Northern Maine Medical Center: A Rural Hospital Gaining Momentum in its Work Toward Quality Improvement

Northern Maine Medical Center (NMMC), a 49-bed, prospective payment hospital located in Fort Kent, Maine, was one of six organizations selected to participate in the 2022-2023 Rural Healthcare Provider Transition Project (RHPTP).

During its year-long engagement, NMMC worked with RHPTP’s financial and operational technical assistance (TA) consultants from Stroudwater Associates to identify top opportunities in the current payment environment that will result in improved performance and help determine financial risk and strategies to address operational cost efficiency. The NMMC team also worked with consultants at Stratis Health to focus on building a solid foundation for ongoing quality improvement (QI) across the organization, including establishing a shared and consistent approach to QI to improve efficiencies, workflow and communication.

Below are some of the hospital’s top accomplishments and early outcomes made possible through its RHPTP participation.

Top Accomplishments:

• 84% improvement in operating margin
• 100% quality health improvement program (QHIP) quality incentives obtained 
• 44% increase in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Summary Star Rating
• 66% increase in patient portal usage 
• 64% improvement in pre/post building infrastructure that embeds quality improvement in practice assessment
• 136% improvement in pre/post Population Health Readiness Assessment
• Began marketing annual wellness visits via social media and the hospital’s digital sign 
• Increased rural health clinic visits by about 300 patients
• Hired a Performance Improvement Director 
• Created a quality assurance and performance improvement (QAPI) plan and reporting structure 
• Developed and implemented staff training plans for a “Stop the Line” campaign and QAPI education
• Implemented strategies that support diversity, equity and inclusion within the organization
• Created departmental organizational charts for tracking quality improvement initiatives
• Successfully introduced formal Lean training for leaders and managers
• Performance Improvement Director achieved Lean white belt certification
• Introduced monthly newsletters that focus on quality improvement, service, employees, growth, community involvement and finance 
• Re-engaged the hospital’s Community Advisory Group that provides financial, quality, program service and health care provider updates

The NMMC team has reached its goal of implementing all of the quality areas of improvement recommended by Stratis Health TA consultants. Departments now have organizational quality charts which allow leaders to connect staff to goals, increasing staff engagement and accountability. The NMMC team has begun to see a shift in staff understanding and attitudes toward QI now that each of them - including frontline staff - can see exactly how they contribute to the positive changes. As new staff are hired, quality improvement is introduced and emphasized from day one with increased education during onboarding. 

The hospital's new department-wide quality bulletins - which highlight QI topics and concerns - have improved communications between teams and staff. Since relaying updates to the community is also a priority, the NMMC team re-introduced the hospital's Community Advisory Group, a group composed of community members who meet quarterly to discuss health care challenges, successes and needs. 

As a result of its financial and operational work with Stroudwater consultants, and the strong support and engagement of hospital leadership, NMMC has improved its operating margin and revenue cycle controls and metrics, lowered its cost structure, and better optimized all available revenue. Additionally, the hospital executed provider contracts that offer incentives aligned with hospital strategies. Stroudwater consultants guided the NMMC team in implementing the tracking of population health data within the hospital's electronic health record system, which has brought visibility to important population health concerns. The hospital has also successfully increased its annual wellness visits through a comprehensive marketing plan. Over the last year, NMMC has seen a 66% increase in patient portal usage, thanks to the team’s dedication in educating and engaging patients. 

The momentum of the NMMC team's work in RHPTP has built over the last year and is now beginning to result in positive measurable outcomes such as increased star ratings and improved scorecards. Many processes learned from RHPTP TA consultants are replicable in moving toward value-based care, allowing the team to envision what additional departments, or areas of improvement could benefit from the project. The hospital's future goals and next steps include increasing feedback to providers from annual wellness visits, adding physician scorecards, developing onboarding training for hospital leaders, creating new departmental quality improvement materials and considering roadblocks to primary care access in the community. Participation in RHPTP has helped create a pathway for many of the organization's goals, while considering population health and sustainability along the way. Above all, the NMMC team is stopping to reflect on the progress that staff members make and celebrate accomplishments along their journey to value-based care.