Walking Together: The MaineHealth Story
From an address delivered by James F. Orr III, who served as the first president of the MaineHealth Board of Trustees from 1999 to 2000, at the First Annual Leadership Dinner, May 6, 1999:
I'd like you to meet Christopher Glenn of Saco. "C.J." is ten years old, and he's had asthma for nine of those years. He wants to play sports, but that's been a problem until recently. Then he became involved in a pilot program at Southern Maine Medical Center, one of three pilot programs sponsored by a MaineHealth, Blue Cross and Blue Shield and the American Lung Association of Maine. The program has given him a new inhaler regimen, and the nurse coordinator has worked with his school to help make his asthma management easier. The result? He was off to baseball practice when this picture was taken.
C.J. is a perfect example of the kind of community-based health status improvement that can be accomplished with cooperation and collaboration. The childhood asthma project orchestrated by MaineHealth and its partners has made a huge difference in his life.
What's important to know is that the asthma project didn't begin just last year. It began nine years ago.
The story of how the pediatric asthma program came about is the story of MaineHealth. And the story of MaineHealth is the story of cooperation and collaboration among healthcare providers in southern and central Maine. It is a story of successful ventures, of false starts, of disappointments, of opportunities seized, all with a consistent theme of working together, of walking together down a road that might have been much different had there not been a MaineHealth.
Where we are today looks different than we envisioned it nine years ago. But it is grounded in the same principles that created it. MaineHealth today is beginning to produce not only some of the results we had hoped for, but some we had not anticipated when we started. That's what happens in a principle-based organization that is still evolving.
And I will say at the outset that this might sound like a Maine Medical Center history at the beginning, but it is far more than that. It's just that the organization we know today as MaineHealth evolved from MMC's original corporate structure.
To understand where MaineHealth began, you have to understand the environment in 1990. Maine had 40 not-for-profit hospitals, each with its own board and each with a similar, but almost exclusive, mission: to serve the needs of its community. 40 hospitals in locations that were largely accidental as opposed to planned. 40 independent and unconnected hospitals, competing for limited resources in a tough environment.
The people in this room are well aware of the changes happening at that time: increasing volume, rising costs, declining reimbursements, and on the horizon, the threat of managed care. Maine's hospitals were faced with a choice. They could decide to enter the battle for survival by all-out competition with other hospitals, or they could decide to work with other not-for-profit, community-owned hospitals to see that the best care was made available to their communities.
At Maine Medical Center, then-interim president Don McDowell posed the same question that was likely being asked throughout the state. If cooperation and collaboration are the right approaches, he asked "who should provide the leadership, and who should accept the challenge to begin to bring some order to what one could call a 'health care unsystem'?'"
If the answer were to be "not us," he reasoned, that would send us in one direction. If, on the other hand, Maine Medical Center decided to exercise its leadership position to attempt to bring some order, that would take us in quite a different direction.
In a September 1990 letter to a Maine Medical Center trustee who had raised questions about the advisability of collaboration, McDowell characterized the second alternative. He cast it in very broad terms, but I ask you to pay close attention to the principles behind the words:
"We would seek opportunities to bring hospitals together to plan programs jointly, we would encourage joint ventures with other providers, we would try to impact the continuance of care to provide a more smooth transition, and we would use as our guide the effectiveness and efficiency of the system. That is, we would not make control and size the goal, rather, we would attempt to impact the process in a positive way through informal and formal agreements, contracts and/or investments."
The question was answered at a board retreat at the Harraseeket Inn in Freeport the following February. There, MMC's trustees unanimously voted on a set of conclusions that began "The Maine Medical Center must enhance and expand its leadership role in regional and state health care concerns." The question had been answered. MMC would be a leader in cooperation and collaboration.
So it came to be that in 1991 and 1992, at a small inn in the western Maine foothills, there were two very significant meetings. Every hospital CEO, trustee leader and medical staff president in southern and central Maine was invited to these meetings, at which a professional facilitator helped them walk through a discussion as to what cooperation and collaboration might mean, and what a more rational healthcare "system" might look like. Out of these meetings came the creation of the Maine Health Forum, a group of 16 hospital CEOs who met over dinner some 15 times during 1992 and 1993.
These early gatherings represented the very best that could have come from cooperation and collaboration. A "system" that included all these hospitals would have taken us far down the road toward better healthcare in our region. But it was too soon. The time was not right for such a major cultural and political change. It would take several years before some of the members of that group actually began to come together. Until then, cooperation and collaboration would have to proceed on a smaller scale.
In the fall of 1991, the Maine legislature passed the Hospital Cooperation Act, a law conceived and presented by Maine Medical Center. It removed some of the anti-trust threats associated with conversations among hospitals, and was critical to any significant move forward in cooperation and collaboration.
MMC's sense of a larger role was evident in a report issued in November 1991 by the Mental Health Task Force. In each area of study, the recommendation included working with other agencies in the development of a continuum of care. There was even a section devoted to the support and integration of other community agencies. Those principles are echoed in today's headlines, as you look at the roles MMC and MaineHealth have taken in saving what is now Spring Harbor Hospital of Maine Medical Center.
In April 1992, a full-scale experiment in cooperation and collaboration began in Portland. The trustees of the three Portland hospitals, Maine Medical Center, Mercy Hospital, and Brighten Medical Center, met to discuss what might be possible in Portland.
In September, the boards issued a joint resolution supporting the concept of developing an integrated healthcare delivery system, a system that would "provide access to the full continuum of care and provide health profession education, to better meet total healthcare needs and improve the health status of the community."
Now, remember those last words "improve the healthcare status of the community." They will play an increasingly important role later in our story, and ultimately they will become our story.
A Cooperation and Collaboration Committee from the three hospitals submitted its report "The Vision for Cooperation and Collaboration" in July of 1993. The report outlined the creation of a new corporate entity that would govern the three hospitals that would set about consolidating duplicated services, seeking economies of scale, reducing costs and enhancing the healthcare services available in the community. It was to be, in short, a "super hospital," with the goal of creating a rational, non-duplicative, ever-improving healthcare system for Portland and the surrounding area, and in some cases for the state.
Even though the proposed governance structure included equal representation for each hospital on the new governing board, the "three-hospital" proposal failed at the 11th hour, over issues of control.
It is important to note that the shared governance envisioned in Portland was an indication of how we thought a system should work, and not coincidentally is the model MaineHealth has used.
This was the end of an unparalleled experiment in Maine. It also was the end of any thoughts we may have had that voluntary cooperation and collaboration would be easy to accomplish.
The leadership at Brighton Medical Center, Board Chairman Richard Roy and his colleagues, and CEO Jim Donovan, saw the value of collaboration and shared a similar vision of a collaborative future, and the MMC and Brighton boards re-engaged in collaboration talks.
At the same time, MMC began laying the groundwork for a local competitive environment. Among the steps taken was the formation of a physician-hospital organization, a collaborative business venture with local physicians to enable managed care contracting.
The MMC PHO is today a central part of our healthcare delivery effort, and has enabled us to not only contract with managed care but to offer our own managed care product in partnership with Blue Cross and local physicians.
Physician involvement has become a hallmark of MaineHealth and, as we'll see later, reflects our belief that physician involvement is critically important to an improved healthcare system.
The blueprint for the future was laid out in August 1994, in a revised Long Range Plan for the Maine Medical Center Foundation. The Foundation had been formed in 1987, simply as a vehicle to support Maine Medical Center's expanded ventures in a very tight regulatory environment. Its only mission was to support the mission of Maine Medical Center. The 1994 Long Range Plan changed the mission, and the destiny, of the Foundation forever.
Where before the Foundation existed to support the activities and ensure the viability of an acute care hospital, it now had a larger, much larger, mission. The mission statement of 1994 is lengthy, but the first paragraph is very important:
"The Foundation will lead the development of the premier community care network that provides a broad range of integrated healthcare services for populations in Maine and northern New England. Through the Foundation's affiliated organizations, the network will provide services along the full continuum of care as necessary to improve the health status of the populations it serves in a cost-effective manner."
Note the reference to "health status." You'll be seeing more of those words.
It is ironic that in December 1994, a vestige of the defunct three-hospital consolidation talks was presented to the community. The first-ever Community Health Profile of Greater Portland was a joint project of Maine Medical Center, Brighton Medical Center, Mercy Hospital and the City of Portland, with assistance from the United Way of Greater Portland and the Chamber of Commerce of the Greater Portland Region. It was a harbinger of MaineHealth's coming emphasis on health status.
In March of 1995, the merger of Brighton Medical Center into the Maine Medical Center Foundation was completed. The transition plan would forever change the nature of each hospital. It called for the moving of the acute inpatient services at Brighton to the MMC campus, and the establishment of Brighton as an outpatient center providing urgent care, day surgery and other services. The plan also called for the establishment of inpatient rehabilitation beds at the Brighton campus. All of these changes and more have been accomplished.
The Maine Medical Center and Brighton merger, and the consolidation and program enhancement that resulted were the best examples to date of the value of cooperation and collaboration. As a concrete measure, the combined operating costs for the two hospitals were lowered by $15 million a year. As part of the merger agreement, a $2 million fund was set up to preserve the osteopathic heritage that had contributed so much to healthcare in Portland, and that fund now sponsors educational programming in osteopathic medicine.
I can't stress enough the wisdom of the Brighton Medical Center board and leadership in making the merger possible. They clearly saw the future and they were true leaders in the development of our integrated delivery system.
A strategic plan for the Maine Medical Center Foundation adopted in July of 1995 began to draw the outlines of the "integrated delivery system" envisioned in the Foundation's mission.
It identified five essential components of such a system and the strategies to achieve them.
The plan stated that in order to develop a true system, we would need:
The provider network then consisted of Maine Medical Center and Brighton Medical Center, along with their extensive outpatient services and specialty physician practices. Both hospitals had begun to develop primary and specialty physician practices in the early 1990s, and they added great depth to the fledgling system.
- A provider network covering a full continuum of care, everything from physician care to hospital care, from diagnostic testing to long-term care
- A health insurance plan to allow the system to share risk and align the economic interests of its providers
- A community health status program to improve the health status of its communities
- Programs for the support of health education and research
- An information system and other infrastructure to tie the system together.
In October 1995, Maine Medical Center and a group of local physicians took an important step in bringing their business objectives together, with the creation of the Maine Heart Center.
This jointly owned corporation developed "package pricing" on cardiac services for employers and managed care organizations. That same month, MMC created a Management Services Organization that provided "front-office" practice management services to area physicians.
Today, the renamed PracticePartners offers a comprehensive range of services to physician practices in the system and beyond.
Changes in mission led to changes in structure for the Maine Medical Center Foundation. It was important to the growth of the system that it not be viewed simply as Maine Medical Center "writ large." A true system could not be led by a single acute care hospital, it had to be a broader, more inclusive governance structure. So in early 1996, the boards of MMC and the Maine Medical Center Foundation were separated, as well as the administrative leadership. These were more than paper changes, and they were significant. The Foundation now had a separate Board, and a separate CEO.
The system began to grow.
In August 1996, LincolnHealth – St. Andrews Campus and Healthcare Center in Boothbay Harbor joined the Foundation, adding its integrated network of primary, acute, home and long-term care to our family. The leadership of Mary Lou Koskellar and Harry Pelton and their long view of the future was instrumental in this first geographic expansion of the system.
Community Health Services, which provides home care services in Maine's largest population center, joined in September 1996. Chairman Meredith Tipton and President Chip Liversidge helped add this important new dimension to the system's Portland region.
Miles Health Care in Damariscotta, the parent of Miles Memorial Hospital and related services, joined the Maine Medical Center Foundation family in January 1997. Miles Health Care had been integrating locally for a number of years, and offered not only acute hospital care, but long-term care, home care and physician care. Its leadership, including Pat Lyden, Judy Tarr and Dr. Ed White, had already recognized and acted on the value of integration, and added their vision to ours.
In January 1997, our organization became "MaineHealth." The new name was adopted to begin to articulate for the public that this was something new and different. Our tagline declared us to be "The Care you Need, the People you Trust," familiar people and organizations working together in new ways.
1997 was to be a busy year for MaineHealth.
In February, the Falmouth Family Health Center opened, housing physician practices and support services such as radiology and laboratory.
In March, Maine Medical Center opened its Scarborough campus, further enhancing the outpatient services options within the system. That same month, OH+R, an occupational health company, entered into a joint venture with MaineHealth. And the final merger of Brighton Medical Center into Maine Medical Center was completed.
Also in March, MaineHealth moved into its own offices in downtown Portland, completing a physical separation that reflected its system-wide emphasis.
In April, Maine Medical Center was able to add a health plan to the MaineHealth family. Maine Partners Health Plan, a joint venture of MMC and Blue Cross and Blue Shield of Maine was approved and would be ready for market for fall open enrollment. Physician involvement in governance and management — unique among all managed care plans in Maine — was a key component of this plan, and has proven to be a major selling point for employers and employees.
The inpatient rehabilitation services called for in the original Brighton transition plan came to be in May 1997, when Maine Medical Center and HEALTHSOUTH formed a joint venture hospital, New England Rehabilitation Hospital of Portland at the Brighton campus.
In November, another joint venture with Intellicare of Maine brought a physician office call center into the family, expanding the system's capacity to communicate with patients.
These joint ventures reconfirm the MaineHealth principle of cooperation and collaboration, and the belief that partnerships can bring about positive change.
In September of 1997, MaineHealth developed an agreement that described a cooperative "relationship" with Southern Maine Medical Center in Biddeford. This agreement followed extensive discussions about corporate integration and formalized our commitment to work together.
You will remember that a focus on community health status was part of the original vision of the three-hospital talks in Portland, and you may have noticed that it has become steadily more prominent in MaineHealth's words and deeds. By November 1997, a new Strategic Plan stated it clearly and unequivocally:
Working together to make the people in our communities the healthiest in America.
1997 was capped off in December with the affiliation of MaineGeneral Health in Augusta and Waterville with the MaineHealth family. MaineGeneral Health is itself the product of a two-hospital merger, and is a large system that includes long-term care and home care. Its affiliation cemented a long-standing relationship with Maine Medical Center and also expanded MaineHealth's geographic scope into central Maine. Board chairman Arnie Yasinski, then-CEO Warren Kessler and current CEO Scott Bullock were instrumental in this important affiliation.
The pace of growth continued into 1998.
The consolidation of laboratory services in the region, a long-pursued goal, was realized in January. The laboratories from MMC, Brighton and NorDx, MMC's for-profit laboratory subsidiary merged into a new NorDx that was a member of the MaineHealth family.
The MMC Geriatric Center opened in July, offering a new dimension to senior care and heralding a coming MaineHealth emphasis on senior health.
During 1998, work was beginning on that most important part of MaineHealth's mission: health status improvement.
With staff in place, we turned to a very important, easily identified health status need: improved care for children with asthma. Asthma is a serious health problem in Maine. An estimated 22,000 children under the age of 18 have the disease, and it is the leading cause of school absenteeism from chronic disease. We know how to manage asthma, but still our children make too many trips to the emergency room and miss too much school.
We brought together the members of our family, Blue Cross, the school nurses association and other organizations for a collaborative attack on this problem.
The result was AH!, Asthma Health for Children, a collaboration that perhaps only MaineHealth could have orchestrated. The project has produced a public education campaign, and has awarded half a million dollars in funding for three pilot projects in asthma management.
Our Healthcare Commitment
Health care is a unique relationship between those who receive it and those who provide it. This is not simply because it involves matters of life and death, but because the vulnerability of the sick confers extraordinary power and responsibility on the caregivers. Such a relationship cannot be set into law; it is far too personal and far too important.
MaineHealth believes that this relationship is based in moral and ethical responsibility. We pursue our work guided by these principles and always striving for the ideals they embody.
We also rolled out a model smoking cessation program in 1998, an employer-sponsored program at Hannaford Bros. Employees are given the tools and support they need to quit, with the cost picked up by the company.
- The relationship between caregiver and care receiver must be preserved and protected
- All people must have access to necessary health care
- Care must be of the highest possible quality
- We respect the dignity and worth of each individual
- People are entitled to the information they need to make informed decisions
- Responsible lifestyle decisions are an important consumer responsibility
- People should know who is taking care of them and where policy decisions are made
- Health care is a local matter and is best governed at the community level
- Our responsibility extends to the society at large
MaineHealth funded an innovative osteoporosis prevention program at Miles Healthcare during 1998 and beyond, providing a means to assess new ways of approaching this serious health issue.
The general public also gained from MaineHealth's emphasis on health status in 1998. Two MaineHealth Learning Resource Centers opened, one at the Falmouth Family Health Center and one at MMC's Scarborough campus. These centers provide free a wealth of health information in print and in video, and also provide Internet access and a trained staff person to help consumers search the World Wide Web for health information.
The centers offer a wide range of classes for consumers, on topics ranging from healthy cooking to parenting.
At the end of 1998, MaineHealth developed a special professional education program. The Physician Leadership Fellowship is providing doctors nominated by member organizations with the business and leadership skills they may not have received in medical school. It is a recognition that physician leaders will be critical to the ultimate success of a healthcare system, and these 19 physicians and their sponsors are making an investment in the future.
Also in December 1998, MaineHealth responded to the public debate about "patient rights" with a statement of its position. "The Healthcare Commitment," printed in your program, is a simple statement of our beliefs, founded in the same principles that have brought us together as a system. It recognizes the sanctity of the physician-patient relationship and calls for a common sense and common decency approach to healthcare.
We have known from the beginning that the success of MaineHealth was the success of its members. Here's an incomplete but illustrative round-up of what our members have been up to for just the past couple of years:
Maine Medical Center opened The Barbara Bush Children's Hospital at Maine Medical Center, and the Marshall L. and Susan Gibson Pavilion for the care of adult cancer patients. It also began construction on a new Family Practice Center and medical office building.
LincolnHealth – St. Andrews Campus and Healthcare Center broke ground for St. Andrews Village Retirement Community, a new retirement and assisted living community, and created a school health center.
Community Health Services expanded its home care offerings to include cardiac rehabilitation, diabetes, and wound care, and added a personal health services program to complement its professional nursing care.
Miles Healthcare instituted a Phase II cardiac rehabilitation program and completed planning for Chase Point, a new assisted living and retirement community.
Our affiliate MaineGeneral Health has embarked on a multi-million dollar expansion and improvement project at both its Augusta and Waterville locations, and has merged with HealthReach, a large home care provider.
The system now boasts a psychiatric hospital and an outpatient behavioral health organization, with the acquisition by Maine Medical Center of the bankrupt Jackson Brook Institute. We believe that the new Spring Harbor Hospital of Maine Medical Center and Spring Harbor Counseling will form the basis for long-awaited and desperately needed improvements in behavioral healthcare for southern and central Maine as presaged in that report way back in 1991.
Within the past month, a regional physician-hospital organization has been created, bringing physicians from throughout the system's geographic coverage together for managed care contracting.
Which brings us to the present, exhausted but energized by the potential of this organization we call MaineHealth. The future will bring more changes and more successes. We have much work to do in health status, a fledgling geriatric services program, challenges to meet in clinical integration of services among members, an information system to develop, new members to welcome.
But if I had to illustrate what MaineHealth is all about with just one example, if I could show you just one image of what the future holds, it would be "C.J." Glenn.
He's breathing easier these days. He's breathing easier because of good medicine and good care, to be sure. But it's also because we have built an organization on good principles. We are demonstrating that cooperation and collaboration can work, and that if you follow your principles you ultimately can't go wrong.
The future will bring more changes and more challenges. But I assure you, it will look much like the past in one very important way: the greater good will come first, as we walk together in service to our communities.