A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Commence Phase Four

Commence Phase Four

July 31, 2012

At around 10:30 Monday night, the legislative leadership released the text of their bill called "payment reform" for short in the State House, but majestically formally titled "An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency, and Innovation" (read the bill text here, and download the legislature's 4-page summary here (both pdf)).

In its 349 pages, the bill does much more than just push our insurers and other payers to use what are called "alternative payment arrangements." There are major investments in prevention, changes to insurance laws, malpractice and mandatory nurse overtime provisions, hospital checklists, investments in health workforce and health information technology and a restructuring of the state's health care administrative structure (please join me in mourning the demise of the Division of Health Care Finance and Policy, whose name I picked out in 1996). There's a lot here, and we'll be doing a "hidden treasures of the payment reform bill" post in a few days.

The summary of the 349-page bill is titled "The Next Phase of Massachusetts Health Reform." While many will be calling this phase 2 of health reform, our vision goes back much further. By our count, this is phase 4. Our once-a-decade list starts with the 1988 Universal Health Care law that is still the legacy of Governor Dukakis, the creation of MassHealth in 1996, and, ahem, RomneyCare, as they say (we don't), in 2006. This law meets the lofty standard of those 3 earlier reforms, and like the 3 before, will have a national impact.

Today's bill completes the process started in 2007, when HCFA filed comprehensive consumer-driven cost control legislation, and urged the legislature in 2008 to form a payment reform commission. The next phase will be implementation, which, of course, is more complex and more impactful than legislation.

Fulfilling the pattern of 2008 and 2010, the legislature will be voting on July 31, the last day of the session, on a major health care bill. We strongly urge a yes vote. Here's the text of our statement:
-Brian Rosman

Statement from Health Care For All Executive Director Amy Whitcomb Slemmer Regarding the Cost Control and Delivery System Reform Legislation

"We applaud the House and the Senate for reaching an agreement on the health care cost and delivery reform legislation. This historic legislation affirms Massachusetts' leadership in consumer focused health care innovation, and we expect the nation will again look to the Massachusetts experience as a model for quality, affordable care for all.

"This bill is good news for health care consumers in Massachusetts. By changing how doctors, hospitals, and other providers are paid, the bill aligns incentives to promote patient-centered care focusing on health and disease prevention, while lowering health care costs. By paying for quality, not quantity, our state's health care delivery system will be better and more cost-effective.

"The legislation improves the quality of care patients receive by encouraging the active participation of patients and their families in making health care decisions. A truly transparent and integrated system allows patients to make informed decisions about their care. We are particularly grateful for the legislators' vision and requirement for strong consumer representation on the Health Policy Commission and individual ACO governance because it ensures that the patient voice will be represented in decision making.

"We are pleased that the final version of the bill includes a number of provisions that put patients at the center of our health care system. Strengthening the roles of medical homes, community health workers, valuing chronic disease management, and providing for licensed alcohol and drug counselors in the delivery of services is both cost effective and will lead to greater consumer empowerment and better overall health.

"We strongly support the creation of the Prevention and Wellness Trust Fund. By providing $60 million in funding for proven disease prevention programs, the legislation will begin to move us away from a sick care system and towards a true health care system that is aligned and focused on keeping us healthy. This first-in-the nation fund is established for four years in the bill. We support providing the fund with a permanent sustainable funding mechanism so that these cost-saving programs continue to keep us healthy.

"We support the integration of behavioral health into the overall health system through the establishment of behavioral health medical homes and the vigorous implementation of the federal Mental Health Parity and Addiction Equity Act. Together these laws will make it easier to navigate and access this part of our health delivery system.

"We are also pleased that the law continues the Massachusetts insurance rebate program, which provides rebates to consumers when insurers do not spend an appropriate amount of our premium dollars for medical care.

"The next challenge will be to implement this comprehensive legislation. Health Care For All is looking forward to working closely with members of the Patrick Administration, elected leaders in the State House, and the members of the Health Policy Commission to swiftly and effectively implement this groundbreaking law."