🔒Fixing health care | Lisa Letourneau, Maine Quality Counts

As an emergency physician, Lisa Letourneau became adept at quickly assessing a situation, setting a course of treatment and bringing in other medical professionals to get the job done. Now, as executive director of the nonprofit Maine Quality Counts, she's doing triage on a different kind of patient — the state's health care system.

"I think that's why I'm drawn to it, the problem-solving aspect of it," she says of her emergency work. It also holds true for her work at Maine Quality Counts, where she's earned a reputation for tackling problems in a focused and analytical way, and knowing all the right people to tap to get the best results.

And though she doesn't work in an emergency room anymore, Letourneau is still helping patients, albeit in a little more removed way. In 2006, she helped turn a statewide conference on health care quality into a nonprofit with a $1.6 million annual budget and 10 employees. Its more than 80 members include health care organizations, primary care practices, hospitals and payers, all of which are dedicated to finding ways to change how health care is delivered and paid for in Maine, with patients at the core. She's served as executive director since 2008.

The key to boosting the quality of health care, says Letourneau, is systematizing processes. Doctors, she says, "aren't used to thinking about that — they're focused on treating the person in front of them." And while they may be able to say how they've helped a specific patient with diabetes lower her blood sugar, they haven't always looked at what kind of continuing education a diabetic person might need, or how they're improving diabetic care for all their patients.

Maine Quality Counts is helping practices find out "who their population is and how they're coordinating their care over time — who hasn't come in, and who's the most sick and what are they doing to coordinate their care," say Letourneau. "We're really changing the culture."

It does that through a variety of programs, including Aligning Forces for Quality, a national initiative funded by the Robert Wood Johnson Foundation. Maine is one of 16 communities participating in the program, whose mission is to "align efforts in communities to drive health care quality," says Letourneau. Many of the participating communities are large metro areas; Maine is one of three states (Minnesota and Wisconsin are the others). The program encourages the measuring and public reporting of quality data, and works to reduce disparities in health care around the state.

"There's no debate that quality needs to be improved. Everyone — even more so, with the national debate — is recognizing that things have to change," says Letourneau. "It becomes a question of how to change, what's the role government will play, and how to finance it. There are more opportunities as recognition grows and heightens, and there's no other organization like us [in the state], a nonprofit, multi-stakeholder improving health care quality."

Maine Quality Counts is also leading a statewide program called the Patient-Centered Medical Home Pilot, a two-year-old initiative to strengthen the work of primary care practices. Maine was one of eight programs nationwide to receive additional funding from Medicare to expand the pilot this June from 26 practices to 76. Maine Quality Counts received more than 100 applications from practices to fill the new 50 spots.

"It's a very high bar to even apply; I was flabbergasted that we had that many," says Letourneau. Practices needed a fully implemented electronic medical records system and recognition from the National Committee for Quality Assurance, which would have taken thousands of hours of work and just as many dollars. The interest, she says, "is a combination of leadership realizing that it's the right thing to do and that it's the direction the future is going."

Participating practices receive some funding to help them hire new staff or otherwise take the extra time needed to better coordinate patient care, things like following up with patients after they leave the hospital. And insurers, like Anthem and Aetna, are changing their payment systems to these practices to encourage this kind of care. But a carrot isn't enough, so Maine Quality Counts' role is to help physicians learn how to be leaders in their practice. "It's like if you told me I'd win $1 million in the Olympics for running the mile," she says. "I still couldn't run the mile. I'd need help, I'd need a trainer.

"We're using a team approach, and using health information technology to identify the patient population and find gaps in care, which is something [physicians] aren't trained to do or incented to do," she adds. In the traditional payment system, "the practice that has the worst outcomes gets the same payment as the practice that does the best."

And while Letourneau says there's no hard data yet on the effectiveness of the program, the participating practices are reporting fewer emergency room visits by their patients, and happier, more engaged staff. "Like other [pilots in the country], we've shown that it can work, it does work and it's a lot of work," she says.

Letourneau, a Winslow native who's worked in Maine's health care industry since her residency at Maine Medical Center, is getting some leadership training of her own. She's one of about 36 physicians participating in a new leadership program through the Daniel Hanley Center for Health Leadership in Portland. The group meets every three months for two-day learning sessions taught by national experts. Meanwhile, Letourneau is mentoring another medical professional.

"It's a really critical part, because physicians haven't been great leaders for changing health care in this country," she says. "They deliver excellent care, but that doesn't necessarily change the system. We have to help them lead change, and learn not to be afraid of it or resist it."

The best way to advance change, says Letourneau, is by bringing together all the stakeholders — patients, employers, insurers and doctors. "It's definitely hard to do things together, but when you do it together, you move further." And while they all might have seemingly disparate objectives, their common thread is improving health care for people, she says. "It helps keep people in the room — who can say they're not for that?"

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