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David_morales Posted by: David Morales, Commissioner, Division of Health Care Finance and Policy

About a month ago I began provider site visits across Massachusetts as a way to better understand health care system delivery issues, local market dynamics, challenges, and opportunities to integrated care and provider leadership visioning in an evolving health care marketplace.

Last week I spent some time with several providers in Western Mass. and got an up-close view of their innovative responses to reimbursement challenges, evolving patient utilization trends, and integrated care planning. A few key lessons merit pointing out:

  • First, these providers recognize that they are employers –- often the largest employers in the area –- and that they are uniquely positioned to “nudge” consumers’ health care decisions toward complete, integrated, and lower cost care. By partnering with other area employers, these hospitals and physician groups are beginning to develop "purchasing networks" that collaborate with insurers to create low-cost, local-care plans for their employees. Their goal is twofold: lower the annual cost of care and premiums and develop innovative health care benefit plans that better meet the specific needs of their employees.
  • Second, Massachusetts is a dynamic state and every area is very different. Western Mass. is confronting its own set of challenges and operates in a distinct labor market from the eastern part of the state. Small businesses make up the majority of their business leadership and employment base and as such there are fewer dedicated human resource managers to handle their health benefits. Providers operate in challenging market areas (including competition from Connecticut and New York) and must plan for geographic realities that are different from eastern Mass. In particular, recruiting a highly-skilled workforce to isolated community hospitals can be difficult.
  • Third, these providers are not working in isolation: hospitals, physician groups, employers, and health plans are at the table, collectively redesigning a health care system that is rapidly evolving. From access to primary care and "wrap-around" care, to smarter insurance benefits that reward quality and prevention, every stakeholder is thoughtfully engaged and planning for a health care delivery system that is moving toward better coordination of care and where more must be done with less dollars.

Because there is no one “right” solution for mitigating health care costs and system redesign in Massachusetts, we must be thoughtful, cautious, and pragmatic as we redesign our strong, yet complex, health care delivery system. Western Mass. offers some simple yet smart principles for us to consider as we continue to better plan for system integration: employers (of all sizes) must play a critical and active role, solutions must be tailored to the market realities of the geographic area, and candid and ongoing cooperation from all stakeholders is essential.

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