FOR THE BETTER part of this decade, Massachusetts had been on a roll regarding its health system’s performance. Since passage of the 2006 universal health insurance law, we’ve been tops in having the lowest number of uninsured the nation. Recent national surveys on cost, quality, access, and public health from the Commonwealth Fund, the United Health Care Foundation and others show the Bay State to be best or among them. As Michael Widmer noted in his October 7 Upload piece, over the past five or so years, even the state’s performance on controlling costs has also been a national standout.
Still, history teaches that these trends can turn downward on a dime. And self-congratulations can obscure lingering and insidious system weaknesses. The current controversy over the proposed merger of Beth Israel Deaconess Medical Center, Lahey Health, and other hospitals and physician organizations into “Beth Israel Lahey Health” (BILH) brings into sharp relief underlying systemic problems that are getting worse, not better.
Last week, the state’s Health Policy Commission released its final analysis of the cost, quality, and access impacts of the merger. They estimate $158.2 to $230.5 million in added annual costs above current projections from this deal. Also last week, the health commission reported on the projected annual costs of Question 1, the November Massachusetts ballot initiative that would set statutory nurse-patient ratios in all acute care hospitals – estimating $679 to $949 million in new annual costs in our $61.1 billion state health system. Continue reading “What Does the Beth Israel/Lahey Health Merger Tell Us?”
[This commentary was published on June 24 on the Commonwealth Magazine website.]
PHASE 2 OF THE BAKER ADMINISTRATION’S ambitious health reform agenda emerged this past week. It contains good and smart proposals – and worrisome ones needing attention.
Phase 1 is an ambitious effort to transform much of the state’s Medicaid program, known as MassHealth, into “accountable care organizations.” ACOs aim to focus hospitals, physicians, and other providers on improving population health, care integration, and efficiency. That effort, blessed by the outgoing Obama administration last November, is well underway – unless congressional Republican efforts to repeal the Affordable Care Act throw everything into a tailspin.
Phase 2 came last week, when the Baker administration released a set of proposals to Senate and House leaders, a package of changes to MassHealth and other health programs aiming to save $314 million in fiscal year 2018, which starts July 1, and more beyond. All the proposals need state law changes (to be incorporated in the nearly finished FY 2018 state budget) and/or federal approval. Continue reading “5 Takeaways from Baker’s New Health Reform”
[I wrote this commentary for the Spring Issue of Commonwealth Magazine to profile Massachusetts’ new move into accountable care organizations, an experiment that deserves watching. Dr. William Seligman co-wrote with me.]
IN A WILDLY uncertain national health care environment, something new, audacious, and risky is happening in MassHealth, the Medicaid program that provides health coverage to 1.9 million people who are poor, elderly, and persons with disabilities in Massachusetts. Gov. Charlie Baker’s administration is betting that an emerging health care delivery and payment model, called “accountable care organizations,” can restrain rising costs by keeping enrollees healthy and out of expensive settings, especially hospitals. Positive results will have big consequences for the state, for medical providers, and for hundreds of thousands of MassHealth enrollees who will become part of ACOs this year and into the future.
The ACO scheme is the major part of a massive new federal Medicaid waiver that Team Baker won from the outgoing Obama administration days before the November 8
election that put Donald Trump in the White House. The Obama administration liked the Baker plan because it fit with their mission to move US health care away from expensive fee-for-service payment and toward value-based financing that rewards quality and efficiency. Though no one knows for sure which way the Trump administration will move, right now it’s full speed ahead at MassHealth on the ACO agenda. Continue reading “MassHealth Dives into Accountable Care”
Below is an article — Setting Hospital Prices by Ballot Initiative — just published in the winter edition of Commonwealth Magazine:
A LOOMING 2016 ballot initiative threatens to upend the foundations of hospital finance in Massachusetts, even if the measure never reaches the voters. The clash involves a fractured hospital community, insurers, a labor union, and state government in a controversy more than 25 years in the making.
For decades, savvy Massachusetts policy entrepreneurs have learned to use the threat of a statewide ballot initiative to compel legislative change that would never have happened absent the ultimatum. I saw this up close in 1994 when Common Cause forced major campaign finance reform through a Legislature eager to avoid the group’s more punishing ballot proposal. In 2000, health care advocates used this strategy to win passage of a managed care patient bill of rights. In 2014, the Massachusetts Nurses Association used the tool to score a new policy in their 20-year grudge match with the Massachusetts Hospital Association over state-mandated nurse/patient staffing ratios. Used well, the strategic ballot initiative is a proven and powerful public policy tool. Continue reading “A Looming Ballot Question May Upend Mass. Hospital Payments”