Improving the quality and integration of health care is one of the primary goals of the Patrick-Murray Administration’s efforts to contain health care costs. Alternative payment methods will work to contain health care costs only if Massachusetts has enough providers who are prepared to coordinate their efforts to deliver the highest quality, person-centered care. In July the Executive Office of Health and Human Services received 42 responses to our “request for information” (RFI) on the development of integrated care organizations, commonly known as Accountable Care Organizations (ACOs). We want to use the information to ensure the transformation of the delivery system to one where primary care is a strong foundation and providers are encouraged to deliver integrated care without compromising their commitment to their patients. Indeed, the major outcomes that we want to see as a result of more integrated care and payment incentives to promote change are to maintain people’s health so they don’t need healthcare services at all; patients manage chronic diseases to reduce costly emergency department visits and hospitalizations; and reduce complications associated with hospital and other care and unnecessary readmissions. We want to stop paying for poor quality and unnecessary care.
Encouraging the formation of integrated care organizations has the potential to improve the quality of care by encouraging providers to collectively take on the responsibility of delivering appropriate care across a health care system as opposed to individual providers acting in isolation in multiple clinical settings. Governor Patrick’s February legislation calls for the state to ensure that certain clinical standards, quality measures and financial conditions are met to ensure that patients’ access to care is not compromised. The concept of integrated care organizations is still new and recent analysis raise important considerations.
Some of the issues we are exploring and want to resolve in partnership with others include maintaining competition in the market by encouraging multiple right-sized ACOs, ensuring that physicians have appropriate leadership in ACOs, understanding the investments that are required for transformation, legal barriers, how to best protect consumers’ access to care, and the role of health plan design to encourage consumers to seek high quality, less expensive care. We appreciate the diverse range of respondents who address these and other questions.
ACOs are the topic of conversation everywhere in the country. The New England Journal of Medicine recently published a perspective by Paul Ginsberg of the Center for Studying Health System Change that rightfully points out that ACOs are a response to the fee-for-service system, one which rewards excessive consumption of health care services but fails to promote the management of chronic diseases; and to the failure of managed care and capitated payments in the past which provided incentives to physicians to restrict access and take on too much financial risk. A recent report by the Commonwealth Fund emphasizes the need to ensure that providers have the data and analytic capabilities to manage the patient populations for which they take on financial risk and to negotiate appropriate risk-sharing arrangements with payers. A commentary in the Journal of the American Medical Association explores whether the establishment of ACOs could have on health disparities and the role of quality reporting to monitor disparities in quality of care.
There is tremendous potential for this next phase of reform to improve the quality of care and contain costs. As we review the responses to the RFI I am sure we will note thoughtful solutions to some of the problems we anticipate and learn about new issues we have not considered. While the Administration is still completing its analysis of the responses we received, we are making the responses available to the public. See instructions below on how to access the RFI responses online.
The Patrick-Murray administration is committed to working together with the federal government, the state legislature, providers, payers in the state, employers, consumer advocates and others to make progress on this important reform.
To access the RFI responses:
1. Click here.
2. In the upper left-hand corner, click on the ‘Solicitations’ tab
3. Click on ‘Search for a Solicitation’
4. In the ‘Document Number’ field, enter 11LCEHSACCTCAREORGRFI and click search
5. Click on ‘there are one (1) solicitation(s) found that match your search criteria’
6. Click on the eyeglasses
7. Click on the Updates tab
8. Click on the eyeglasses icon
9. Select and download response
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