For the past six months, local attention on the Massachusetts health reform law has focused – appropriately – on the complex and difficult decisions faced by the Commonwealth Health Insurance Connector Authority as we attempt to make coverage available to the half million state residents without health insurance. Blue Cross Blue Shield of Massachusetts – an original and vocal supporter of the reform movement – has participated actively in this public debate and will offer an array of new, innovative products to individuals and small businesses seeking coverage under the new law.
But the public focus on the Connector has obscured what should – over time – become an equally influential public body – the state’s new Quality and Cost Council. The Council is chaired by the Patrick administration’s new Secretary of Health and Human Services, Judy-Ann Bigby, M.D., who has a longstanding commitment to quality and equity in health care.
The architects of the reform law understood that sustaining the affordability of health insurance would depend on slowing the growth in health costs. And that is why the Legislature created a Quality and Cost Council, charged with establishing health care quality improvement and cost containment goals and then acting to ensure that the goals are attained.
For too long, the conventional wisdom among health experts is that it is impossible to improve both access and quality while simultaneously moderating costs. We believe – and research increasingly demonstrates – that the opposite is true: that the most promising route to controlling costs is to improve the quality and effectiveness of health care.
Patient safety is a great place to start. We believe that the Council can learn from “best practices” here and around the country. In Pittsburg, for example, Allegheny General Hospital was able to reduce a common, deadly and costly type of infection (central-line associated bloodstream infections) to near zero in just one year, despite an increase in patient volume. Allegheny has sustained this low infection rate for three years, thereby saving lives and reducing the financial exposure of the hospital and the community.
The immediate measure of the success of our health reform law will be our ability to extend affordable insurance to the uninsured. Our long term success, however, will depend on our community uniting to moderate health spending by making care safe and effective for every patient, every time. The Quality and Cost Council has a unique opportunity to build a shared vision that delivers the full promise of health reform: not just universal coverage but universal quality as well.
Andrew Dreyfus is the executive vice president for health care services for Blue Cross Blue Shield of Massachusetts and the former president of the Blue Cross Blue Shield of Massachusetts Foundation.
But is Allegheny General Hospital world-renowned?
And does MittCare cover visits to Allegheny? Or will another $400/mo. need to be mailed to a separate corporate headquarters in Penn. too?
For those who will participate?
I think this thread gets to a critical issue in this debate that has received too little attention. It also brings into focus some important distinctions between insurance, health costs, and health care.
I’m lucky because I have had health insurance as long as I can remember. However, high-quality insurance has not always translated to high-quality health care. In fact, from my perspective, the care part of the equation is getting worse, even as my insurance premiums rise. This has serious implications for the commonwealth as more people sign up for the insurance programs under the new law.
In June of 2005, my primary care physician of some 15 years retired. At the time, he recommended another doctor in his practice at Tufts New England Medical Center. But, in July of 2005, I entered a graduate program and was required to purchase primary care coverage through my school. The health center assigned me to a primary care physician.
During my year in school, I never saw my assigned physician. She was on maternity leave for most of the school year, and when she returned, she was so heavily booked that I could not schedule a physical before I graduated.
After graduation, I contacted my old doctor’s office to sign up with the physician he recommended. I was told it would take at least four months to schedule a physical.
After eight months of trying, I still have been unable to schedule a physical due to the fact that the doctor only sees new patients one day a month. As a result, it has been two years since I have had a routine physical.
Now, this is a relatively minor concern in one sense, but how often have people developed conditions that a physical would have caught at an early stage that preempted severe illness and expensive care?
Now, economists will tell you that consuming health care drives up the cost of insurance, so for the time being I am helping to keep insurance costs down by not consuming health care.
But, if I, or anyone else with insurance, can’t see someone who can perform basic preventative care, we could end up with more serious and expensive problems or end up having to break down and visit an emergency room at much greater cost to everyone.
The state is in the process of adding tens of thousands of people to the insurance rolls, and therefore increasing the demand for health care services.
So, while the commonwealth fixates on the rollout of the new insurance law, and while experts toil away to make insurance affordable to everyone, if people ignore the underlying issue of health care, and making it accessible, efficient, affordable, and effective, all the insurance in the world won’t make us any healthier, or save us any money in the long run. The flipside is that better care will drive down costs for everyone.
Sorry to hear of your troubles, Sean. Those of us working in “the system” (I’m a nurse) know that it’s broken on just about every level and your experience is very common. This is why so many citizen activists have been working for fundamental system reform for years and years.
Many people still get good care but way too many do not as a direct result of policy-makers refusal to tackle the interrelated problems in system access, cost, and quality. These issues are inherently related and are interdependent so cannot be seperated. Tackling these issues in a serious way requires regulation of the insurance and hospital industry in a serious way.
Lawmakers have consistently refused to do step up to the plate on this, resulting in willful neglect of our healthcare system that has been ongoing for years.
See for yourself by asking Senator Richard Moore for transcripts from the last 10 years of State House hearings before the Joint Health Care Cmte on the proposed MA Health Care Trust bill, or ask the many long-serving lawmakers why only one state office-holder publicly supported ballot Question 5 for fundamental health system reform in 2000.
Folks, don’t have the wool pulled over your eyes yet again; this post of Andrew Dreyfus’is misleading when he states: “…the conventional wisdom among health experts is that it is impossible to improve both access and quality while simultaneously moderating costs.”
Nothing could be farther from the truth.
As has been stated before on this blog and elsewhere, more people than not who are involved in the system know that healthcare system reform cannot be successful nor effective without using an approach that treats it as a system comprised of 3 major components:
1. Access to care
2. Quality of care
3. Cost of care
Because these 3 components are fundamentally interrelated and interdependent.
Not understanding this system dynamic or intentionally crafting reforms that ignore it in order to placate powerful interest groups such as the insurance industry and/or powerful hospital chains, is like trying to treat a person having a heart attack without understanding and addressing the interrelatedness and interdependence of the heart, the lungs, and the brain.
This approach is quite likely to have disappointing and harmful results, just as our current reform plan that builds on the wasteful and costly private insurance industry without enacting regulations that require fair and meaningful cost controls and quality indicators will have disappointing and harmful results.
Health policy experts, authors of journal articles, books and major research projects on health reform and health system economics understand this and have published on it. Health care providers understand this. Many patients and family members understand this. This is not rocket science nor is it anything new.
When are people going to wake up and realize that THE EMPORER HAS NO CLOTHES!!!
Our broken healthcare system is the way it is because lawmakers and citizens allow it to be treated as a commodity in the profit-driven marketplace rather than an essential social good that should exist for the benefit of one and all.
Treating health insurance and healthcare as a commodity wastes HUGE SUMS of money and drives down access and quality of care. In MA and in the U.S. we spend two and a half times MORE on hc than all other industrialized countries yet we rank 37th in quality, cost effectiveness and access as mesured by the World Health Organization. We must demand to know where all that money is going, because it’s our money!!!
In MA we collectively spent $62 BILLION last year on HC; it is the largest item BY FAR in our state budget (the budget that has a >$1Billion deficit for next year)
The Emporor clearly has no clothes.
Who do you think should take the lead to fix this mess – the health insurance industry that is a prime creator of the new “individual mandate” plan?
To learn about a different approach to health reform, one that is people and patient-centered you can visit http://www.DefendHealth.org or http://www.MassCare.org/about We must harness the existing momentum for reform but dramatically re-chart the course for the benefit of all.