QC History 2003 - 2015
Early Days: Improving Chronic Illness Care
Maine Quality Counts (QC) began in the fall of 2003 when it was recognized that many providers and organizations in the state were starting to take steps to improve chronic illness care, and that there would be real benefit to sharing this learning. This was a short time after the publication of the Institute of Medicine’s “Crossing the Quality Chasm” report, and around the time that Dr. Ed Wagner and his colleagues at the MacColl Institute (Group Health) had developed the “Chronic Care Model” as a synthesis of best practices for improving chronic illness care. Driven by this shared recognition and belief in the value of promoting a systems approach to improving chronic are, Dr. Karen Bell (at that time, Medical Director of Blue Cross Blue Shield of Maine) and Dr. Lisa Letourneau (at that time working for MaineHealth) brought together a diverse group of stakeholders with a plan to convene a statewide conference to communicate the growing business case for changing systems of healthcare, and to expand on successful efforts to date to improve chronic care.
We convened a multi-stakeholder Advisory Group that decided to hold a series of statewide conferences on chronic illness care. We aimed to use the conferences to familiarize stakeholders with the elements of the Chronic Care Model, including the business case for quality, and to show how Maine healthcare providers had successfully implemented the model to improve outcomes. We wanted to demonstrate how systemic change was improving care in Maine primary care practices, and to make that case that all stakeholders needed to take an active role to improve health care quality and costs in Maine. We felt that we needed to do more to forge collaborative relationships between providers, employers, and payors to speed broader adoption and support sustainability of the Chronic Care Model.
The First Conference
The Quality Counts, Part 1 conference was held in December 2003, with close to 200 attendees representing providers, employers, payers, and policymakers. The conference highlighted the Chronic Care Model, and provided specific examples of Maine providers who were using population-based approaches and information systems to improve care. In addition, links were made between Quality Countsand key health policy initiatives in the state including Dirigo Health.
Quality Counts, Part 2 was then held in April 2004 with over 300 people attending, and featured Dr. Ed Wagner, primary architect of the Chronic Care model. The conference successfully engaged additional stakeholders, focused on further understanding and implementation of the Chronic Care Model, and provided more specifics on how to implement its components in practice. At that meeting, Dr. David Stephens (then at AHRQ) challenged attendees by asking us whether we would simply all just disperse after the conference, or whether we would commit to working together on a continued shared agenda to improve chronic care. The group of conference planners took the challenge and quickly drafted the following mission which was brought to the full group of attendees and energetically endorsed at the end f the meeting:
“Quality Counts is committed to working together across organizations and across communities, to improve healthcare systems and outcomes with the people of Maine. Quality Counts will work with Dirigo Health to coordinate existing but disparate efforts across the state that support local, patient-centered, and coordinated systems of care AND the resources that support them. Its goals are to promote consistent delivery of high quality care; improve access to healthcare; and contain healthcare costs.”
Becoming an Organization
Following the success of the initial conferences, an Advisory Group was convened and held a strategic planning meeting in July 2004. The group reaffirmed a commitment to work together to promote comprehensive adoption and assessment of the Chronic Care Model across Maine, and adopted the mission noted above. The group further agreed that the primary organizational functions for Quality Counts would include providing leadership and serving as a change agent for promoting improved chronic illness care; influencing state health policy; advocating for change; coordinating and inventorying existing improvement efforts; improving communications between and among health care resources; and facilitating technical assistance such as training and education. Members of the Advisory Group were invited to become Corporators of Quality Counts (now Member organizations), which subsequently filed for incorporation for Quality Counts as a distinct corporate entity in the state of Maine in June 2006. The QC Corporators then elected an initial Board of Directors representing employers, providers, government and consumers.
The next step forward came in February 2007 when Quality Counts, in conjunction with the Maine Health Management Coalition and the Maine Quality Forum, was selected as the lead agency in Maine for the Robert Wood Johnson Foundation’s (RWJF) Aligning Forces for Quality initiative, an effort that sought to lift the quality of health care by aligning efforts on performance measurement and public reporting, quality improvement assistance to providers, and consumer engagement on the use of quality data. RWJF recognized the Aligning Forces initiative as one of its major strategic initiatives, and offered continued funding for this work, which expanded to include a focus on improving health care equity and changing payment systems. Shortly following the AF4Q award, QC sought and was awarded IRS 501(c)3 tax-exempt status as a public charity in April 2008.
Following that start, many other stakeholders in the state joined QC, and have contributed to its success as a multi-stakeholder regional improvement collaborative and neutral convener seeking to align improvement opportunities in the state. In addition to our work under AF4Q, and with the support of other grants and contracts, QC took a leadership role in 2008-2009 to serve as one of the key conveners of the multi-payer Maine Patient Centered Medical Home (PCMH) Pilot, launching what has become a 6-year effort to lead a statewide initiative to transform primary care models and payment.
In 2009, QC engaged in a strategic planning process that updated our mission and identified the following vision, and strategic priorities, which have remained in place since that time:
Mission: Quality Counts is transforming health and healthcare in Maine by leading, collaborating, and aligning improvement efforts.
Vision: Through the active engagement and alignment of people, communities and healthcare partners, every person in Maine will enjoy the best of health and have access to patient centered care that is uniformly high quality, equitable, and efficient.
- Further increase system alignment to transform health and healthcare
- Promote a sustainable system of quality improvement assistance to all providers in Maine
- Foster meaningful consumer engagement in transforming health and healthcare in Maine
- Promote integration of behavioral and physical health
- Assure the organizational success and sustainability of QC needed to meet our mission
In 2010, the QC Board endorsed its “10 Simple Rules for Alignment”, establishing a key commitment to aligning improvement efforts in the state.
In 2011, QC was asked to change its name (after being notified by an organization in Wisconsin of a potential copyright infringement, noting it produced a health care report on quality with the same name), and legally changed its name to Maine Quality Counts.
Expanding Reach and Scope
Since the passage of the Affordable Care Act, QC has leveraged many opportunities to participate in national and local health care reform efforts, and has led a range of initiatives related to delivery system and payment reform, including the following:
- 2010: Maine PCMH Pilot
- 2010: QC launches FirstSTEPS Collaborative and QC for Kids efforts to improve child health
- 2012: CMS Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration
- 2012: Launch of Community Care Teams
- 2013: MaineCare Health Homes, expansion of PCMH Pilot
- 2013: QC 2014 features Don Berwick – reaches 800+ attendees
- 2013: Launch of Choosing Wisely in Maine
- 2013: Maine State Innovation Model (SIM) initiative – QC contracted to support Health Homes, Behavioral Health Homes Learning Collaborative, Patient-Provider Partnership (P3) Pilots
- 2014: MaineCare Behavioral Health Homes launched
- 2014: QC 2014 features Doug Eby
- 2014: Launch of Maine Chronic Pain Collaborative to address crisis in opioid prescribing
- 2014: Launch of Chronic Disease Improvement Collaborative to improve diabetes, HTN care
- 2015: QC implements staff/structural reorganization to build project management capacity
- 2015: QC 2015 features Atul Gawande, hits maximum capacity of 1200 attendees
- 2015: Launch of Spreading Choosing Wisely in Maine
- 2015: QC selected by CMS to lead Northern New England Practice Transformation Network
2015 marked the largest expansion of QC’s quality improvement support to medical practices, funded by the award of a three-year contract with the Centers for Medicare and Medicaid Services (CMS) to engage more than 500 primary and specialty practices across Maine, New Hampshire and Vermont in the Northern New England Practice Transformation Network, a regional component of CMS’ national Transforming Clinical Practice Initiative.