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

Chances are that you’ve never heard about the Division of Health Care Finance and Policy – unless you’re a serious health policy wonk. Unlike many state agencies, the Division’s primary purpose is not to manage direct care programs, but rather inform their development or impact. Since most people never need to directly interact with us, they don’t realize the wealth of information or analysis we offer. Coincidentally, many health care policy organizations rely on or use our reports to develop their own work.

Basically, the Division produces reliable and objective analysis of the Massachusetts health care delivery system … if it’s an important issue in health care, chances are we’re studying it. But here’s my conundrum – how meaningful is objective and quality research if it only gets read and reviewed by a limited audience?

When I started as Commissioner in January, I decided to focus on one very obvious need – engaging all of you with our work. It isn’t easy. I must admit, our stuff is pretty complicated. But it’s also critical – especially given national health care reform and ongoing discussions at the state-level about high costs and the transition to an integrated delivery system.

Over the next several months, I hope to accomplish two things: (a) continue producing high-quality work that helps demystify the MA health care delivery system and informs discussions about health care at all levels, and (b) provide that information in a manner that is easily accessible and understandable to a broader audience.

Specifically, I want to focus a substantial portion of the agency’s analytic capacity as a think tank on three key areas highlighted by findings in our recent cost trends reports (on the marketplace, premiums, and trends in medical claims as well as a final report): (1) Transparency, (2) Integration, and (3) Wellness.

Transparency:  Let’s be honest, today most people who use medical care have no idea what their care actually costs and believe that someone else is paying for their medical bill. As Dr. Michael Collins, chancellor of the University of Massachusetts Medical School and senior vice president for health sciences at the University of Massachusetts, recently wrote in "Transparency a key to reform," an opinion piece in the Worcester Telegram & Gazette, “we need easy access to the true price of our office visits, hospitalizations, and diagnostic tests. If we can find out the price of a hotel room or a cross-country flight with a few clicks of the mouse, we can lift the veil currently covering the price tag attached to health care.”

To that end, we recently proposed regulations to collect and make data available on all health care claims in Massachusetts through a database called the All-Payer, All-Provider Claims Database (the “APCD”).  The database will facilitate unprecedented transparency – via this tool, we can design reports about health care costs, quality, and utilization to assist you in making informed choices about how and where to access care and how much it really costs you or your employer.

Health Care Integration:  When was the last time you visited your doctor and actually had a smooth transition from your doctor to other medical services you needed outside of his/her office? Our data suggests that an effective tool to combat high annual increases in cost is to transition over time to a health care delivery system that provides a full range of medical services in a “one-stop-shopping” manner that eliminates costly intermediaries, reduces unnecessary tests, promotes wellness, and improves health outcomes.

We are developing analyses that will inform the health care system’s transformation toward a more integrated, coordinated, and patient-centered model. For example, we want to provide information on best practices related to care delivery, geographic trends in utilization, physician-hospital links, quality management, capacity, etc. Increasingly sophisticated analyses and data will be needed in order to help develop the most efficient health care organizational structures and optimize performance.

Wellness:  Our delivery system is built to treat (rather than prevent) illness.  We must transition toward a wellness model that promotes primary prevention and primary care. Achieving this change is a cultural challenge we must tackle immediately.  It is a necessary investment that will improve the overall health and productivity of the Massachusetts population. In fact, a recently published HealthAffairs analysis of Medicare spending, "Chronic Conditions Account for Rise in Medical Health Care Spending from 1987 to 2006" found that two-thirds of the rise in national health care spending during this time period was a result of the growing prevalence of treating chronic disease.

Going forward, we intend to partner with key stakeholders in order to design meaningful analyses and provide objective data to the full spectrum of audiences – government, private employers, health care and social service providers, health insurers, and the public. We want to support the development of an integrated health care delivery system that is sustainable, transparent, and accessible to all.

But in order to be successful, we need you to be involved and understand these issues, especially who pays what for different types of medical services. Your voice is critical in ensuring that these important issues stay in the forefront of the minds of policy makers and industry leaders alike.

Also, as a part of our commitment to transparency and engagement in government, the Massachusetts of Division of Health Care Finance and Policy uses several social media tools including Twitter, Blogs, and RSS feeds. We use these tools to keep you informed about the work we are doing and as a way to get feedback.You can follow us on Twitter at And, you can learn more by visiting the Commonwealth Conversations: Mass Health Care blog.



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