Brown talks accountable care at WCGH Community Advisory Council meeting

Nov 28, 2012
Dr. Vance Brown, Chief Medical Officer at Maine Medical Center since 2008, spoke about accountable care and the changes that will bring.

Waldo County General Hospital held its annual Community Advisory Council meeting on Monday, Nov. 19, at the University of Maine Hutchinson Center.

The nearly 150 Council members in attendance heard Dr. Vance Brown, the chief medical officer at Maine Medical Center since 2008, talk about accountable care and what it means for the future.

After talking about his uncles, Phil and Brad Brown, who were veterinarians in the area and known as “characters,” Brown said it’s time to get serious about increasing the value of health care that is provided. He said per-capita health care spending in the United States is far greater than in any other industrialized country, and yet we compare poorly on many indicators of health, especially adult obesity.

Brown said studies of Medicare costs across the country have shown “an unbelievable amount of variance in how care is provided.” For example, the annual cost of care for a Medicare patient in Portland is around $6,000, while it is $12,500 in Dallas.

Brown broke the health care system down into three levels:

• effective care: services which are of proven value, such as the use of beta-blockers for a heart attack patient;

• supply-sensitive care: services which seem to be based on capacity, such as an increased use of specialists when they are readily available; and

• preference-sensitive care: services such as knee replacements, lumbar back surgery and hysterectomy for benign uterine conditions, which vary greatly from hospital to hospital, and have alternative treatments available.

Brown said there is “a huge need for change,” and the health care system has “to deliver value, versus doing a service and getting paid for it.”

MaineHealth and Waldo County General Hospital are part of a program to see how accountable care organizations (ACOs) can be successful. Brown said the success of an ACO depends on four fundamental changes in how care is delivered. They are:

• comprehensive primary care: investing in primary care to build one-stop comprehensive services through primary care doctors;

• more support for patients: having nurses and other trained professionals spend more time with patients to help them understand their health care needs and to access services;

• better information technology: providing a shared health record, so patients who have more than one doctor can have those doctors see their full history and communicate with each other; and

• new quality improvement programs: having physicians and nurses work together to achieve specific quality goals which will measure their success.

Brown used as an example a story from The Atlantic Monthly of how accountable care could work in the future. An 82-year-old widow who lives in Anaheim, Calif., got on her scale one morning, as she does every morning, and found she had gained three pounds. A half-hour later, as she was eating her breakfast, her doctor’s office called -- her scale was wired to a monitor in the office, and they noted her three-pound weight gain. The woman had congestive heart failure, and a weight gain like this could indicate a buildup of fluid in her lungs.

She saw her doctor that day. He adjusted her medications and she was monitored closely for a few days. This avoided potentially serious health complications and a stay in the hospital, and the care the doctor provided cost far less than it might have, had more serious treatment been required.

Brown concluded by saying that while we’re not paid to provide care like this today, over time accountable care will change that. Accountable care has the potential to address the needs of people like that woman much more effectively than our current way of delivering health care.

Also at the annual meeting,

• Dr. Ralph and Mary Snyder were honored for being members of the Community Advisory Council (formerly known as the Board of Incorporators) for 50 years;

• Lee Woodward, president of the Board of Directors of the hospital, said this has been a championship year, with the hospital being honored as one of the 100 Greatest Community Hospitals in the country, He said Mark Biscone, executive director of the hospital, is clearly the most valuable player, but there are also tremendous position players, who make the team even better;

• Peter Haddock was given a cake by the Board of Directors of the hospital for having served on that body for 30 years; and

• Thirty-five individuals were elected to the Community Advisory Council. They are: Brian Beaulieu, David and Judy Beebe, Philip Carthage, Syrena Gatewood, Carol Good, Kevin Johnson, Traci Kirkpatrick, Carol Knight, Amy Marnecheck, Ryan Otis, Sharon Romanow, Eric Sanders, J.B. Turner, and Christine and Dennis Urick, all of Belfast; Dora and Roscoe Pinkham of Belmont; David Felton of Brooks; Skip Bates, Rebecca Greene and Douglas Hise of Camden; Iris Hooper of Frankfort; Kathleen and William Maseychik of Jackson; Andrew O’Brien and Virginia Yarnell of Lincolnville; Thomas Flacke, Norman Schultz, and Rebecca and William Vachon of Morrill; Sarah Tomalty of Northport; Eric Belley of Rockport; Elizabeth Bowen of Swanville; and Charles Pray of Waldo.

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