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

Last Tuesday, Governor Patrick signed a bill into law that will provide immediate relief for small businesses and help to lower health insurance premiums.  At the signing ceremony, the Governor restated his commitment to making health care as affordable as it is accessible.

There are a lot of new opportunities in this law for employers and others to help manage health care costs.  For example, insurers will be required to offer a “select network” or a “tiered network” with premiums that are 12% lower than a standard product.  Small employers will be able to form cooperative health plans, which allow small businesses to band together to negotiate premiums with insurers. The Connector, along with the Department of Public Health, will provide subsidies to small businesses to initiate wellness programs for their workers. To read more about these provisions here.

The Division of Health Care Finance and Policy (Division) will play a major role in implementing parts of the new law. These efforts include:

  • Integrating Health Care – The Division has been charged with developing “bundled payment” pilot programs that promote clinical integration of services, particularly for sick patients with chronic and acute diseases. Bundled payments essentially provide a single payment for all medical services related to a condition or treatment.
  • Promoting Transparency – The Division is trying to make the Massachusetts health care system more transparent by developing meaningful ways of understanding the cost of care.  Under this new legislation, we’ll now need to define and collect data on total medical expenses or “TME,” relative prices, and hospital inpatient and outpatient costs for public reporting.
  • Improving Quality – I will be chairing an advisory panel that will make recommendations to the Department of Public Health in developing a “standard quality set” of measures to better inform the delivery of medical services and allow for meaningful comparisons of providers on uniform, objective measures.

While these are great steps forward, it is important to note that the tools we are working to develop will only be useful insofar as employers use them to engage with their employees and to become more prudent purchasers of health care.

I hope to hear from you about how the Division can provide the information employers need to help be part of the solution in controlling health care costs and improving quality.

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