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Poster Child For Coming Health Reform: ‘Better Care Is Cheaper’

For a glimpse of the future of Massachusetts health care as Gov. Deval Patrick envisions it, consider Phyllis Minsky.

CommonHealth’s interview with Phyllis Minsky, whose story suggests big potential savings in health care costs in Massachusetts.

At 82, Phyllis is complex. Medically, that is. Widowed young and veteran of 35 years in the financial services industry, she comes across as a resilient spirit, all backbone and humor and gratitude for small favors. But there’s no denying she’s up against a lot: diabetes, asthma, chronic lung disease, a blood pressure problem that leaves her prone to sudden blackouts. At one point, she was on 20 different medications.

Luckily, Phyllis has a secret weapon these days: Wendy Atamian. A nurse with 35 years of experience, Wendy is Phyllis’s “nurse care manager,” which means that she stays on top of Phyllis’s health: She helps coordinate her doctors’ visits and medications; sets up home-based services after hospital stays; advises her if she’s in pain or can’t sleep. Wendy even suggested a simulator test to help determine whether Phyllis should still be driving.

“Wendy is always there when I need her,” Phyllis said. Together with Phyllis’s primary care physician, Dr. Michael Bierer, “I think they’ve saved me many trips to the emergency room and urgent care” — “which is a blessing.”

15 percent of Medicare patients make up over 75 percent of health care spending.
It’s not just a blessing for Phyllis — it’s a money-saver for the health care system. Older patients with multiple chronic diseases are the biggest consumers of health care; some 15 percent of Medicare patients make up over 75 percent of health care spending. Cutting the costs of their care is a must if the relentlessly rising health cost curve is ever to be bent — the goal of the next phase of Massachusetts reform.

Multiply Phyllis Minsky by 3,200. That’s the number of patients in the five-year-old pilot project that she’s part of, the Mass General Care Management Program. Begun at Mass General, the care management program has now expanded to Brigham & Women’s Hospital and the North Shore Medical Center, for a six-year total of more than 8,000 patients.

And that may be only the beginning.
Continue reading

Malpractice Lessons For Mass. From Michigan: Safer Doctors Mean Safer Patients

WBUR host Bob Oakes


WBUR’s Morning Edition host Bob Oakes reports here:

BOSTON — One plank of Gov. Deval Patrick’s plan to bring down soaring health care costs in Massachusetts is to change the laws around medical malpractice.

Under proposed changes, doctors in Massachusetts would be able to apologize to patients — without the risk that their apology could be used against them later, in court. The state would also implement a six-month “cooling off period,” so that hospitals and patients could try to resolve problems without lawsuits.

Rick Boothman, the chief risk officer at the University of Michigan health system, uses some of the ideas that Patrick is proposing. If his hospital makes a mistake, they tell the family they’re at fault and apologize — without the condition that the family won’t sue.

Boothman told Bob on the air today that the Michigan approach has dramatically cut the number of malpractice claims, as well as the number of those claims that end up in court. And it has changed medical culture, too.

“In order to make patients safer, we have to make doctors safer,” he said. “This is the only profession I know where it’s inherently risky to begin with, and a mistake can ruin someone financially. That’s unfair.”

“We tell our staff that they must always feel free to express sympathy and empathy to a family,” apart from any apology, he said. And as for apologies, “We not only say ‘I’m sorry it happened,’ but ‘I’m sorry we did this.'”

“We have to find a way to keep physicians and nurses professionally accountable,” Boothman said, “but we have to make the system far less punitive.”

Nancy Turnbull: Mass. Health Reform 2.2 — The Beta Testing Begins

By Nancy Turnbull, associate dean of the Harvard School of Public Health

Last week saw the long awaited release of Health Reform 2.2 (aka Governor Patrick’s proposed payment reform legislation.)

The release is designed to add significant new features to enhance Health Reform 1.0 (the major overhaul of 2006), and its two minor subsequent upgrades from 2008 (provider and insurer cost hearings and special commission on payment reform) and 2010 (more transparency, more commissions).

HR 2.2 survived extensive alpha testing within the Patrick administration, and has now been released in a beta version that can be tried by the legislature. The beta version is about to enter wide release. Extensive usability testing is planned so that others will have the chance to react and suggest revisions.  It’s too early to tell if any fatal bugs will doom HR 2.2. The new system appears to be a less drastic departure from the current version of the operating system than some had hoped but many others had feared.

HR 2.2 has many positive new features, including:

  • It is designed to be a major new platform to improve system-level performance. While preserving the best features of HR 1.0, it acknowledges that the existing platform on which HR 1.0 was built is costly, wasteful and inefficient, and that dramatic changes are needed to better and more fairly allocate system resources.
  • It sets aggressive benchmarks for judging system performance, pegging performance to best practices, including those in other countries.
  • Continue reading

Our ‘Reform 2011’ Forum Wants You! Presenting Guest Post #1: ‘HMO Deja-Vu’

Commenter Dennis Byron expects a back-room deal on health care reform right around the time the fireworks go off above the Hatch Shell.

Thanks to WBUR’s Martha Bebinger and an all-star team of guest posters, CommonHealth served a unique role documenting the debate that culminated in the passage of the landmark Massachusetts health overhaul of 2006. (The full archives are here.)

Now, Gov. Deval Patrick has just officially launched Health Reform II, and all the signs are pointing to 2011 as the year for the second great wave of health care reform here. Once again, CommonHealth aims to serve as a forum for the exchange of interesting and important thoughts on what should be done. To offer a submission or sound us out, please just hit the “Get in touch” button below. Warning: We must be merciless about keeping guest posts readable and user-friendly. The piece below is an example of how punchy writing and strong opinions can bring a potentially soporific subject to life.

Our guest poster: Dennis Byron is a researcher in enterprise software market statistics who has just started his own blog on Massachusetts health care statistics here. He’s an active commenter on CommonHealth who casts a gimlet eye on the results of health care reform so far, and I’m always grateful when he writes in because he has a spot-on detector that picks up when I’ve glossed over something or failed to ask the right skeptical questions. He describes himself as semi-retired and “clearly with too much time on his hands;” I hope that remains true enough for him to keep commenting.

Patrick’s Proposal: Too Soon To Tell But…

By Dennis Byron

The details of the latest of many Massachusetts health care reform efforts are still dribbling out. But the message is unclear. It’s either the beginnings of socialized medicine in the Bay State or it’s a moderate attempt to slightly tweak a world-class healthcare delivery system to make it better. In reality, it’s too soon to tell. It’s not just that you probably still have not read the actual 50-pages-plus of proposed legislation but, more important, the legislature is going to change it anyway just as it has changed a half-dozen or more “health care reform” efforts dating back to the 1970s. Last year alone the Great and General Court changed the “2006 reform” twice.

Commenter Dennis Byron (on a trip to Helsinki)

But if history is any indicator, get your two cents’ worth in now because the changes are going to be made in a back room on Beacon Hill and signed into law at 11:30 pm July 3rd.

My personal take is that both the current proposal and the 2006 effort are/were solutions looking for problems. The combination of the two is not going to change anything and might make things worse.

I admit that when I see propaganda, I assume I am getting a snow job. For example: Continue reading

Health Reform 2011: After The News Come The Skeptics

Now that everyone’s had a chance to digest Gov. Deval Patrick’s big cost-cutting health reform proposal, questions about it’s scope and ambition (or lack thereof) are bubbling up.

For an overview on some of the more controversial elements of the plan, including greater state authority for insurance rate-setting and a voluntary payment reform plan, here’s WBUR’s Martha Bebinger on Morning Edition today:

“…the bill would give the state insurance commissioner the authority to look at what each insurer is paying a hospital when considering whether to approve or reject the latest insurance rates. Alice Coombs, president of the Massachusetts Medical Society, worries about having someone who doesn’t understand medicine decide what charges are reasonable.

“We have to be very careful about this notion of just looking at costs alone. So it’s cost and quality,” Coombs said.

But Andrew Dreyfus, president and CEO of Blue Cross Blue Shield, says this pressure on doctors and hospitals will help lower rates.

And here’s Paul Levy, outgoing CEO of Beth Israel Deaconess Medical Center, who writes on his blog that the new rate-setting authority should help rein in costs, but worries about whether the proposed shift away from fee-for-service medicine will offer the kind of choice that consumers now demand:

On the choice front, the Governor adopts the religious dogma of pricing discussed here earlier, stating that “the existing fee-for-service payment system is outdated in the medical field.” He apparently understands that doing so is inconsistent with consumer choice and thus he “encourages the formation of integrated care organizations (commonly referred to as Accountable Care Organizations or ‘ACOs’)”. As discussed in the last two paragraphs of this post, insurers and providers better tread carefully here. Unless consumers are confident of getting the same or better quality of care from the restricted network serving them, there will be extreme negative feedback in the future. Transparency of outcomes will definitely help, but the power of habit and reputation is long-lasting.

Excerpts from Deval Patrick’s Speech On Health Reform, Phase II

“If the legislation I file today feels like pressure on the market, good! Good! That’s exactly what it’s intended to do.”– Gov. Deval Patrick

Herewith some choice excerpts from Gov. Deval Patrick’s speech this morning, as well as remarks from Dr. JudyAnn Bigby, chief of health and human services. My little fingers were flying as fast as they could, but if any errors crept in please let me know and I’ll fix them. (And if you have the time, here’s the full speech.)

“At the current pace of increase, health care spending will consume a third of the median family income in Massachusetts by 2016. What health care threatens to do to family budgets it is already doing to government and business budgets. Health care costs account for 40% of state spending and have grown at nearly 8 percent annually the past three years.”

“The challenge of high health care costs is not unique to Massachusetts and it has nothing to do with our experiment here in universal health care.”

“Just as we devised the model for universal access, I believe we can crack the code on health care costs. One of the main reasons for the high cost of health care is the way we deliver health care. Most health care is currently provided under a ‘fee-for-service’ model that creates financial incentives for the quantity of care a patient receives, not the quality…There is no financial incentive in the current system for good care, only for more care. what we have is an expensive system that fails to provide the best care for patients…That has to change.” Continue reading

Where’s The Stick, And Other Questions For The Governor

After delivering a sweeping speech on the second wave of health care reform, and getting many hugs and back slaps from business leaders and various movers and shakers gathered at the Intercontinental Hotel, Gov. Patrick took questions (some annoying) from reporters. Here are four:

1. Wouldn’t you consider this price regulation? (Specifically, the part that grants the Insurance Commissioner more authority to crack down on excessive insurance premium hikes.)

2. Why didn’t you include more punitive measure in the plan? (For hospitals and physician groups that don’t comply and begin to lower costs.)

3. How do you deal with the winners and losers in this plan?

3. Where’s the stick?

Here’s how the governor responded:

Introducing…Massachusetts Health Care Reform, Part Two

Gov. Deval Patrick

By Carey Goldberg and Rachel Zimmerman

Let the history books record: On Feb. 17, 2011, Massachusetts officially launched Health Care Reform II, seeking to go where no state had gone before and stem the relentless growth in medical costs by transforming the system of health care.

Amid a sea of dark business suits Thursday morning, Gov. Deval Patrick presented his plan to the Greater Boston Chamber of Commerce at the InterContinental Hotel (the proposed legislation is here). Speaking so emphatically that at one point his voice broke to a high note, he told the gathering:

“Universal health care in Massachusetts has been a resounding success, and rightly serves as a model for what’s possible for the rest of the nation, but it costs too much. Health care in Massachusetts is now universally accessible but it is not universally affordable.”

Later that day, the governor filed a bill on containing health costs and transforming the system of payment, and also held his first meeting with a “working group” of health care, business and other leaders on his plan.

Patrick described his bill as consisting of four main pieces:

1. It proposes to provide a set of standards and benchmarks for the formation of Accountable Care Organizations and other alternative payment methodologies. (That is, ways to shift the system from “fee for service,” in which providers are paid for each procedure,” to a system of “global” or “bundled” payments that put a provider on a budget for a patient’s overall care and give bonuses for quality.)

2. It empowers the commissioner of insurance to consider a wider array of factors when deciding whether to approve premium increases, including the underlying provider rates and how they compare to medical cost inflation. (Read: the state has more power to crack down on high premiums and costs.)

3. It creates an advisory council of stakeholders and consumers to monitor how payment reform is implemented.

4. The bill seeks to redirect the system of medical malpractice in favor of apology and prompt resolution, to deemphasize so-called defensive medicine.

An additional point: It sets up a new state office to act as a “one-stop shopping” point to help “innovators in the medical community” with pilots and other experiments. And its overarching aim is for new-style health care organizations with incentives for healthier patient outcomes to predominate by 2015.

Overall reaction among attendees in the hubbub after the speech appeared largely positive, but this phrase kept popping up: “The devil is in the details” and the details aren’t clear yet. You can listen to some initial thoughts from health care leaders who were there here, here, here and here. And click here for the skeptical morning-after reaction.

Excerpts of Gov. Patrick’s remarks are here, and WBUR is scheduled to air the governor’s speech in its entirety this Sunday.

Inside Scoop: Patrick Expected To Give Major Speech On Controlling Health Costs Thursday

Gov. Deval Patrick is expected to speak Thursday on health care


WBUR’s Martha Bebinger reports:

Here’s the most solid fact on which this post is based: Governor Deval Patrick is scheduled to speak at a Greater Boston Chamber of Commerce breakfast Thursday morning.

Now here’s the buzz: Word in the halls of the State House is that he will make the speech an urgent call to halt rising health care costs.

We know Gov. Patrick has been promising legislation that would map a path to global payments in Massachusetts within five years.  I’m not hearing from anyone who expects to see the details of that legislation on Thursday. 

They do expect to hear the governor explain how he’ll pressure more doctors and hospitals to move towards global payments and limit rising rates in the private insurance market as well as in the Medicaid budget and at the Group Insurance Commission.

We talked last month about one idea in the works that seems to be taking hold: the governor is telling some hospitals he wants the authority to set the rates they can charge if, after three years, hospitals are still asking for increases of more than 2%.  Blue Cross CEO Andrew Dreyfus says he hopes the governor does not set a cap because it will suggest that annual increases are okay while the goal should be level or decreasing rates.

Speaking of Mr. Dreyfus, there is a coalition of insurers, hospitals and business groups meeting about the plans the Governor is expected to outline on Thursday.  This coalition is in touch with Governor Patrick and members of his cabinet.  The most interesting political dynamic here may be whether the Governor and this coalition find a way to work together.

Signs That Second Stage of Mass. Health Reform Is Shifting Into Second Gear

Whoops. It took my politically attuned WBUR colleague, Ben Swasey, to point out that there’s been a heck of a lot of Massachusetts health care news lately, a confluence of mounting political pressure and changes in the industry itself. I’d been too deep in the trees to see the forest. And I’d been so focused on waiting for the Patrick administration’s upcoming bill on payment system changes, I’d somehow failed to register that the next stage of Massachusetts health care reform — global payments and cost-cutting — is already upshifting, bill or no bill.

Let’s just take a moment to wrap up this month’s events so far:

Newly Re-Elected Deval Patrick Says Cutting Health Costs A Priority

Boston Mayor Menino Says Cutting Health Costs A Priority

House Speaker DeLeo Says Cutting Health Costs A Priority

Tufts Health Plan and Harvard Pilgrim Health Care Explore Merger

Tufts/Harvard Pilgrim Merger Could Help Control Costs

Blue Cross Blue Shield Reports Promising Results on its Global Payments Plan

Blue Cross Says Providers Must Control Costs, Or Else

And this is a bit further back, but:
Partners Planning Reduction Of Costs

Readers, would you add any? Send them in and I’ll add them to the mix. And do you share this sense of acceleration, or am I deluded?