Introducing…Massachusetts Health Care Reform, Part Two

Gov. Deval Patrick

By Carey Goldberg and Rachel Zimmerman

Let the history books record: On Feb. 17, 2011, Massachusetts officially launched Health Care Reform II, seeking to go where no state had gone before and stem the relentless growth in medical costs by transforming the system of health care.

Amid a sea of dark business suits Thursday morning, Gov. Deval Patrick presented his plan to the Greater Boston Chamber of Commerce at the InterContinental Hotel (the proposed legislation is here). Speaking so emphatically that at one point his voice broke to a high note, he told the gathering:

“Universal health care in Massachusetts has been a resounding success, and rightly serves as a model for what’s possible for the rest of the nation, but it costs too much. Health care in Massachusetts is now universally accessible but it is not universally affordable.”

Later that day, the governor filed a bill on containing health costs and transforming the system of payment, and also held his first meeting with a “working group” of health care, business and other leaders on his plan.

Patrick described his bill as consisting of four main pieces:

1. It proposes to provide a set of standards and benchmarks for the formation of Accountable Care Organizations and other alternative payment methodologies. (That is, ways to shift the system from “fee for service,” in which providers are paid for each procedure,” to a system of “global” or “bundled” payments that put a provider on a budget for a patient’s overall care and give bonuses for quality.)

2. It empowers the commissioner of insurance to consider a wider array of factors when deciding whether to approve premium increases, including the underlying provider rates and how they compare to medical cost inflation. (Read: the state has more power to crack down on high premiums and costs.)

3. It creates an advisory council of stakeholders and consumers to monitor how payment reform is implemented.

4. The bill seeks to redirect the system of medical malpractice in favor of apology and prompt resolution, to deemphasize so-called defensive medicine.

An additional point: It sets up a new state office to act as a “one-stop shopping” point to help “innovators in the medical community” with pilots and other experiments. And its overarching aim is for new-style health care organizations with incentives for healthier patient outcomes to predominate by 2015.

Overall reaction among attendees in the hubbub after the speech appeared largely positive, but this phrase kept popping up: “The devil is in the details” and the details aren’t clear yet. You can listen to some initial thoughts from health care leaders who were there here, here, here and here. And click here for the skeptical morning-after reaction.

Excerpts of Gov. Patrick’s remarks are here, and WBUR is scheduled to air the governor’s speech in its entirety this Sunday.

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  • Ed~

    We still don’t have a Healthcare Plan in the U.S. Not even in Mass…

    This law does not allow for reducing costs (for medical procedures nor for medicine) through bargaining by a strong insurer.
    It does nothing to curb the +25% waste that private health insurance companies consume for each $1 (advertising, overhead, CEO salaries).

    It also does nothing to help doctors and hospitals reduce their staff costs for fighting private insurance for fee reimbursement and payments.

    When a healthcare system is run on a profit-first motive, WE the consumers lose. Always.

    Does little good if you offer coverage and services to everyone if it isn’t “affordable”. In the case of healthcare, this is often a matter of life & death. That’s why this “healthcare industry” is so profitable… and so inhuman in the Healthcare Market decides what is fair in the United States rather than We the People.

  • MedMalStore

    I have been back and forth on the whole health care reform idea, as I’m sure many have.  Everyone knows that something needs to be done, but nobody seems to want to go in the obvious direction.  We value life so highly and standard of life nearly as (sometimes more) highly.  I am surprised that we are not seeing more news about caps on malpractice damages than we are.


  • AppDev

    You can read the Governor’s proposed law in controlling health-care costs. I did.
    An act improving the quality of health care and controlling costs by reforming health systems and payments

    The law does allow the insurance commissioner to regulate provider rates [Sec. 17], but that is just a Band-Aid on a fee-for-service system. It does not regulate amounts of services delivered and billed.

    The law does not require or set a timetable to require capitation payments. They remain voluntary. It only sets up a process for adopting payment regulations [Sec. 14] and a “pilot program” [Sec. 21(d)]. If no organization signs up for it, the “pilot program” is an empty program.

    There is an attempt to include Medicare in the payments system [Sec. 21(a)], useless because the state is not a participant. Surprisingly, there is no provision for Medicaid, where the state has a major role.

  • Razia Gupta

    These are all good ideas but I think reform for medical malpractice is critical. The high costs that defensive medicine is adding to health insurance premiums affects everyone. Reform is needed but I don’t think caps are the way. Caps will help bring down medical malpractice insurance rates, but it does little to help patients who are severely injured. ( see ). We need reform that is original and will help both sides. I think we could see a huge decrease in defensive medicine which will in turn bring down health insurance premiums. It will also bring relief to doctors who are being squeezed from lower reimbursements and higher costs of doing business.


  • Paul Levy

    Here are some comments about the Governor’s prosposals: