Volume 17, No. 2, Spring 2009
By Representative Cleon H. Turner
In the current economic climate, it may seem disheartening to realize that, yes; Massachusetts faces alarmingly high healthcare costs—among the highest in the country. Health insurance premiums have been rising steadily over the past eight years, and many argue that these costs are limiting the ability to expand access to care for all Commonwealth residents.
Massachusetts currently utilizes a fee-for-service system where services are unbundled and paid for separately. Under this approach, doctors and other healthcare providers receive a fee for each service, including but not limited to office visits, tests or procedures. The current payment system has been heavily criticized, with many arguing that it sacrifices both quality and cost and results in volume-driven rather than value-driven healthcare.
Hope comes in the form of the Special Commission on the Healthcare Payment System, established in 2008 to evaluate the current system and investigate reforms that would provide incentives for effective patient-centered care that would reduce variations in the quality and cost of care.
The Commission, which consists of 10 members, also is responsible for recommending both a common transparent payment methodology and a plan for implementing that formula across all public and private payers in the Commonwealth. The Commission first met in January and has held numerous meetings since then. Recognizing the drawbacks in the Commonwealth’s current payment system, it has been focusing on evaluating various alternative models, including medical home, pay-for-performance, episode-based and global payments. It also has been charged with investigating non-payment strategies such as evidence-based purchasing, global budget and tiered networks.
The Commission last met in April, where it expressed support for the global payment model. Under this plan, healthcare providers would receive fixed payments per month for each patient. The payments adjust to cover two types of services: partial and full. The difference depending on the range of services provided.
Partial covers primary care and/or specialty services. The expanded full global payments address primary, specialty, hospital and other covered services. The model stipulates that a provider group or network accept shared or full financial risk for care of covered persons.
The motivation for backing the global payment model includes the fact that it allows for risk adjustments in payments for severity or performance, and provides incentives to constrain unit cost, service mix and volume. It has also been previously tested. Notably, Blue Cross Blue Shield of Massachusetts expressed support for the system when it unveiled its new Alternative Quality Contract this year—a contract which incorporates a global payment model.
Of course, the Commission still has work to do. A global payment system, while attractive to patients, would require providers to bear financial risks for the care of covered patients. To address this, the Commission is meeting with stakeholders this month before submitting its final report to the legislature May 29. More information can be found on the Commission’s website: http://mass.gov/dhcfp.
(Representative Turner, D-Dennis, is a member of the Legislature’s Joint Public Health Committee.)
By Senate President Therese Murray
Last year, I introduced legislation that builds the foundation for a more transparent and efficient modern healthcare system. As part of that second phase of healthcare reform we laid out a trailblazing goal of statewide implementation of electronic health records as part of an interactive information exchange by the end of 2014.
Thanks to this commitment, Massachusetts is well positioned to maximize federal funding in this area.
The federal stimulus package includes support for providing access to the benefits of health information technology for every American by 2014. And there are reimbursement incentives through Medicare and Medicaid for providers to adopt this technology.
The stimulus legislation provides $2 billion to support grants and loans for health information technology, academic medical centers, interoperability testing, demonstration projects and further research and analysis.
There’s also an estimated $17 billion for Medicaid and Medicare incentive reimbursements starting in 2011 for providers and hospitals that use electronic health records. This translates into potentially more than $500 million in Massachusetts alone.
The state has provided $15 million in initial funding and established the Massachusetts e-Health Institute within the Massachusetts Technology Collaborative. Even before the federal bill was passed, the Institute had begun work on a multi-year implementation plan. This provides Massachusetts with a head start on other states that only now are beginning to plan for these systems.
Furthermore, a 5-to-1 federal match on state spending contained in the stimulus will multiply our own $15 million investment into $90 million for the e-Health Institute. Other states, in the midst of their own budget shortfalls, will be hard-pressed to make any significant investment that may receive a similar match.
We are now positioned to dramatically reduce duplication, provide higher quality care, empower physicians and consumers with more accessible health information, and ensure usability with standardized, uniform coding across the spectrum.
Most of these federal funds will flow directly to physicians and hospitals to reimburse them for purchasing these systems individually. This means the state must be proactive in ensuring that they make informed decisions.
Vendors and salesmen already are aggressively reaching out to doctors about purchasing particular software systems, some of which we know do not deliver on all of their promises. In the absence of impartial guidance from the state, doctors acting alone may be sold systems that will not meet future standards.
The state also must aggressively push high-quality systems that will be compatible with true health information exchanges. Electronic records alone do not provide the system-wide savings and quality improvements that are possible. All records must meet a high standard, with strong privacy protections, and be able to exchange information in real time.
Controlling the growth in healthcare costs will provide long-term benefits to our economic competiveness, as well as healthcare access. Massachusetts again leads the way.
(Senator Murray, D-Plymouth/Upper Cape, is the first female President of the Senate in Massachusetts history.)
By Senator Rob O’Leary
Thirty percent of Massachusetts school children are overweight. That’s shocking; but the more you learn about obesity in our schools the scarier it gets.
Over the past decade obesity rates have more than tripled among our school children. Today teachers struggle to fit in all of the required academic coursework they are expected to complete, leaving little time for recess and other forms of exercise or health education.
Massachusetts law only mandates that schools provide students with 30 minutes of physical activity a week, but even including playtime at the home, a third of our schoolchildren report exercising less than three times a week.
It’s time that our schools join the battle against childhood obesity.
An overweight child is being set up for a lifetime of bad habits and health risks. Obesity in children has been linked to an increased risk for type 2 diabetes, early-onset heart disease, sleep apnea, asthma, and psychosocial effects such as decreased self-esteem. In one large study, 61 percent of overweight children between the ages of 5 and 10 already had at least one risk factor for heart disease and over a quarter had two or more. Studies predict a 70 percent chance that an overweight child will be overweight or obese as an adult. Obesity-associated chronic diseases have become the first three leading causes of death in this country.
Some may argue that a child’s weight is an issue to be handled by parents and physicians. I disagree.
The Massachusetts Department of Public Health has just adopted a regulation requiring every school in the state to test the Body Mass Index (BMI) of students in first, fourth, seventh and tenth grades. The BMI determines if your weight is appropriate for your height. The results will be mailed home to parents confidentially, and parents can opt out of the testing. The hope is that school screenings will motivate families to adopt healthier habits for the sake of their children.
This legislative session I have been granted a new leadership post as Chairman of the Joint Committee on Education. Through this position, I hope to work on a variety of issues facing our school children, including finding a comprehensive way to address the growing problem of childhood obesity.
I want to explore programs that promote partnerships between cafeterias and local farmers, which would give schools access to healthy foods at affordable prices and provide local agriculture with new markets. More than 2,000 school-to-farm programs already exist in 39 states. Plus, some states, such as Colorado, regulate what beverages are served and sold in schools–an idea that may have merit here.
We could even go a step further and regulate what can be served in school lunches, an action taken recently by Texas.
And I want to explore the feasibility of sending school lunch nutrition facts home to parents, plus improve health education for our students so they, too, can evaluate nutrition information.
As I explore how best to address this issue, I welcome input from constituents. Together we can help make our schoolchildren brighter…and lighter.
(Senator O’Leary, D-Cummaquid, represents the Mid and Lower Cape and Islands and is a member of the Legislature’s Joint Public Health Committee.)