Opening Letter

To Our Readers,

The theme of “strategy” is one that is appropriate for this newsletter for two reasons. One, in the past few months MPCA has finalized its three year strategic plan and has an exciting work to be done on the horizon. Two, the idea of moving our newsletter from an email format to a blog format was a strategic one in itself. With that thought in mind, we welcome you to our new blog format, one we hope will make our articles more accessible to an even broader audience.

As we live in what seems like a constant stream of communication changes, we at MPCA wish to stay at the cutting edge while remaining as accessible and current as possible. This accessibility is paramount to our members, but when it comes communicating the great work both we and our members are doing, the accessibility is important to the public at large.

Not only are we looking strategically at communication, but also throughout our organization. Through adding new positions, examining new programs, and seeking funding opportunities on a spectrum of new and existing populations and practices, we continue to positon ourselves strategically to continue being a national leader as both a PCA as well as individual health centers.

Following, as always, is a collection of perspectives of the work being done by both PCA staff as well as health centers. We invite you to take time to read through and reflect on not only how you are working strategically, but also how you can implement more strategic planning into your everyday processes.

We would also like to take this time to wish all of our readers a happy and healthy holiday season.

Happy reading and happy holidays,

Jeb Murphy

Director of Communication and Data Coordination

Introducing Cecelia French, MPCA's Quality Improvement Project Manager

Hello! My name is Cecelia French and I am beyond thrilled to have joined the MPCA staff in October as their Quality Improvement Project Manager. I will be leading MPCA’s efforts in Emergency Preparedness and Breast/Cervical Health Initiatives, as well as supporting other quality improvement programs. I come from an undergraduate background of medical biology and sociology and have pursued interests in public health through medical missions and various internships. I am currently finishing my Master of Public Health in epidemiology at Boston University and will graduate in January. I am particularly passionate about the social determinants of health and utilizing epidemiological studies and measures to aid in combatting health inequality. I am grateful to be able to start my career in public health, working to improve healthcare in the great state of Maine.

Fostering Strategic Partnerships to Improve Quality in Maine Community Health Centers

One important duty to fulfill as a membership organization for Maine’s Community Health Centers (CHCs) is to form and maintain strategic partnerships with entities whose missions align with those of the Maine Primary Care Association (MPCA) and the CHCs. Achieving high quality in the primary care setting is an ongoing process that requires many stakeholders to be engaged. This engagement allows CHCs to move toward improved quality as a state.  The following paragraphs summarize a few examples of strategic partnerships MPCA has, and how they have impacted quality improvement.

1.       The American Cancer Society (ACS): MPCA, ACS and eight CHCs completed a two-year project (Dec 2013 – Nov 2015) focused on increasing colorectal cancer (CRC) screening rates through the use of Fecal Immunochemical Tests (FIT). The FIT kits are a less invasive, highly specific, lower cost screening modality that can be offered to patients who refuse a colonoscopy. Thus, addressing patient barriers while also increasing screening rates for the practice. Partnership on this project has led to a New England wide Learning Collaborative on CRC improvement that is modeled after our two-year project.

2.       The Maine Cancer Foundation (MCF): MPCA’s current work with MCF is focused on tobacco assessment and cessation rates in two CHCs. Both participating CHCs had high screening rates at the beginning of the project, but their cessation referral rates were struggling. One CHC has been able to increase their focus on behavioral health through this project by establishing protocols to refer tobacco users for brief interventions with their behavioral health staff. They have also started to work with the Center for Tobacco Independence to provide training for their clinicians.

3.       HealthInfoNet (HIN): Over the next year, MPCA is working with HIN to connect eight CHCs bi-directionally to the exchange. Currently, most CHCs can view the data available on HIN and this interface will allow them to also upload patient information – creating a fuller patient profile available to users across the state.

4.       i2i Systems: MPCA has partnered with i2i Systems very closely over the past three years to implement population health management software in eight CHCs through our Health Center Controlled Network (HCCN). The two software platforms i2i offers (Tracks and PopIQ) allow CHCs to increase their reporting capabilities beyond what is available through their EHR. Additionally, CHCs who are members of the HCCN are beginning to share population health level clinical quality data openly through PopIQ. This allows CHCs to improve as a network by supporting partnerships between low and high performers for particular measures.

These are just a few examples of the strategic partnerships MPCA has created in an effort to assist CHCs in reaching their clinical quality goals. They have allowed MPCA and the CHCs to participate in a number of meaningful population health interventions, implement useful software and collaborate to increase the flow of clinical data across the state.

Oral Health Strategy in the Primary Care Setting

By Ashley Mills

In 2000, former Surgeon General David Satcher released a report on Oral Health in America, revealing how oral disease is a silent epidemic, especially in underserved populations. Three years later, former Surgeon General Richard H. Carmona built upon Satcher’s report and released a National Call to Action to Promote Oral Health. This Call to Action highlighted the many disparities related to oral health and charged individuals, whether as community leaders, volunteers, healthcare professionals, researchers, or policy makers, to collaborate and promote oral health and reduce disparities.

Satcher’s report also highlighted how oral health is essentially the gateway to general health and well-being. Yet so often, oral health is disregarded in primary health care settings. In order to improve general health and well-being, we must work strategically to integrate oral health prevention and improve the dental referral system in primary care in order to promote oral health and reduce the many relative disparities.

As MPCA works to align and integrate oral health with primary health care, we will utilize the practical model introduced by Qualis Health, and released this year in a white paper: Oral Health: An Essential Component of Primary Care. Among a call to action and many other educational discussion topics on oral health, the white paper models a framework for successful preventative oral health delivery and referral improvement in primary care settings.

Briefly, the strategic integration model is essentially a 5-step streamlined framework. The five steps that can be easily taken to integrate oral health care into an already established system can be simplified to the following terms: Ask, Look, Decide, Act, and Document. The first step in the process is to ask brief questions regarding patients’ oral health care (i.e. do you have a dentist?). Second, the physician or even the medical assistant looks in the patient’s mouth to determine if there is anything significant they can see. Then, the physician or medical assistant can decide what actions to take next by reviewing and discussing their findings. Acting involves discussing intervention and referrals, if needed. Lastly, documenting the findings and actions taken. This way, follow-up and referral close-out is possible.

The white paper also compares this integrative strategy with behavioral health integration to illuminate the similarities and help visualize the possibility. For example, early intervention can reduce impact and prevent complications. Both are present in primary care, and can interfere with general health care. Differences that are important to recognize include provider education, underdeveloped relationships, billing and payments and the lack of a structured referral process.

The strategy used to drive change in behavioral health integration can be adopted and adapted in order to successfully integrate oral health in the primary care setting. As MPCA works to introduce this framework, our efforts will be focused on protecting and promoting oral health within established medical care offices in an organized and efficient manner.

                Soon we will be releasing a survey to: 1) gather baseline data/information regarding the state of Oral Health in Maine’s FQHCs; 2) seek out grant opportunities for improving access to Oral Health, reducing Oral Health disparities and improving overall Oral Health; and 3) build concrete Oral Health offerings and implement effective Oral Health improvement strategies to enhance the overall health of Maine’s FQHC patients.

Emerging Views on Risk Management as a Strategy

As we enter the era of value-based payment, aligning management strategy with “systems thinking” will be essential to achieving high levels of performance.  Following are some thoughts on relevant concepts and practices as they relate to systems, quality, safety culture, and risk management.

A model of healthcare systems:

The word “system” is often used in conversations about healthcare, yet its meaning is rarely defined.   Recognizing the need for a common definition, the Institute of Medicine (IOM) introduced health professionals to the Sociotechnical System model of healthcare in its 2012 report “Health Information Technology and Patient Safety.”  Sociotechnical systems, per the IOM, are comprised of people, technology, process, organization, and environment.  The performance of the system is described as a product of the dynamic interaction of these components, and it is the unanticipated effects of component interaction that can undermine the quality and safety of care.  For example, a flawed medication reconciliation process may result in the persistence of an out-of-date medication list in an electronic health record.  A clinician utilizing this information might unwittingly prescribe a contraindicated medication.  The ensuing medication error would be due the interaction of the clinician, information technology, and reconciliation process—not individual incompetence. The performance of people is shaped by the system of which they are a part.

The new view of quality and safety in complex systems

An extensive body of research has revealed that healthcare systems are not inherently safe and that human error should not be seen as a cause of poor quality care or patient harm, but as a manifestation of deeper problems within the system of which people are but one part.  In this view, the human component of the system is alone capable of creating safety in the course of making decisions and performing work.  People recognize anomalies, identify problems, and mitigate the potential for adverse events.  Failures occur when a confluence of factors unexpectedly undermines the intentions of individuals and groups within an organization—exceeding their ability to detect, avoid, or mitigate risk.   

Safety Culture

The emergence of this new view of adverse event causation has led to widespread adoption of the term ”safety culture,” coined in the 1986 report on the Chernobyl Nuclear Reactor 4 disaster (International Nuclear Safety Advisory Group (INSAG), 1986).  Safety Culture reflects the extent to which individuals, teams, and leaders at all organizational levels strive to remain aligned in the continuous work of creating safety through their values, strategies, attitudes, and behaviors.   The horrific nuclear disaster at Chernobyl was tightly linked to the erosion of safety culture.

A key feature of a strong safety-oriented culture is the routine elicitation of staff perception of change in system performance, and by assessment of the potential risk(s) associated with change.  This is essential because failure typically arises from the unanticipated side-effects of change to system components (e.g., staffing, processes, facilities layout, technologies…) that are not addressed by strategies and protocols that respond to known sources of risk.  Rapid identification of emergent risk and prompt mitigation hinges on the expertise and practices of frontline supervisors and their teams; their ability to detect anomalies, recognize aberrant situations, and to respond effectively and efficiently as a team to mitigate the risk of an incident, or to stop the progression of an adverse event and recover. Leaders can make or break these capabilities and must reinforce a cultural orientation toward safety and quality continually through both word and deed.

Implications for Risk Management and Performance Improvement

Risk assessment must shift from a focus on discrete components of the health system (for example, the expectation that the introduction of information technology into clinics would, by itself, eradicate myriad safety and risk issues) to a focus on the interactive context of care and the potential for unintended side-effects of change--whether triggered through changes within our work settings, or by events in external settings. The era of pay-for-performance is upon us and the shift from a component-oriented risk assessment and mitigation strategy, to a system-oriented risk assessment and mitigation strategy is necessary to match management capability with the demands of pay-for-performance.

From The Maine Migrant Health Program

Serving Maine’s Wreath Workers in Washington County

The Maine Migrant Health (MMHP) Program has had a successful season serving the men and women who make it possible for companies like Worcester and Whitney to provide wreaths to Wreaths Across America and Maine’s quintessential balsam products to holiday greens retailers. Maine’s wreath workers are primarily local Mainers living DownEast or have Haitian or Latino backgrounds coming from points across the US and Mexico to work in the area for 6 weeks. The long hours including tipping boughs for the wreaths and assembling them. MMHP, a health center without walls, provides on-site medical care from its mobile unit during the chilly nights after long workdays. Partnerships with local providers such as Harrington Family Health Center, DownEast Community Hospital, MaineCoast Memorial Hospital, and the optometry practice of Dr. Thomas Crawford ensure that the patients receive medical, dental, and vision care that MMHP cannot provide on the mobile unit. Most patients do not speak English, so the culturally and linguistically appropriate care coordination provided by MMHP is essential to ensuring that patients are well taken care of and able to access the broad range of medical services needed during their time in Maine. MMHP’s network of Camp Health Aides (CHA) and Community Health Workers (CHW) provide essential components of outreach, clinic coordination, and health education. Many thanks to all the providers, staff and partners who are making this year’s wreath season a success for patients and business alike.

From HealthReach Community Health Centers

Kingfield Health Center Thankful for Successful Food Drive

 Sherra Osgood, Practice Manager

Sherra Osgood, Practice Manager

The Mt. Abram Health Center staff would like to say thank you to the people of Kingfield and surrounding communities who donated to their Thanksgiving Food Drive.  The health Center received 113 pounds of food donations and reached the goal of providing five complete Thanksgiving dinners to local families in need.

“The community really showed their generosity this year through food and monetary donations,” said Sherra Osgood, Practice Manager.  “We sincerely appreciate the thoughtfulness of our patients and community members during the holiday season.”

Many individuals also donated money, which will be used to stock and replenish the health center’s onsite food closet throughout the upcoming year.  Patients are encouraged to visit and use the food closet anytime the Health Center is open.

For many families and individuals in Franklin County, food insecurity is a harsh reality that must be faced 365 days a year. If you would like to support Mt. Abram Regional Health Center’s ongoing effort to keep their food closet stocked, please consider a cash or nonperishable food donation.


From Penobscot Community Health Care

Penobscot Community Health Care (PCHC) has been named a "Leader in LGBT Healthcare Equality" for the fifth year in a row in the Healthcare Equality Index, an annual survey conducted by the Human Rights Campaign (HRC) Foundation.  PCHC was the only healthcare facility in Maine to achieve the status and earned top marks for its commitment to equitable, inclusive care for LGBT patients and their families. 

PCHC hosted “A Home for the Holidays” Benefit Dinner and Auction at the Bangor Conference Center on December 2nd  to raise final dollars to complete critical facility renovations in the comprehensive shelter, health clinic, and transitional housing units at Hope House Health & Living Center. More than 300 community members, local leaders, and businesses were in attendance to support those who are homeless in our community.  The event raised almost $100,000 in sponsorships from the generosity of 43 local businesses, community organizations, and individuals.  PCHC also rasied $17,000 from donated items acutioned at the event.

From Sebasticook Family Doctors

Sebasticook Family Doctors has gone to the dogs - and cats, birds and any other non-human companion that one may have.

The Kibble Club is a new program at SFD and is designed to assist low-income patients in feeding their furry friends especially during the winter months.

“Animals provide comfort day and night, they don’t mind being told the same story over and over again, provide companionship and completely unconditional love,” said Alexis Winslow, animal lover and intern at Sebasticook Family Doctors, and mastermind behind the Kibble Club. “But animals need proper nutrition and attention to survive so we want to help. Pets are an important part of a family, especially for seniors. Pet can give them a sense of purpose.”

Studies have found that that pet owners are healthier, have less stress, and use less medication. They also recover faster from surgery and illness, tend to deal better with stressful situations, and are less likely to feel lonely. And the need for social contact and support is often not met for older individuals who may have lost friends and family members.

            The Kibble Club is completely funded by donations of either pet food or money, with which supplies can be purchased. People are encouraged to drop off donations at any one of SFD’s five locations.

“We are hoping some stores will support the cause as well,” said Winslow. “We would happily take the damaged goods because we just tape up the bags and pass them on.”  

            There are eligibility criteria to become a member of the club, including being a patient of Sebasticook Family Doctors, meeting the income guidelines, and ensuring the animal is spayed or neutered. This is a supplemental program only can cannot be the sole source of nourishment for the animal but it will help.

            Patients complete a form agreeing to the terms and are given a membership card to present when they pick up their allotted pet food.

            “If we can help with pet food, than the patient can spend the money on medicine, or food for themselves or on oil,” said Winslow. “It is heartbreaking to think that some people have to choose between basic necessities. And people who love their pets are going to put them first.”    

            There are naysayers, of course, with judgmental overtones who chide that if people cannot afford to feed themselves, they should not even have a pet. But aside from the health benefits pet ownership bestows, sometimes circumstances change and an illness or lost job can be financially devastating.

“The answer is not to take the pet to a shelter but to help and support the owner,” added Winslow.

            This is a tough road to be sure. Programs that depend strictly on donations face challenges. But Sebasticook Family Doctors is up to it.

            “That’s what we do here,” said Winslow. “We take care of our patients and help them in any way we can. We never want to think of a family that has to give up their beloved pet. We just had to do something.”

             Family. Whether human or furry – that’s what Sebasticook Family Doctors is all about.


Sebasticook Family Doctors serves Canaan, Dexter, Dover-Foxcroft, Newport and Pittsfield.