Massachusetts' Decisive Move to Attack Health-Care Costs - The Atlantic

What we learn from the health-care law signed today in Boston could provide valuable insight for the rest of the country.

Massachusetts Governor Deval Patrick, pictured here at a rally with his wife, has just signed into law what may be a national milestone for health-care reform. (Jason Reed/Reuters)

Last week, Massachusetts took the next significant step in reforming its health care system -- a bill that will save the state as much as $200 billion in the next 15 years. Today, Governor Deval Patrick signed it into law, saying that Massachusetts has "cracked the code" on controlling health-care costs.

We needed to crack that code. Massachusetts is six years into implementing the precursor to the Affordable Care Act (ACA) -- the law that every state, now that the Supreme Court has upheld its key provisions, is now trying to decide how to implement. Our own landmark legislation, which then-governor Mitt Romney signed into law in 2006 and which became the blueprint for the ACA, has enabled Massachusetts to guarantee health-care coverage to a larger percentage of our population than any other state: 98 percent of our residents are covered, and 99.8 percent of children are insured.

But when Massachusetts passed the law, it made the calculated decision to tackle the thorny issues of cost and quality later. That time is now.

Massachusetts' health-care costs have escalated at an unsustainable rate. Consumers experience these increases as higher deductibles, copayments, and out-of-pocket costs. We've begun to get a good picture of what was contributing to the rising cost of health care -- and a clear indication that spending more was not necessarily contributing to our overall health.

For the first time on a statewide scale, we will move away from the current fee-for-service system, which pays for every procedure, test, and office visit, but does not pay for phone consultations, e-mail exchanges, home visits, health education, or wellness and nutrition education. In short, the system pays when stuff is done to us, but it does not support efforts to keep us healthy.

For the first time, we will move away from fee-for-service.

Your doctor is paid when you have an office visit, but if you have a question about whether or not you need to be seen, she will not be paid for that phone conversation. And if you need to be seen after hours, what happens? You are sent to the emergency room, where you will receive the most expensive care in our system. Chances are that the treatment that you receive or the tests that are performed to diagnose you will not be reflected in your overall medical record: you will be responsible for self-reporting to your primary care doc, or more often than not, tests will be repeated in a different setting.

The law signed by Patrick will change the way doctors, hospitals, and other providers are paid so that they are paid to keep us healthy. If your doctor was able to save you a trip to the ER, to take just one example, they will be rewarded for saving the whole system money -- as they aren't now.

In the improved delivery system, the relationship between the primary-care provider and the patient is highly valued. The expectation is that providers will have more time with each patient, and we as patients will be more engaged in our care. Efficiency will come as doctors and other providers organize to deliver team-based care that is better integrated and patient-centered.

Our new law also establishes a first-in-the-nation Prevention and Wellness Trust Fund: a four-year commitment to community-based public health initiatives that have proven track records, as demonstrated in improvements in overall health statistics for participating jurisdictions. At Health Care For All, a consumer-advocate organization that has worked to guarantee high-quality health care to everyone, we expect this investment -- a down payment on improving our populations' health -- to return rapid results.

The transition required by this legislation will not be easy. Just as we've learned lessons that other states can learn from in the past six years, we will learn new and important lessons for other states along the way. One of the wonderful opportunities included in this health reform legislation is that the newly formed governing body of the state's cost-control efforts will have health-care consumers as members, and its inaugural charter requires that all members be free of conflicts of interest. This was a controversial provision. But as consumer advocates, we believe that this decision-making body will be empowered to make principled choices focused on the bottom line of saving money and improving health care quality.

Massachusetts' health care system continues to be a work in progress. There are remarkable leaders and innovators around our community who have brought their best thinking to this next era of reform. The legislation we just passed represents a significant amount of compromise, and will likely be an initial step toward comprehensive delivery reform. But one thing we know: what we learn in Massachusetts will again provide valuable insight and success that the rest of the country would do well to emulate.