Posted by:
JudyAnn Bigby, MD, Secretary of Health and Human Services

Yesterday marked a health care milestone in Massachusetts which I’m particularly pleased to blog about: Governor Patrick announced comprehensive health care payment and delivery reform legislation that is designed to control rising health care costs and improve patient care throughout the Commonwealth.

The Governor's proposal, “An Act Improving the Quality of Health Care and Controlling Costs by Reforming Health Systems and Payments,” builds upon the Patrick-Murray Administration's bold leadership and success in achieving universal access to health care in Massachusetts. The bill takes the next important step: it offers a solution to ensuring that health care is universally affordable.  This legislation changes the model for payments to providers and recognizes that doctors, nurses, and other providers want – first and foremost – to take care of their patients.

By encouraging the growth of “integrated care organizations” (ICOs), comprised of groups of providers that work together to achieve improved health outcomes for patients at lower costs, the bill offers alternatives to the current fragmented system that individuals find too complicated to navigate, especially when they have significant medical problems. Over the long term, providers who emphasize health and wellness or help individuals manage chronic medical issues, improve health and reduce system costs, but most importantly, make the patient experience better. In the current model, providers are not rewarded for those outcomes.  Through this legislation, the Commonwealth will change incentives in the payment system by providing the necessary infrastructure and support for global and other alternative payment methods and innovations. 

Specifically, this legislation:

• Encourages the formation of integrated care organizations (commonly referred to as Accountable Care Organizations or “ACOs”) by providing standard criteria for ACOs;
• Requires that an ACO be certified by the Division of Health Care Finance and Policy (DHCFP), with financial oversight by the Division of Insurance (DOI), and directs DHCFP to standardize alternative payment methodologies;
• Requires that if contracts between payers and ACOs include shared savings, that savings must also be shared with consumers;
• Provides that the Attorney General will use existing authority to monitor ACOs to ensure no anti-trust violations occur;
• Aims to expand the use of alternative payment methods and significantly reduce fee-for-service payments by the end of 2015;
• Ensures transparency of payer and provider costs, provider payments, clinical outcomes, quality measures, and other information necessary to discern the value of health services which helps guarantee that consumers and businesses have accurate and available information about their health care.

Today’s announcement not only reflects the Patrick-Murray Administration’s enduring commitment to harnessing the rising costs of health care, it also marks the emergence of the next phase in Massachusetts health care reform: viable solutions to make care affordable.

To read the full press release about today’s announcement: http://bit.ly/eGGzTa

To read the legislation: http://bit.ly/fF8QVx