with the state's aging population, has brought that collaboration to a new level, and health care systems are rewriting the strategy on how to better care for patients and still stay in business.

The move to join forces is “heating up,” says M. Michelle Hood, president and CEO of Eastern Maine Healthcare Services. Given the challenges, health care “has to be innovative to reach people where they are.”

Mark Fourre, CEO of MaineHealth's Pen Bay Medical Center and Waldo County Hospital, says much collaboration rises from finding ways to provide the best care while keeping rising costs in check. “As any business owner and our government will tell you, we can't keep putting the amount of money into health care that we are if we want to maintain a healthy economy.”

That impact is also felt by the state's much smaller health care providers, says Charles Dwyer, of the Maine Health Access Foundation.

The makeup of Maine's small, remote communities have always been “a delicate ecosystem” for health care, says Dwyer. That balance has tipped in recent years with mill closings, health policy upheaval, technology changes and other factors.

MeHAF is urging communities to ask, “How might a system that's more integrated benefit not only the population's health, but the economic strength of that community?” Dwyer says. The foundation gave $240,000 to five programs in January to help rural health care systems work out plans access and sustainability.

While MeHAF's focus is on rural systems, Dwyer says the push to collaborate is felt statewide.

“It's essential for organizations in urban areas as well as rural, large ones as well as small ones,” he says.

'Out of necessity'

The many issues that are affecting health care are behind two major MaineHealth collaborative efforts this year.

In July, the state's largest health care system announced that a $10 million grant from the Alfond Foundation will fund the MaineHealth Cancer Care Network, a collaboration with a number of Maine providers and Dana-Farber Cancer Institute in Boston.

At the same time, the system is working to unify its 12 hospitals and providers under a single governing system and budget.

The two moves are different types of collaboration, yet are driven by some of the same forces — rising costs, changes in how patients access medical care, systemic changes.

Fourre says the leading cause of errors in medicine is a breakdown of communication. The cancer network improves communication between different elements of care, which are often found at different sites. Among the features, it will allow patients to communicate with providers via video, and they'll be provided a “navigator,” who will help them understand and coordinate care.

One aim of the program is to allow patients to stay close to home when possible, but still have access to state-of-the-art treatment they may not otherwise have had.

Since most small hospitals no longer provide the services and procedures patients need, the network builds connections and gives them better access to those services, Fourre says.

The 18,000-employee network's unification move is an administrative collaboration, driven by changes in health care reimbursement and the health care economy. While there is concern about loss of local control, it's getting harder for many of the network's hospitals to survive financially with separate governing boards and budgets, Fourre says.

A unified system, which must be approved by the boards of the member hospitals, would allow revenues to be spread better across the system and resources to be used more efficiently, he says.

Maine Medical Center, with its 600 beds, can scale its expenses. But 65-bed Franklin Memorial Hospital in Farmington, which merged with MaineHealth three years ago, doesn't have that economy of scale. It doesn't offer many of the services that provide revenue for larger hospitals. Smaller hospitals, those with 25 beds or less, can be designated critical access and be eligible for federal grants, but Franklin Memorial is too large.

“It's in the middle,” says Fourre. “With hospitals like Franklin Memorial and [99-bed] Pen Bay, what do you do?”

“It's pretty much impossible for a small hospital to stand alone, or even a big one,” Fourre says. “Hospitals are coming together out of necessity.”

'There's a ripple effect'

At the other end of the spectrum, but affected by the same issues, are the recipients of Maine Health Access Network's Rural Health Innovation grants.

Lincoln's Health Access Network, Mayo Regional Hospital in Dover-Foxcroft, and Pines Health Services in Caribou received $30,000 catalyst grants. Central Maine Healthcare in Lewiston and Healthy Acadia in Ellsworth and Machias got $75,000 acceleration grants in the first round.

The grants are “focused on how systems might transition to serve the community and create more sustainable health care,” Dwyer, a program officer for MeHAF, says.

The smaller grants are designed to promote discussion, look at needs and develop a plan. The second-year grants help fund pilot programs. The ultimate goal is for groups to find sustainable approaches to health care access that will weather changes in the industry and the economy.

MeHAF's effort is just one element in the movement to strengthen Maine's rural health care partnerships. Two years ago, 10 hospitals in the state's poorest counties were awarded an $848,000 grant for a three-year pilot Rural Health Innovation Network.

The program, administered by Cary Medical Center in Caribou, includes Fort Kent's Northern Maine Medical Center, Houlton Regional Hospital, Millinocket Regional Hospital, St. Joseph Hospital in Bangor, Penobscot Valley Hospital in Lincoln, Mount Desert Island Hospital in Bar Harbor, Mayo, Calais Regional Hospital and Down East Community Hospital in Machias.

Links between rural health care providers in Maine go back far, but are being enhanced through the push for partnerships, and many have multiple connections. Pines Health Care, a network of providers throughout Downeast and Aroostook County, is connected to Cary. EMHS has forged a partnership with Mayo.

Dwyer says the need for innovation is particularly acute in Maine's rural areas.

When a major employer closes or there's a major health care policy change, “a ripple effect takes place across every sector,” Dwyer says.

Those ripples affect a community's health care, particularly access. Many of the state's smaller hospitals have lost doctors, stopped providing certain procedures or services, or closed.

“How to you maintain a hospital in an area where there's no major employer?” Dwyer says. “How do you do it when much of the population is on Medicare or Medicaid, or lacks insurance?”

And the other side of the coin: “How do you get employers to locate a business in an area with no hospital?”

Encouraging more connections

Those on the forefront of health care partnerships agree that the state's' tradition of collaboration has helped as the culture of health care changes.

“There's a long history of collaboration, and I think we'll see it continue,” Dwyer says.

Hood, of EMHS, says that successful partnerships must also include education, the government and business. There's still a long way to go with the state government “and it's hard to get traction with the cycle of elections,” she says. It's also difficult getting some commercial payers on board, but their involvement is crucial, she says.

Bangor's 400-plus bed Eastern Maine Medical Center is part of Brewer-based EMHS, as are a dozen other health care facilities stretching from Presque Isle to Mercy Hospital in Portland. The system employs 11,000 and serves a quarter of the state's population, including many who are on Medicare or Medicaid or who lack insurance.

For collaboration to work, “we can't have people who are on different pages, or have different goals,” Hood says.

“We're going to be in a period of tremendous change for the foreseeable future,” Hood says. “We should just anticipate it's going to look different, and be open to new structures, new partnerships and new players.”