Not so fast, Gov. Patrick. In today’s Boston Globe: [Massachusetts Governor Deval Patrick's new health care bill] would establish standards for groups of hospitals and doctors called accountable care organizations, which are expected to become common as providers band together to treat patients and coordinate their care for a budgeted fee, splitting these so-called global payments. The bill would give the insurance commissioner the authority to regulate accountable care organizations and the attorney general the power to examine provider consolidation for potential antitrust problems.Legislators were generally supportive, but made it clear that the proposal will undergo, in the words of House Speaker Robert A. DeLeo, “a long, involved debate process, with extensive fact-finding.’’ “It’s very complicated, and we’re going to take our time and go through it,’’ said Senate President Therese Murray.
Still, it’s possible that Massachusetts will beat the rest of the country to some more sustainable payment system. Extra! Extra! Twelve Points of Broad Agreement On Payment Reform!! It may look like torpor, but it's actually unaccustomed harmony on health care payment reform. Naturally, as a member of the media, I am what Spiro Agnew called a “nattering nabob of negativism,” and always lean toward writing about conflict rather than harmony.
So I thought of beginning my report on today’s meeting of the state panel on payment reform by pointing out the huge areas of continued contention. But then I thought, “Wait, what makes news is the unexpected, the counter-intuitive, the “Man Bites Dog” headline. We all expect prolonged if not endless wrangling about the next stage of health care reform in Massachusetts, the daunting challenge of containing costs and revamping the whole system from “fee for service,” in which health care providers are paid for each procedure, to global payments, in which they’re paid a lump sum for a patient’s overall care. Just a brief note on the lingering dissent, since that is not the flavor of the day. Back to the sweetness and light. Lack Of Access Due To Costs Remains A Problem For Some In Massachusetts Despite The State’s Health Reforms — Health Aff.
+ Author Affiliations *Corresponding author Did the Massachusetts health reforms, which provided near-universal insurance coverage, also address problems of unmet need resulting from the cost of care and of inadequate preventive care for diverse patient groups? We found that nearly a quarter of adults who were in fair or poor health reported being unable to see a doctor because of cost during the implementation of the reforms. We also found that state residents earning less than $25,000 per year were much less likely than higher earners to receive screening for cardiovascular disease and cancer.
The state needs to implement new strategies to build on the promise of universal coverage and address specific needs of vulnerable populations, such as limiting out-of-pocket spending for this group. Also, more data are needed on the social determinants of health to identify specific barriers related to cost and access for vulnerable groups that general insurance reforms may not address. Dispatch from Massachusetts: The Individual Mandate Is Working. Austin Frakt, Assistant Professor of Health Policy and ManagementBoston University’s School of Public Health Jul 22, 2010 View all previous columns » In Massachusetts, the individual mandate requiring state residents to buy health insurance is working.
Yet, a similar requirement remains among the more controversial elements of the new national health reform law. Opponents of the mandate resent being required to purchase a product they may not want. Proponents claim that the mandate is necessary to prevent an unraveling of the broader set of reforms in the law. First of all, what does it mean for the mandate to "work? " No insurer could survive a sufficiently severe level of such "adverse selection" (policyholders’ health care costing much more than their collective premiums can cover), and the individual mandate is designed to ensure that they won't face one. The individual mandate is working in Massachusetts because it is preventing a destabilizing level of adverse selection.
Consumer Risks Feared as Health Law Spurs Mergers. The individual mandate is working in Massachusetts. The following is a re-post of my most recent Kaiser Health News column. It has been cited in the 4 August 2010 edition of Health Wonk Review. In Massachusetts, the individual mandate requiring state residents to buy health insurance is working. Yet, a similar requirement remains among the more controversial elements of the new national health reform law. Opponents of the mandate resent being required to purchase a product they may not want.
Proponents claim that the mandate is necessary to prevent an unraveling of the broader set of reforms in the law. But will it work? First of all, what does it mean for the mandate to “work?” No insurer could survive a sufficiently severe level of such “adverse selection” (policyholders’ health care costing much more than their collective premiums can cover), and the individual mandate is designed to ensure that they won’t face one. The individual mandate is working in Massachusetts because it is preventing a destabilizing level of adverse selection. Rate cap for insurer overturned. In a blow to the Patrick administration, an insurance appeals board yesterday overturned the state’s cap on health premium increases for small business and individual customers covered by Harvard Pilgrim Health Care. The three-member administrative panel — which consists of attorneys who work for the state Division of Insurance — found that rate increases Harvard Pilgrim initially sought in April are reasonable given what it must pay to hospitals and doctors.
That ruling trumped the Insurance Division’s earlier finding that the requested increases were excessive, a view that reflects Governor Deval Patrick’s campaign to curb health costs. Insurers yesterday cheered the ruling, which bodes well for three other companies now before the appeals board with their own cases against capped rates. “The decision shows what we have been saying all along,’’ said Lora Pellegrini, president of the Massachusetts Association of Health Plans, a trade group based in Boston. Michael J. Health payment overhaul shelved. The state’s ambitious, first-in-the-nation plan to transform how hospitals and doctors are paid is on hold, at least for this year, largely because of disagreements among key officials, legislators, and providers over how best to control health care spending.
Senate President Therese Murray, a leading advocate of payment changes, said in an interview that she will not file legislation to change the system this year, as originally planned, because of the logistical and political complexity of changing a system that has been in place for decades. The current payment system — in which doctors and hospitals are typically paid a negotiated fee for every procedure and visit — is also profitable for many providers. Murray said discussions about the plan to improve coordination of care and to reduce costs by essentially putting many providers on a budget have been “very frustrating.’’ “It’s like going around in circles,’’ she said. “Nobody is in agreement on anything.’’ State Senator Richard T.