Maine news, sports, weather from Waterville Morning Sentinel

February 27

OUR OPINION: Maine rewarded for health-care payment reform

Every once in a while, we get some good news from Washington.

That was certainly the case last week when the LePage administration announced that Maine would be one of only six states to get a federal grant to implement new programs to lower health-care costs through reforming the ways we pay for services.

Maine will receive $33 million over the next three and a half years to expand its experiment with payment reform, including Accountable Care Organizations, group practices that receive incentives to improve their patients' health instead of simply being paid for tests and procedures.

The model is designed to lower costs and improve outcomes at the same time.

That's exactly the right place for the state and federal government to be directing its effort.

With all the strong words and posturing from Augusta and Washington, it's easy to lose sight of the fact that both capitals are struggling with the same issue.

The shortfall in Maine's Medicaid program (known as MaineCare) reflects the overall high cost of health care throughout the nation. Market reforms in the Affordable Care Act are designed to reduce the number of people who don't have insurance by, among other things, requiring insurers to cover people with pre-existing conditions. It also creates exchanges where insurance companies compete to provide coverage to the people and businesses and provides tax credits and subsidies to help more people buy coverage.

Covering more people will lower overall health costs by taking pressure off emergency room and charity care in hospitals, but it won't, by itself, significantly lower the cost of health care.

Payment models that encourage patients to take better care of themselves, and encourage providers to take an interest in their patients' overall health are the best ways to lower health care costs. And when overall health care costs decrease, the cost of government programs such as Medicare and Medicaid also will go down.

There are other ways in which the state could work with the federal government under the Affordable Care Act. The most important would be expanding MaineCare to the ACA standards covering thousands of Mainers and bringing millions of federal dollars into the state's economy.

There is still time for the governor and the Legislature to do that. In the meantime, it's nice to see the state and federal governments working together on the people's problems and not just fighting each other.

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