There is a growing consensus that Massachusetts must shift health care spending to reward the quality of care patients receive, not the volume. There is a lot of concern about who will win and lose if/when that shift happens. I’m linking to a few of the blueprints offered at public hearing yesterday hosted by a new state commission looking into payment reform.
Secretary for Health and Human Services JudyAnn Bigby asked the commission to consider a system where private and public insurance programs would pay all doctors, hospitals and other health care providers the same rate for the same service. You can read her testimony here. She talks about payments based on a episode of care…could be a single surgery or a year of treatment for patients with chronic conditions like diabetes. This system assumes that someone would coordinate and be responsible for our “episode.” It would be tough for all the docs who practice on their own or in small groups. Bigby suggests that docs in western Mass for example could join some kind of regional center for help with IT and other back office operations.
Lucian Leape from the Harvard School of Public Health also stressed the need for coordinated care to help end waste, errors and uneven care. His testimony is here. Again in the Q and A I was stuck by the discussion about individual physician practices. Leape says they will have to merge into larger groups on some level if a coordinated payment/care model is going to work.
Closing the gap between what primary care docs and specialists make comes up again and again in this conversation. Alan Sager from the Boston University School of Public Health offered a model for boosting primary care physician payments from about $150,000 now to $250,000 and capping the number of patients at 1,000. This might persuade more medical school students to choose primary care, decrease the oversupply of specialists and thus the tendency to see one when it may not be necessary.
Most of the people who testified agreed that there is enough money in being spent on health care already…the challenge is to redirect it to pay for more preventive care that focuses on keeping people healthy.
Martha Bebinger
When are you going to curb costs for the subsidized Commonwealth Care plans that weren’t affordable for so many back in 2007? People can’t afford the copays and are discouraged from seeking care or showing up at health care centers unable to pay but are treated nonetheless.
How about those expensive but crummy Commonwealth Choice plans that won’t save anyone from medical debt short of a heart-lung transplant?
And what happened to the Connector’s and MA legislators’ theme that MA residents would see their premium costs decrease with health care reform?
So far, it’s about the insurance companies and your political careers. That about sums it up.
It’s all sleight of hand. First take over the lives of the low-to-middle income hard-working MA taxpayers and then go after the doctors. The talk among people is that MA residents live in lock down – in a dictatorship. Sounds about right.
Good points, curious.
Also, why is there no asset test to receive MassHealth? I know several who are working part time and in cash businesses who live very comfortable lives, have no shortage of cash in the bank, have beautiful homes in affluent towns, drive brand new (2009) cars, and are on MassHealth.
…and the rest of us cannot even buy a bogus Commonwealth Choice plan for a reasonable premium.