Transforming health care: Portland nonprofit trains doctors to be health care leaders

Jim Harnar, who's stepping down this month after serving 10 years as executive director of the Daniel Hanley Center for Health Leadership, has been thinking a lot recently about "impact."

"How do you measure impact? How do you evaluate what you're doing?" he says. "Measuring leadership can be a really elusive thing. We started out looking at it in the traditional way: Pointing to individuals who've taken one of the Hanley Center's leadership programs and who then stepped up into a position of higher authority. We can point to dozens of care providers who've done that, and that's a significant measurement: When you're out trying to build support for your organization, that's a very helpful data point."

One of the more sweeping examples is the Hanley Center's 6th annual leadership forum at the University of Southern Maine in June 2008 attended by nearly 75 health care leaders from across Maine. The forum tackled Maine's primary care system, focusing on the emerging "patient-centered medical home" model and payment reform issues arising from that model's emphasis on proactive medical care that fell outside traditional fee-for-service practices. The forum's participants identified six action steps and the guiding principles that could shape how those recommendations were implemented. Reflecting the Hanley Center's emphasis on collaboration, champions were identified to advance the six initiatives — among them, Maine Health Management Coalition, HealthInfoNet, Maine Quality Forum, Finance Authority of Maine and Maine Primary Care Association.

Fast forward seven years: In their first-year report on its State Innovations Model initiatives, delivered last November, Maine's SIM partners note that upwards of 74 primary care practices, with roughly 567 providers, are participating in the patient-centered medical home pilot program. Another 100 practices, with roughly 508 providers, are participating in a similar initiative for MaineCare, a federal/state program that provides assistance to people with limited resources.

Although the SIM initiative won't end until 2017, the first-year report cites a consensus among stakeholders that the transformation of Maine's primary care system is heading in the right direction — setting the stage for improved coordination of health care as well as payment reforms that are tied to keeping people healthy.