This week, a team from Massachusetts will travel to Chicago for the initial meeting of the State Quality Improvement Institute. The Institute is a program of Academy Health and the Commonwealth Fund to assist several states, including Massachusetts, to improve the quality of health care. Our team, led by Health and Human Services Secretary JudyAnn Bigby, MD, will have the opportunity to brainstorm on possible solutions to several important issues with national experts on those topics. This intense review will assist the Commonwealth to better conceptualize quality improvement strategies, analyze potential tradeoffs, and consider possible implementation tools.

The Commonwealth Fund, which is the sponsor of the State Quality Institute, issues an annual report card on state health system performance. Massachusetts currently ranks #8 in this assessment, and we hope that what we learn through the Institute will be put to use to improve our ranking and the quality of care offered to Massachusetts residents.

Why should we care about our ranking? Well, it’s not about ego or bragging rights. It’s about improving health care quality and containing health care costs through improvements in efficiency. This should matter to every working person in our state who pays for their health care through their share of health insurance premiums, their out of pocket costs, their employer’s share of health care through foregone wages, and their taxes which support the uninsured and other health costs.

A recent report by the Congressional Budget Office notes that with improvements in efficiency in the delivery of health care, “researchers have estimated that nearly 30% of Medicare’s costs could be saved without negatively affecting health outcomes if spending in high and medium cost areas could be reduced to the level in low-cost areas, and that those estimates could probably be extrapolated to the health care system as a whole.” Now, I’m not talking about the 30% savings that Single Payer advocates allege can be save by eliminating the current health insurance system. These are saving in the delivery of health care by providers.

Each state participating in the State Quality Institute has been asked to identify five of the quality indicators from the Commonwealth Fund Scorecard where they will attempt to make a difference in outcomes and, consequently, improve their position on the Scorecard. Massachusetts has selected, as its five quality indicators, the following:

1. Percent of adult diabetics who received recommended preventive care. Massachusetts currently ranks #11.

2. Medicare hospital admissions for ambulatory care sensitive conditions (ACSCs) per 100,000 beneficiaries (ages 65 and older). Massachusetts currently ranks #32.

3. Medicare 30-say hospital readmissions as a percent of admissions. Massachusetts currently ranks #41.

4. Total single premium per enrolled employee at private-sector establishments that offer health insurance. Massachusetts currently ranks 48.

5. Total Medicare (Parts A&B) reimbursements per enrollee. Massachusetts currently ranks last.

The goal of our efforts is to identify strategies to improve these statistics and utilize pilot projects to test the efficacy of those strategies. If quality outcomes improve at least to the level of the number #1 ranked state in these categories and costs can be contained, we will be on the right track to saving lives and dollars.

Of course, while we focus on these quality improvements as part of the State Quality Institute initiative, we cannot ignore our commitment to preventing hospital acquired infections, reducing falls in hospitals and nursing homes, or addressing some of the other quality indicators where our scores are embarrassingly low, such as:

· Colorectal cancer deaths per 100,000 population. Massachusetts ranks 39th

· Breast cancer death per 100,000 population. Massachusetts ranks 35th

· Percent of home health patients with a hospital admission. Massachusetts ranks 35th

· Percent of nursing home residents who were physically restrained. Massachusetts ranks 31st

· Percent of high-risk nursing home residents with pressure sores. Massachusetts ranks 29

· Percent of long-stay nursing home residents with a hospital admission. Massachusetts ranks 24th

The first two of these measures are a reflection on the need for all of us to get the required screening and tests for colorectal and breast cancer which, if diagnosed early, can often be successfully treated at a reasonable cost compared to the later costs of care. The other four indicators should represent a challenge to our long term care community – skilled nursing facilities, home health agencies, and others – to aggressively address these problems and to identify a strategy – working with the state – to improve the performance on these measures as well.

Senator Richard T. Moore
Senate chair of the Joint Committee on Health Care Financing