Several weeks ago, Gov. LePage highlighted something well worth discussing when it comes to health care in Maine. Speaking on a news-talk radio station, our governor made the important point that our healthcare system has to shift from treating disease to keeping people well.

“If you’re sick, we pay doctors to get you healthy instead of paying doctors to keep you healthy,” he said. “I think we’d want to keep society healthy instead of treating illness.”

I completely agree.

The governor went on to suggest that Maine’s hospitals were “sitting there waiting for people to get sick instead of working with people to keep them healthy.”

On that point, there may be more to the story.

Maine’s local health care delivery systems are in fact making good progress towards a system of care that emphasizes healthy communities.

While the Affordable Care Act has been a contentious development in politics, tucked inside its 2,700 pages is an idea that was gaining bipartisan support well before the Act’s passage, and it is one that has the power to galvanize and transform our healthcare system. People can and do differ on how to get there, but what insiders call the “Triple Aim” sets out three clear goals that should be a source of consensus when it comes to our health care system.

The three tenets are:

Better health for the population;

Better care for individuals;

Lower overall cost of care.

But what does it really mean? How are doctors and hospitals changing what they do to reach these lofty goals? And what impact does that have on patients and their experience in our health care system?

When I was first starting out in medicine, the concept of population health was not front-and-center for doctors. We were trained to focus on the person before us, and to make each decision in the context of what was affecting our patient and how we could best treat that patient.

Public health in my mind and that of many others was a matter for the public sector, driven in most places by government-run public health agencies.

When I was a kid growing up in Minnesota, I remember public health being a very public thing indeed. Immunizations were given by nurses to masses of students gathered in the school gym. I’m sure there was a permission slip system of some kind, but we all just lined up and got our shots. Later, when I was still a student and my wife and I first started our family in Minnesota, our kids didn’t get their immunizations from the pediatrician either. We brought them to a public health clinic in St. Paul where the shots were free, something that was helpful to a young family with very little money.

My career took us to California before we finally settled in Maine, and there again, the public health system in the Golden State was robust and something quite apart from my work as a physician.

Over 25 years ago when we were lucky enough to settle in Maine, I found things here to be very different. Maine was and remains one of a handful of states without a comprehensive public health delivery system. And 20 years ago, Gov. LePage’s concern that our healthcare system focuses too much on treatments and barely at all on wellbeing would ring absolutely true.

But in recent years there’s been a measurable shift. Today in Maine, public health isn’t something that is carried out comprehensively by government, though the state is an important partner. Instead, our hospitals and medical practices have taken on the mission, spurred on by the Triple Aim.

The state has partnered with hospitals and other providers to provide a range of programs and care initiatives that have made a real difference. From smoking cessation to youth obesity, programs run by healthcare providers have leveraged state grant dollars to make a real difference. And organizations like mine have been working on new clinical initiatives like our AMI Perfuse program – which coordinates cardiac emergency care throughout our system – that have had measurable impacts on specific disease conditions.


And Maine also boasts a statewide program unlike any in the country that brings our four major hospital systems and the Maine CDC together every three years to assess community health needs and assist local hospitals in developing plans for improving community health.

These efforts have yielded real results statewide. Just this month, the New York-based Commonwealth Fund, a highly respected nonprofit foundation dedicated to measuring and improving the performance of healthcare organizations nationally, ranked the Portland region as a top performer, placing it in the top 20 percent of more than 300 across the country. The overall rank of 40th was helped by a strong performance in “prevention and treatment” (23rd overall) and a good showing as well (85th) in the measures related to “healthier lives.”

Of the measures my organization tracks, we are beating national averages in increasing childhood immunizations, decreasing tobacco use, combating obesity, reducing hospitalizations and decreasing cardiovascular deaths. Of the things we follow, only cancer deaths show as worse than the rest of the country. It is notable, however, that as drug overdose deaths have risen nationally, Maine has mirrored the trend. We clearly have important work to do there, and our system has formed a working group to develop a system-wide plan to address the problem.

The commitment to healthier communities also extends to how doctors practice medicine and how care is paid for.


One emphasis has been an effort to enhance primary care in local communities. There is a model in health care called the Patient Centered Medical Home, and like so much of what we do, it is accompanied by metrics and certifications. But for the patient, what it means is a primary care practice that takes care of the whole person. That means coordinating care with specialists, but it also means making sure a patient is cared for with regard to mental health, social service needs, substance abuse or any other issue that would impact their health. It means, too, that primary care providers have to view their patients less as people with conditions to treat and more as people with health to maintain.

As a practical matter, this can mean longer and ongoing conversations about quitting smoking, weight loss, exercise habits or any other issue affecting their health.

This relationship-driven approach to medicine is at odds at times with the traditional fee-for-service model of paying for health care.

In response, there is a movement toward new payment models that reward good patient outcomes and lower overall costs. The MaineHealth Accountable Care Organization is one of several efforts underway in the state to change payment models, and it has met with some initial success working with Medicare. This will also become an opportunity for collaboration with commercial insurers and the MaineCare program.

None of this is to say we in Maine have arrived at a healthcare system that lives up to the full promise of the Triple Aim. There is much more work that needs to be done.

But we are making progress in partnership with the state and others, and more such partnerships would help get us closer to that vision.

Maine hospitals and their healthcare delivery systems have a clear and well-developed focus on keeping society healthy, a trend that is only going to grow.