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By Dr. JudyAnn Bigby

The urgent need to change the way we pay for health care is a challenge facing all residents of the Commonwealth. Today, residents are paying more out of pocket while their benefits are decreasing.  The most detrimental consequence of this rising cost phenomenon is that people refrain from getting the health services they need when they need them, which eventuates in higher care costs that impact all of us.

This week, the Patrick-Murray Administration’s Division of Health Care Finance and Policy (DHCFP) convenes four days of hearings at Bunker Hill Community College in Boston The hearings will examine trends in the cost of health care, analyze potential solutions for curbing costs, and further underscore the need to move forward with reforming current systems, to ensure access and quality while achieving cost containment.

Testimony at the hearings will help the Division develop and deliver a final report with viable recommendations from prominent stakeholders in the health care system (including providers, payers and health care policy experts) on how to increase efficiency in the Commonwealth’s health care delivery system.

The full reports, written testimony, and related hearing materials are available online at http://www.mass.gov/dhcfp/costtrends.

The findings described in the Division's reports are not surprising and they highlight the need to think comprehensively about how to decrease costs and to act now! However, we must address more than the cost issue if we want to maintain access to care, improve the quality of care, and at the same time bring down costs. It is increasingly clear that we need to transform the health care delivery system. So rather than focusing on the price of an admission or test or procedure and how many of these we pay for, we need to focus on processes of care, clinical practice improvement and improving quality. We know that we have a combination of too little care delivered or too little care delivered in the right place, such as in primary care practices instead of the emergency department. We know that some are receiving too much care or the wrong care and this not only drives up costs, it's also harmful. All this goes on as the costs of care to consumers, employers and government keeps going up!

The answer to this conundrum is a value-based system that is focused on ensuring that residents are getting the best value out of their health care dollars. A system based on value for the patients will align incentives to achieve the outcomes we want: access and quality at lower and sustainable costs. Value in health care is not determined by the price of one unit of care and a quality measure that approximates whether an outcome for that unit of care is acceptable. Rather, it should be determined by the patient's outcome of care over the full cycle of care. In order to realize this value we need integrated systems of care and we must pay for that integration.

This week's hearings provide an opportunity to hear diverse opinions about interventions to control costs and improve care as well as the role of government in promoting these changes. I am excited about what we will learn and look forward to ensuring that as we continue to develop programs and work closely with the Legislature to produce a bill the Governor can sign this fall, we will take advantage of the wealth of information presented today.

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