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Rep. Sánchez On Progress and Challenges in MassHealth Delivery Reform Efforts

Rep. Sánchez On Progress and Challenges in MassHealth Delivery Reform Efforts

June 22, 2015

Health Affairs Blog Post by Representative Jeffrey Sanchez

Writing in the blog of the leading national health policy journal Health Affairs, state Health Care Financing Committee co-chair Representative Jeffrey Sánchez provides a balanced summary of MassHealth's efforts to push delivery reform forward.

The post, titled Tackling Medicaid In Massachusetts, looks at both the progress we have made, and the serious challenges we have encountered.

After mentioning the success we have had at meeting the cost growth benchmark for 2013, Sánchez frames the issue with the context of the critical role MassHealth plays in the state's health care system:

Now we plan to address our Medicaid program, known as MassHealth. The MassHealth budget has reached 14 billion dollars, more than 30 percent of the state budget expenditures, and the program now serves one-quarter of the state population. MassHealth in its current form is financially unsustainable. If we are serious about improving the health of our residents and bending the cost growth curve, we need to address the state’s biggest provider of health care.

Massachusetts Governor Charlie Baker has announced his intentions to make significant changes to MassHealth within the coming year. He is conducting a series of community listening sessions to gather data on how the program operates and serves individuals. The legislature will certainly have an important role to play in any future reforms.

As House Chair of the Joint Committee on Health Care Financing, I am traveling around the state with my committee members and meeting with a variety of stakeholders to better understand the program and its impact. There is general agreement that the program needs to change, but the specific changes needed are up for debate. We need to go beyond just spending more money and truthfully evaluate the manner in which that money is spent and how it impacts patients.

Chair Sánchez then laments the low level of participation (just 3% of PCC practices) in the Primary Care Payment Reform Initiative, in part due to the lack of sufficient patient data being provided to providers. He's hopeful that the newer Delivery System Transformation Initiative will be able to support the investments necessary to prepare for the transition away from fee-for-service payments toward alternative payment arrangements that hold providers accountable for the quality and cost of care. The key is enhancing communication:

Massachusetts is on the right track with the design of our SIM Initiative, DSRIP/DSTI, and other Medicaid reforms. However, implementation of these policies has proved challenging. From our experience, real-time data and on-going communication between providers, payers, patients, and policymakers are essential for successful adoption of delivery and payment innovations.

Ultimately, Chair Sánchez sees Massachusetts' as again providing a model for the nation:

As a state, we are taking these early experiences to improve implementation of existing policies and inform next steps for Massachusetts health reform. Other states can learn from Massachusetts’ efforts and ensure that stakeholder engagement, data synthesis, and real creativity are incorporated into any health reform endeavor. The next challenge for all states will be to move from scalable pilot programs, to effective state-wide efforts, and ultimately, to national success.

We agree - and we're pleased that Rep. Sánchez emphasizes the value of stakeholder engagement as we move forward.

    - Brian Rosman