Health Reform II – Ensuring that every health care dollar is well-spent

By Senator Richard T. Moore

March 6, 2008 ... In the last legislative session (2005-2006), Massachusetts launched a comprehensive, historic effort to extend affordable, high quality health insurance through a public-private partnership featuring shared responsibility among individuals, employers, and government. We increased access to private market coverage as well. As we continue to implement Health Reform – we have more than 300,000 previously uninsured who now have health insurance.

Our new Commonwealth Care and Commonwealth Choice insurance products, as well as our expanded Medicaid coverage that are the cornerstone of health care reform are subject, however, to many of the same economic pressures experienced by the more than 90% of our residents and employers who have had health insurance all the along. Rising health costs are not sustainable for anyone – our newly insured through health reform or the larger population who have been insured.

The federal government (CMS) has projected rising costs nationally, and we are seeing rising costs in our state health insurance programs as well. Health care spending, according to CMS, continues to outpace overall economic growth and general inflation by more than 6% in both cases, and the share of health care spending of our gross domestic product is growing beyond the current 16%.

We’ve learned that just cutting spending can significantly harm quality, shift burdens to others, and harms our state’s economy which depends so heavily on health care, so arbitrary cuts in services, salaries, equipment, etc. is not the answer. We recognized the need to improve quality and contain costs in Health Reform I, and we prepared the foundation for these efforts by establishing the Quality and Cost Council, promoting infection prevention and wellness, encouraging health information technology, and these are beginning to work.

While many reports at the federal and state levels project rising costs, they do not tell us how much of the current and project spending on health care is well-spent! While we continue the successful implementation of Health Reform I, we must address the problem of rising health costs beyond the new health access programs throughout our entire health care system. The bill that we have filed today is a comprehensive plan to improve the quality of health care while containing costs and an affordable level for individuals, for businesses, and for state government and its taxpayers.

Senate President Murray and I – with our legislative colleagues – are committed to building a health care system in which every Massachusetts resident has affordable access to the highest quality care. To reach that goal, we must control costs to ensure that every health care dollar is well spent.

Our extensive proposals to improve the quality of care represent the most significant things we can do to reduce costs. In addition, we focus on cost-containment initiatives aimed at the various support functions of health care like purchasing, human resources, finance and information technology. To reach the goals of improving quality and containing costs, our bill focuses on:

Expanding access to primary care physicians and nurse practitioners will prove the quality of care, promote prevention and wellness, and minimize the traumatic and expensive reliance on emergency department care. We propose to expand enrollment at UMass Medical School for those who will enter primary care practice. We establish a Massachusetts Center for Primary Care Recruitment and Placement. We establish a program for medical practitioner medical debt relief for primary care physicians and nurse practitioners. We call on UMass Medical School to provide an enhanced learning contract for those who will enter primary care. We establish a pilot for housing assistance for primary care physicians, and we expand consumer choice of nurse practitioner services.

Expanding access to health information technology such as computerized physician order entry systems and electronic health records will improve the quality of care, help to better manage those with expensive and chronic disease who account for over 75% of health care spending, and we will improve the safety of our health system which adds to health costs and, more important, costs thousands of precious lives through preventable errors and infections every year. In that regard it’s especially appropriate that we launch this initiative at the start of National Patient Safety Awareness Week (March 2 – March 8). Our new bill will call for investment in computerized physician order entry and electronic health records and establishes the Massachusetts eHealth Institute with goals for attaining full state utilization of health information technology.

Expanding access to information on cost of care through a more transparent process will help us all understand what’s driving costs and point us to additional ways that we can spend health dollars more wisely and efficiently. Our bill gives the Division of Insurance the responsibility to hold hearings on insurance premiums that exceed 7% and we task the Quality and Cost Council to hold similar public hearings on provider rates

Enhancing opportunities to curtail unnecessary costs such as educating prescribers about equally therapeutic, but lower cost brand or generic drugs, and eliminating the unnecessary and costly contact of drug marketers with prescribers – something we’re proud that the Medical School and its clinical partner have worker hard to address and, which, we hope, will be a model for other hospitals and medical schools. We also begin to tackle the impact of the medical malpractice system and its tendency to promote costly defensive medicine by directing a study of medical malpractice and options for reform.

Every day that we delay addressing this challenge, the more challenging it becomes to achieve universal coverage in Massachusetts. And as the number of uninsured grows, the goal of containing costs while improving quality will grow more elusive. Recognizing this challenge, my House Co-Chair of Health Care Financing and I have agreed to hold the public hearing on this bill on March 12th. I am hopeful that we can move expeditiously to get this bill before the full Senate and House in the coming weeks as we also work on the budget and bonding legislation that will provide some of the additional resources that this bill requires. Health Reform II is officially on the public agenda!

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