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Maine Group Seeks to Cut Health Care Costs by Creating Standard Insurance Plan

Patty Wight
/
MPBN
Beverly Neugebauer, the executive director of Coastal Women's Health Care in Scarborough.

SCARBOROUGH, Maine - Under the Affordable Care Act, Maine is one of several states to receive a $33 million, three-year grant to improve health care and reduce costs. Now in its second year, one of the project's goals is to develop something called a Value Based Insurance Design. The idea is to create one standard insurance plan, offered by every health insurance company, that promotes the most effective treatments.

At a time when administrative costs for doctors' practices average about $83,000 per year per physician - according to the Commonwealth Fund - efficiency equals survival. It's especially true for independent practices, like Coastal Women's Health Care in Scarborough. Executive Director Beverly Neugebauer says technology - from automated check-in to electronic medical records - has reduced administrative tasks and costs.

But after a five-year effort to streamline as much as possible, Neugebauer says she's run out of options. "You know, we're as lean as we can be, and physicians do not get reimbursed higher every year. It actually goes down every year. So we're at this point, is this sustainable?"

So Neugebauer is now looking outside the practice for ways to increase efficiency. She says one area that could stand improvement is insurance. She says her staff devotes a lot of time trying to understand requirements and codes in varying insurance plans. This affects when and how the practice is paid, and guides patients to the right services and providers.

"Today I'd tell you there's no way for us to know every plan and help our patients," Neugebauer says. "If we're experts and we can't even figure it out, it's very hard to help patients get care and use benefits correctly."

"We're wasting a lot of money on unnecessary services, we're wasting a lot of money on administrative costs," says Nancy Morris, of the Maine Health Management Coalition. "And it's really difficult to operate an office practice under the current system."

Morris is spokesperson for the coalition. She says the answer is: standardize. So the Maine Health Management Coalition is leading the charge to create a Value-Based Insurance Design plan. In other words, one standard insurance plan that every insurance company will offer - a plan that encourages evidence-based, cost-effective treatments. And the way it will do that is by using a simple, color-coded system.

"Green means go," Morris says. "Green's a great service. Yellow means slow down, there's some potential choices I have here. And red means I should slow down because it looks like costs could be high on this service, and there could be some dangers to me."

Both physicians and patients alike will see this color coding - to encourage appropriate treatment and involve patients in decisions about their care. "So it takes us away from the discussion of, 'Is this service paid for or not?' towards a discussion about, 'Is this service valuable or not?' " Morris says.

Dr. Neil Korsen of Maine Health is part of a group of physicians, brokers, and insurance companies working to create a standardized insurance plan. Another member of the work group, Mike Deschaine of Cross Employee Benefits, says Maine has some of the highest health deductibles in the country.

"The track we're on right now is unsustainable," Deschaine says. "This discussion, I think, gives some hope for bending the cost inflation curve."

For a standardized insurance plan to work, insurance companies need to be on board. And nearly all of the insurance companies represented in Maine are part of the working group. Aetna's regional medical director, Dr. Kenneth Snow, says his company is all for making plans easier to understand. "Definitely we will see some far greater agreement and consistency across plans."

Nancy Morris of the Maine Health Management Coalition says once a standard plan is created, it could put a huge dent in administrative costs. And it's a model she thinks could make a huge improvement to health care in Maine - and perhaps elsewhere in the nation.