Amid Maine’s continued economic fragility, tax relief is now the top policy priority on both sides of the aisle. With restricted tax dollars, the state will struggle to meet growing demands for jobs, health care access, social services and education.

In this climate, Maine must be clever and brave enough to accomplish more with less, clever to see new opportunities and brave to try them out, even when they challenge strong arguments for business as usual.

A major item in our toolbox is the notion of regionalization. This is the idea of consolidating services to reduce spending on administrative overhead, which sounds simple and obvious in theory.

Three contiguous towns may have three separate fire departments with three administrative structures, three firehouses, three training operations, three accounting departments and three of everything else. A regionalization plan might result in one fire department serving all three towns, saving significant administrative overhead costs while potentially delivering more modern and coordinated fire service to the three towns.

Yet, as usual, the devil is in the details: Which institutions become larger regional entities and which ones are integrated into them? Which fire station and which fire chief inherit the regional title, and which ones are folded into the new fire department? What town will willingly part with its fire station, even if they know it will save money and improve service? Questions of which institutions benefit, and which do not, are controversial, highly political and essential if any regionalization initiative accomplishes its objective of delivering more with less.

Regionalization has enormous potential in the health care sector, where any benefits would have widespread implications not only for the health care system itself, but for the economy and culture of Maine, which is in many respects driven by the challenges of rising health costs and the need for improved access to care.

The recent report of the Hospital Study Commission, though flawed in some respects, is to be applauded for its willingness to ask the right questions about the potential for regionalization in health care. The state abounds in opportunities for reallocating health services to accomplish substantial operational and capital cost savings, while protecting, and in many cases advancing, quality. Conservatively, I would estimate hundreds of millions of dollars per year in Maine could be saved and overall quality significantly improved.

Creative collaboration is not new to the health care community. Our health system and all of my health system colleagues around the state have engaged in hundreds, if not thousands, of collaborations to achieve better, more efficient health services. Indeed, the health care sector ought to be renowned among business sectors for its innovative collaborations.

Still, we have only begun to tap the full potential for cost saving improvements. The key will be fostering this creative potential and asking the right questions and our willingness to put aside some of the politics. The health care community can and must be engaged in moving forward toward increased efficiency and even more regionalization.

Franklin Memorial Hospital recently engaged in a voluntary regionalization process, working with our local towns to regionalize our ambulance services. We consolidated five regional EMS services into one new service to be called NorthStar EMS, with anticipated improvements in the quality of our service along with savings of more than $125,000 per year, an amount currently paid by local property taxpayers.

NorthStar will build on the heritage of those five longstanding services: Rangeley, CES, AMPS, LifeStar and Sugarloaf Ambulance Services. We plan continued improvements in equipment, staff retention, computerization of operations, communications and service quality. For the first time, we will also deploy EMS staff to community service opportunities when they are not occupied by emergencies.

None of this is simple or easy, and some of our residents are more comfortable than others with the impact of NorthStar on their towns. Most have been willing to give this a try, and we commend these individuals for their courage and innovation. The long-term advantage to residents is dramatic: NorthStar will have the capacity to maintain a top-quality service with up to date equipment and training, and deploy its resources strategically to offer the maximum benefit at the least cost to taxpayers.

NorthStar is one among many precedents for voluntary collaborations among Maine citizens and health care providers. With the state serving as a motivator – not a mandater, since the public resists government intrusion on personal health decisions – there is potential for dramatic improvements statewide.

In health care and other sectors in Maine, regionalization will be one tool to achieve our common goals of achieving more with less, though it may sometimes seem uncomfortable or painful. We need to persist in asking the right questions about business as usual, because business as usual is not working anymore. While there may be limits to Maine’s resources, there are no limits to our resourcefulness as long as we are all willing to be a little more clever and brave.

Richard Batt is president and CEO of Franklin Memorial Hospital.