December 13, 2004

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Maine Quality Forum Advisory Committee Receives Dirigo Update
The Maine Quality Forum Advisory Committee met on Friday, Dec. 10 and received an update on the progress of all the various aspects of Dirigo Health. Relative to DirigoChoice, the health insurance program partnered with Anthem, Trish Riley announced that 141 small businesses have enrolled in the plan with 2131 members. Dirigo Health Officials are still hoping to have 10,000 covered lives in the plan by the start-up date on January 1, 2005.
DirigoChoice coverage will start on Jan. 1, 2005 for those eligible persons who sent in completed applications by Dec. 1.  Individuals who are unemployed or whose employer has not offered health insurance for at least the past year will be able to enroll starting in February, and coverage for these individuals will begin April 1.

Employers with 50 or fewer employers will be able to purchase coverage for their employees if they contribute at least 60% of each employee's program cost.  Individuals and the self-employed will be able to purchase coverage at group rates, but there is a cap on the number of self-employed (sole proprietors) who can enroll.  The limit is 2200 individuals in the first year and enrollment so far is about one-half of the limit.

The major attraction of the DirigoChoice Plan is the availability of state subsidies for employees whose household income is at or below 300% of the poverty level.  The sliding scale subsidy applies to deductibles and the annual out-of-pocket maximum as well as the monthly premium.  There is also 100% coverage for preventive health services, including annual physicals, mammograms, well-baby visits and flu shots.  Prescription drugs have no deductible but have co-pays of $10/25/40.  There are also cash incentives for selecting a PCP and completing a health risk assessment.  Other features include mental health parity, no waiting period for pre-existing conditions and coverage for domestic partners.

The Medicaid expansion set to take effect on April 1 remains a controversial part of Dirigo.  The legislation calls for the expansion of MaineCare eligibility for parents with minor children from 150% of the federal poverty level to 200% on April 1, 2005.  Childless adults earning between 100% and 125% of the poverty level also become eligible on April 1.  If an employer chooses to enroll in DirigoChoice, employees who are eligible for MaineCare will be able to enroll in DirigoChoice.  Many statehouse observers believe the expansion will be delayed because of the state's $735 million deficit for the two-year period beginning July 1.  Others have argued that the state's first obligation should be to the existing MaineCare members and the persons and institutions who provide care to them.  Both the Maine Medical Association and the Maine Hospital Association have opposed the expansion without additional funds appropriated to increase reimbursement rates for MaineCare providers.

For more information about Dirigo Health or to access a list of Anthem appointed insurance agents, go to  For a list of federal poverty figures, go to

Maine Quality Forum Advisory Committee Re-elects Officers
The Maine Quality Forum Advisory Committee on Friday reviewed its work the past year, began discussion of goals for 2005 and re-elected officers.  Re-elected as Chair of the Council was Robert McArtor , M.D. of Maine Health.  Re-elected as Vice-Chair was Rebecca Colwell of Gardiner. 

At the Friday meeting, Trish Riley from the Governor's Office of Health Policy and Finance thanked Council members for their work "above and beyond the requirements of the Dirigo legislation."  She asserted that the Forum is the umbrella agency that can make the translation of health and medical science to the public.  She stated that, "MQF is the place to get information from the system to the people in a way that the public can understand."

Further, Ms. Riley emphasized the need to operate with urgency, with an emphasis on making appropriate change while balancing the integrity of the process.  She noted that the Forum must adhere to a rigorous schedule.  Dr. Dennis Shubert, Executive Director of the Forum, offered the need for freedom to act, when he feels he can act on previous consensus of the Advisory Council.  During the second half of the meeting, Council members and members of the public attending the meeting, including MMA representatives, participated in a visioning exercise that focused upon three questions.

  1. What are MQF's major accomplishments this past year?
  2. What opportunities were missed?
  3. What are the priorities for next year?

The data from the exercise will be analyzed thematically and the results (including the raw data) will be sent to the members.  This will serve as the foundation for a discussion of priorities and work planning at future meetings.

The Advisory Council meets next on Friday morning, January 14, 2005 in Augusta (211 Water St. at the Dirigo Health Agency offices). [return to top]

Congressman Tom Allen Holds Press Conference to Promote Consumers Union Website Comparing Drugs
First District Congressman Tom Allen held a press conference on Friday to promote a new website and public information campaign by the non-profit advocacy group Consumers Union.  Consumers Union is the well-known publisher of Consumer Reports.  The Maine Medical Association, through the presence of Katherine Pope, M.D., Chair of the MMA Legislative Committee, participated in the press conference.

The new website and campaign is aimed at providing physicians, health care providers, patients and the general public with independent research on the comparative clinical effectiveness of prescription drugs.  The campaign complements Congressman Allen's efforts through federal legislation (H.R. 2356, The Prescription Drug Comparative Effectiveness Act) to appropriate federal funding for evidence-based research on the clinical use of prescription drugs.

The link to the new CU website is:

The link to the Congressman's website about his legislation to fund comparative effectiveness research by the NIH and the Agency for Healthcare Research and Quality (AHRQ) is:

Dr. Pope's comments at the press conference follow:

    Good morning.  My name is Dr. Katherine Pope and I am an anesthesiologist practicing here at the Maine Medical Center.  I am also a member of the Executive Committee of the Maine Medical Association and I am pleased to be here this morning on behalf of more than 2600 Maine physicians who belong to the MMA to voice support for Tom's great work and the more recent work of those at Consumers Union to give all of us, clinicians and patients, objective data on which to compare the effectiveness and cost-effectiveness of the medications we prescribe and consume to maintain or improve our health.  We know that escalating health care costs are one of our country's greatest challenges today and we all have an obligation to help contain health care cost growth.  The data produced through Tom's Prescription Drug Comparativeness Act and available on the new Consumer Union website will help all of us make wiser health spending choices. [return to top]

Report from Interim Meeting of American Medical Association
The AMA Interim Meeting, held this year from Dec. 4-7 in Atlanta, considered 140 Resolutions in four reference committees and closed on Dec. 7 having completed its business on time and with a challenge to members to help build its new growth strategy based on the three pillars of advocacy, involvement and communication. 

As described during the House of Delegates opening on Dec. 4, AMA trustees, leaders and staff are already deeply entrenched in efforts to focus our initiatives; provide new, meaningful opportunities for involvement; and better tailor AMA communications to members' needs.

What do members need?  According to facts presented by Ajay Gupta, partner at McKinsey & Co., there are five distinct member segments.  Of those, the needs of two (known as "positive society supporters" and "medical society activists" or, when described collectively, "joiners") will be specifically targeted.  According to Gupta, who quoted focus group participants, "Physicians are working so hard, we need someone who's paying attention to the national issues and trying to advocate for us" and "we need someone representing medicine as a whole."

Examples of solutions already underway include a tighter, more focused advocacy agenda; AMA Member Connect surveys; and re-tooled communications vehicles, which will include regular, accessible updates on the AMA's focused agenda.

The AMA's challenge - and opportunity - is to turn what we've learned into a stronger, more robust connection with our members.  In closing, AMA Chair James Rohack, M.D., indicated that full-dues membership is already improving from prior years.

Presentations at the meeting included a forum on "Pay for Performance," a forum offering different approaches to covering the uninsured (The Ailing American Medical System;  Symptoms, Etiologies, Possible Solutions), and a presentation featuring CDC Director Julie Gerberding, M.D. on "Pandemic Influenza Prevention."  The latter presentation included a scientific discussion of current infectious disease vaccination and other preventive strategies."

The AMA House of Delegates meets next in June in Chicago at its Annual Meeting. [return to top]

Excerpts from Pay for Performance Session at AMA Interim Meeting
It was standing room only at "Pay for Performance;  The Good, The Bad and The Ugly," a session co-sponsored by the AMA's Private Sector Advocacy and Clinical Quality Improvement groups designed to educate physicians about "pay for performance" or "P4P," one of the latest buzzwords in practice today.

A new generation of initiatives that affect a physician's reimbursement based on performance against a set of explicit measures, P4P incorporates evidence-based process and outcome measures into daily practice to achieve quality improvements.  The result in theory:  physicians are rewarded for their performance against these quality measures.

Panel member and California Medical association President Ronald P. Bangasser, M.D., said next year, more than 100 health plans, medical and business groups - covering millions of patients - will have P4P.  "Is this a national trend?" he asked.  "That's up to us to say."

Fellow panel member Michael W. Cropp, M.D., president and CEO of Independent Health, a not-for-profit managed care organization, outlined six ideal P4P measures, including that they be evidence-based, agreed upon by all stakeholders, meaningful to the patient population and collectible.

AMA member Kevin Flaherty,M.D., an ophthalmologist from Wassau, Wisconsin, said he attended the session "to see what the current status of P4P is around the country and how it might theoretically affect my practice, specifically in the future."

Panel moderator and House of Delegates Speaker Nancy H. Nielsen, M.D. ended the session with a Q & A, adding that panel member's presentations will be available at a later date on the AMA Web site.

P4P has already made its way to Maine through the Pathways to Excellence project sponsored by the Maine Health Management Coalition.  Based upon data collected from primary care practices, Bath Iron Works, The Maine Municipal Employees Insurance Trust, Cigna and Anthem all have programs in place to pay additional compensation based upon the agreed upon measures during 2005.  In general, the among of additional reimbursement offered in Maine ranges from about 2 to 6%.

At the forum in Atlanta, MMA EVP Gordon Smith asked panel members about the appropriate tipping point for incentivizing physicians to participate in P4P programs.  Generally, the panelists felt that 5 to 15% was an appropriate range, noting that incentives higher than that could result in physicians not taking on difficult or complex cases that might adversely affect their performance under some of the measurements.

For MMA members wishing to know more about this topic, there are a limited number of copies of an AMA Board of Trustees Report entitled, "Physician Pay for Performance Initiatives" White Paper available from MMA.  Call or e-mail Julie Banta at 622-3374 or to request a copy of the 50 page report which summarizes different Pay 4 Performance programs in place around the country. [return to top]

Update on Flu Vaccine Availability in Maine
Watch for a communication from the Bureau of Health tomorrow (Tuesday) which will reiterate information sent out last week announcing a liberalization of the vaccination guidelines in the face of more doses of vaccine being available than was previously expected.  If a practice is looking for vaccine, a call should be made to the immunization hotline for providers - 1-800-867-4775.

Given the increasing supply of vaccine, the Bureau is now encouraging a more aggressive approach to assure that all vulnerable populations receive the vaccine.  A little extra effort now could make a big difference in January and February. 

Around the first of December, the Bureau sent out a new Health Alert indicating that the Bureau's priority groups for vaccine were now exactly the same as those of the CDC.  This includes all health care workers who provide direct care to patients.. The Bureau is encouraging the use of both vaccine and FluMist.

In summary, there are now three groups which are eligible to receive vaccine or FluMist, depending upon their status.

  1. all those people 65 and over (not just those in poor health)
  2. health care workers providing direct patient care; and
  3. out-of-home caregivers and household contacts of children aged less than six months.

This information is also on the website at www.MainePublicHealth.Gov.

Concern has been expressed by the Bureau about practices not being willing to vaccinate an eligible individual if they are not an existing patient, and about the reluctance of some providers to embrace the use of FluMist.  More information can be obtained about these concerns by talking to the Bureau through the use of the Provider Hotline noted above. [return to top]

Second Annual MMA Charity Golf Event to be held Monday, June 6, 2005
Those active or corporate affiliate members who are golfers and who are preparing their 2005 calenders should block out Monday, June 6 for the MMA's Second Annual Charity Golf Event.  The first event, in 2004, raised nearly $5,000 for the Physician Health Program.

The tournament, in a traditional scramble format, will be held again at the Augusta Country Club in Manchester.  Tentative plans call for a shotgun start around noon, with lunch being available on the deck at 11:00am.

Potential players or hole sponsors can reserve slots now by calling Chandra Leister at MMA at 622-3374 or via e-mail to [return to top]

Jim Parker, Anthem BCBS General Manager Leaving Maine for Indianapolis
Anthem BCBS of Maine General Manager James Parker announced on Thursday that he is leaving Maine to take a position at Anthem's Corporate offices in Indianapolis, Indiana.  Erin Hoflinger is expected to become the General Manager. 

Jim has generally received high marks for his stewardship of the plan since becoming General Manager after he had taken responsibility for the Anthem purchase of the Blue's plans in both New Hampshire and Maine.  For a period of time, he was manager of both New Hampshire and Maine while a new manager was sought in the granite state.

Jim will be running a national division for Anthem and MMA wishes he and his family well as they relocate back to the Hoosier state. [return to top]

Meeting Tuesday on Dirigo's "Tough Choices" Campaign
MMA will participate tomorrow in a meeting of stakeholders preliminary to the Dirigo "Tough Choices" campaign.  The campaign is an attempt to receive input from Maine citizens regarding the trade-offs that might need to be made in developing health policy in Maine in the future.

The campaign will take place in March and will involve a group of 1,000 or more citizens picked from a random sample of 20,000.  Different locations around the state will be connected by video-conferencing with a central moderator who asks participants a series of ethical questions.  Participants respond with an electronic hand-held device which automatically tabulates the responses and projects them on a screen for all to see.

The Tuesday meeting will give stakeholders an opportunity to review some of the questions and to discuss the format.  The meeting will be held at the Maine Hospital Association in Augusta. [return to top]

MMA Payor Liaison Committee Meets with New MaineCare Director
On Dec. 8, members of MMA's Payor Liaison Committee met with new acting Bureau of Medical Services Director Chris Gianopoulos.  As Bureau Director, Chris essentially is the MaineCare Director, as the Bureau is the Medicaid agency for Maine.  Chris had previously served as Director of the Bureau of Elderly and Adult Services for many years.

Discussion surrounded the historically low level of fees, the new claims management system and the continuing problems with the prior authorization program.  More discussions will follow.

MMA members should bring Medicaid issues to the attention of MMA staff so that staff can be aware of the problems.  Contact Andy MacLean or Gordon Smith at or [return to top]

New WellPoint Stock Soars After Merger with Anthem
In the wake of the announcement that Anthem, Inc. and WellPoint Health Network completed their merger earlier this week, shares of the newly created WellPoint, Inc. have soared.  Shares of WellPOint, Inc., trading under the new "WLP" ticker, increased 7.7% to $109.10 on the New York Stock Exchange at the close of business last Wednesday. [return to top]

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