ORIGIN AND MISSION
Maine has created a partnership among three equal organizations and coalitions to focus on quality improvement – the Maine Quality Forum (MQF), the Maine Health Management Coalition (MHMC), and Quality Counts (QC).
The Maine Quality Forum, which is the legislatively authorized component of the partnership, was established in 2003 by Gov. John Baldacci and the Maine Legislature as part of the Dirigo Health Reform. MQF has been charged with collecting research, promoting best practices, collecting and publishing comparative quality data, promoting electronic technology, promoting healthy lifestyles, and reporting to consumers and the legislature.
Quality Counts, established in 2006, is committed to working together across organizations and communities to improve health care systems and outcomes with the people of Maine. Quality Counts coordinates existing but disparate efforts across the state that support local, patient-centered, and coordinated systems of care, as well as the resources that support them. Its goals are to improve health status, promote consistent delivery of high quality care, improve access to health care, and contain health care costs.
In existence since 1993, the Maine Health Management Coalition is an employer-led partnership among multiple stakeholders (including MaineCare or Medicaid). The Coalition works collaboratively to maximize improvement in the value of health care services delivered to MHMC members’ employees and dependents. MHMC has three public reporting initiatives that report quality data on hospitals and primary care practices, using mostly publicly available data that is organized and reported in a manner usable for employers and consumers. Through its Employee Activation Initiative, MHMC helps member organizations develop and share tools to communicate information about quality health care to employees. MHMC also has a multi-stakeholder workgroup that is designing a payment reform model to pilot. The model will build on previous work commissioned by the Maine Quality Forum that analyzed unwarranted variation.
GOVERNANCE
This partnership of partnerships has come together to support a range of quality initiatives in the state, and together with the state’s emerging regional health information organization is an AHRQ-recognized Chartered Value Exchange for Maine, though it has no formal mission or governance structure. Each of the three organizations and coalitions has its own mission, board, and structure, representing diverse stakeholders. The three organizations have cross-populated advisory groups and developed collaborative leadership on initiatives (e.g. the Aligning Forces for Quality initiative’s executive leadership team). Although different funding and governance structures make it challenging to share projects, the partners have effectively supported a range of improvement activities, and they coordinate and communicate in a concerted effort to avoid duplicating efforts.
ACTIVITIES AND ACCOMPLISHMENTS
• Maine’s partnership is focused on the areas of medical home, practice improvement, public reporting, and consumer engagement. MHMC reporting focuses on the physician, practice, and hospital performance levels, using a variety of data sources; MQF uses clinical and administrative (claims) data for hospital reporting and is using administrative data to analyze hospital and physician cost and quality. MQF is transitioning from Maine-designated measures to NCQA/Bridges to Excellence measures. Quality Counts focuses on promoting multi-stakeholder collaboration and the spread of quality improvement learning.
• The Voluntary Practice Assessment Initiative (VPAI) is a 24-month project offering free, confidential quality and patient satisfaction assessments to small, unaffiliated, and certain other primary care practices in Maine. It is funded by MQF, uses MHMC measures, and will provide access to the QC Learning Community (which offers information about tools and resources to help practices improve their systems of care).
• The three organizations together were awarded a grant from the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative. QC serves as the lead organization for the grant, and representatives from QC, MHMC, and MQF serve on the executive leadership team.
• Maine was awarded status as a Chartered Value Exchange by the Agency for Healthcare Research and Quality (AHRQ) in January 2008. MHMC convened the Maine CVE Alliance, which includes MQF and QC, as well as HealthInfoNet, Maine’s regional health information exchange. As part of the CVE, MQF led the successful application for the CMS demonstration initiative to promote the adoption of electronic health records. The project’s intent was to reward the delivery of high quality care supported by the adoption and use of electronic health records in physician practices. (The project has since cancelled by CMS.)
• The partners are leading a three-year, patient-centered, multi-payer medical home pilot. The first phase of the pilot (planning) was completed at the end of 2008. The second phase (implementation) began in January 2009, with solicitation of applications.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
