Not everyone is a fan of what Elizabeth Mitchell is doing. As CEO of the Maine Health Management Coalition in Portland for the past three years, Mitchell has been bringing together employers, hospital and doctors' groups, and health insurance providers to have uncomfortable conversations about the price and quality of health care in the state. And while the 60-plus-member coalition seeks to find consensus in many of its decisions related to revamping how health care is paid for, sometimes majority rules.
"Some groups are threatened by change, regardless of where it comes from," says Mitchell. "There are several bodies that benefit from the status quo."
The status quo has proven to be increasingly higher health care costs for businesses and consumers. The average cost of employer-sponsored health insurance this year rose 8% for individual coverage and 9% for family coverage, according to a survey from the Kaiser Family Foundation and the Health Research & Educational Trust. That burden is particularly high in Maine, says Mitchell. "We have a very low per-capita income, we have high rates of chronic disease and an older population."
But the state also has quality health care. In June, the agency for Healthcare Research and Quality listed Maine as one of five states that showed the greatest improvement in health care performance in 2010, and Medicare ranks Maine third in the country, according to Mitchell. But high costs are still enough to strangle economic growth in the state, she says. "I hear from businesses all the time, and there are so many missed opportunities in investments and jobs because of what they're paying for health care," she said in a previous interview with Mainebiz.
The coalition's goal: Make choosing and paying for health care more transparent, so businesses and consumers know what they're getting and can use their decisions to direct change. Through a nonprofit foundation, Maine Health Management gathers and reports data on the performance of the state's hospitals and doctors. The coalition also helps its members design health care benefit options that maximize businesses' and employees' dollars, and negotiate with health care providers on what Mitchell calls value-based purchasing. Its efforts go beyond brainstorming ways to get employees to the gym. It's helped member The Jackson Laboratory negotiate a direct contract with a single hospital to provide care at an affordable price, and it's also been involved in a pilot program to make primary care practices more involved in overseeing patient care, an initiative selected by Medicare to receive as much as $20 million, paid directly to the 26 participating practices in the state.
The coalition is regarded as one of the strongest regional health improvement collaboratives in the country, and as federal health care reform advances, Maine could be chosen as a pilot site for several national health care initiatives, says Mitchell. "We are trying a lot of things that are innovative, and we hope they work," she says. "I think people come to the table because they share the mission, and between us we'll figure it out."
Mitchell — a former Portland state rep who served in the Legislature at the same time her mother, Libby Mitchell, was speaker of the House — came to Maine Health Management Coalition after serving on its board as a representative for MaineHealth. She also spent four years in London after receiving an Atlantic Fellowship from the Commonwealth Fund and British Council to study international health policy. Now, she serves on the boards or as a member of a number of national health care groups, including the National Business Coalition on Health. She also has four children ranging in age from 3 to 20.
And while some entities may dispute the coalition's efforts, knowing they are paying off is enough to convince Mitchell to forge ahead. She recalls one consumer telling her, "'Before I found out about the coalition, I thought all I could do was complain.'"