Health Reform

MMS 2017 State of the State’s Health Care Leadership Forum: The Election’s Impact on Health Care?

Posted in Affordable Care Act, Health Policy, Health Reform, State of State Forum on October 20th, 2016 by MMS Communications – Comments Off on MMS 2017 State of the State’s Health Care Leadership Forum: The Election’s Impact on Health Care?

The outcome of the national election on November 8 and its potential to shape – either positively or negatively — the healthcare agenda in Washington and locally in years to come was on the minds of the moderators and presenters as they addressed nearly 150 attendees at MMS’s 17th annual State of the State’s Healthcare Leadership Forum held at MMS headquarters on October 19.

Moderators James Braude and Margery Eagan, co-hosts of WGBH’s Boston Public Radio, noted during opening remarks that the-white-house-at-dc-thconstructive discussions of healthcare have been largely absent from the presidential debates and during most national campaign appearances by both candidates. Braude said that the candidates seemed bent to “shed blood” rather than to engage in vigorous fisticuffs about how to control the costs of prescription medicines, for example, or how to improve the Affordable Care Act. Yet many voters, if not most, he observed, collectively worry about these issues.

Ray Campbell, the newly appointed executive director of the Massachusetts Center for Health Information and Analysis (CHIA), said that Massachusetts remains a “bright spot” in this dark national political landscape. In the Bay State, he emphasized, “we have strong bi-partisan support that has transcended party lines” when it comes to providing quality health care for all citizens. Unlike the negative rhetoric that has surface nationally during election-year discussions of Obamacare, Campbell remarked, “there is no talk of a repeal or replacement of Massachusetts’ healthcare reform.” Campbell further noted that CHIA and other state agencies must continue to aggregate data and to use it as fodder to better manage spending, which this year is at a 4.1 percent increase, exceeding the previous year’s benchmarks. “We are exploring ways to do a better job to use the data we collect to shed a light on spending in Massachusetts,” he said, “so we can institute statewide efforts to better control it.”

capitol-dcKate Walsh, president and chief executive officer at Boston Medical Center (BMC), said that while BMC has grown “out of adolescence” by celebrating its 20th anniversary this year, “we still need to improve so we can fulfill our mission, namely to provide ‘exceptional care without exception.’” Toward that end, Walsh said, “we have to earn our patients’ trust and invest in a rigorous quality improvement agenda.” Tailoring programs at the hospital to respond to patients’ needs, such as BMC’s program to treat opioid use and abuse, is just one example of how Walsh envisions BMC to be “part of the solution do to a better job because our patients deserve it.” The challenge facing healthcare institutions in Massachusetts is to “remove barriers” and to “empower patients” to take firmer control of their health.

Michael Dowling, president and chief executive officer of Northwell Health, a conglomerate of 21 hospitals and over 450 patient facilities and physician practices in New York and New Jersey, echoed this theme of empowerment, urging the audience to define it as a movement not just for patients but also for health care providers. “Too often,” Dowling said, “we as health care professionals play the victim. We must take pride in our work, to be optimistic, and face the reality that our business is changing. We must not become prisoners of the past, we must embrace change. One way of doing this is by becoming leaders in the digital world. Otherwise, we run the risk of becoming “Uber-ized,” as someone else will find a way of doing what we do better.” Toward this end, Dowling encouraged his listeners to adapt to the needs of the consumer/patient who, he said, are increasingly more educated, with more access to technology than ever before. He concluded: “We must ask ourselves what skills we will need in the next 5 to 10 years, since our world is always changing, and health care is in a transformative stage.”

Robert J. Blendon, professor of health policy and political analysis at Harvard’s Chan School of Public Health, brought the forum full circle by sharing research he and his colleagues have conducted on the 2016 election, revealing strong partisan views with regards to health policy. Harvard researchers asked, “How Has the ACA Impacted the Country?” They found that 66 percent of Democrats responded that Obamacare has had a positive impact, while 72 percent of Republicans responded by saying ACA has a negative impact. Overall, he noted, healthcare surfaced as the third most important policy issue nationally, with the economy/jobs ranking as the primary issues, and terrorism/national security the secondary issues of importance. Blendon concluded that we will all have to wait for the outcome of the impending election to determine where healthcare emerges in our nation’s priorities.  He concluded, “Major changes in health policy only occur when one party holds the presidency and both houses of Congress.”

–Robert Israel

 

 

 

 

CMS’s Andrew Slavitt talks with MMS about MACRA

Posted in Electronic Medical Records, Health Policy, Health Reform, Payment Reform, Regulation on May 26th, 2016 by MMS Communications – Comments Off on CMS’s Andrew Slavitt talks with MMS about MACRA

Editor’s Note: On April 27, 2016, the Department of Health and Human Services issued a Notice of Proposed Rulemaking to implement key provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), bipartisan legislation that replaced the flawed Sustainable Growth Rate formula with a new approach to paying clinicians for the value and quality of care they provide.  In early May, the Massachusetts Medical Society sat down with Andrew Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services, to talk about the new rule and how it was developed.  More information on the Proposed Rule can be found here.

MMS:  Recently you said that you thought CMS had lost the hearts and minds of America’s doctors, and the new MACRA rule was an opportunity to win them back. Can you tell us how you got to that point and why you think the new proposed rule will change physicians’ perceptions?

CMS Acting Administrator Andrew Slavitt

CMS Acting Administrator Andrew Slavitt

MR. SLAVITT: I want to start with mentioning that the Quality Payment Program that we put out in a proposal comes at a very exciting time in the evolution of Medicare. The implementation of MACRA allows us to take the next transformative step in the Medicare program, by introducing the Quality Payment Program to pay physicians and other clinicians for quality, with a more flexible approach, common-sense approach.  MACRA repealed the SGR and streamlined the patchwork of Medicare programs that currently measure value and quality into a single framework where every physician and clinician has the opportunity to be paid more for providing better care for their patients.  MACRA builds on the important reforms of the Affordable Care Act, which increased the numbers of Medicare clinicians participating in alternative payment models, which are models that reward coordinated, innovative care.

But, there is a lot of fatigue that has come with all the changes over the years. We know it can feel like there are people that sit around thinking of ideas for how to make a physician’s job more difficult; when what is really happening is the accumulation of requirements over time, passed in a series of laws or that come through a series of regulations. If people don’t implement and manage them carefully, we end up in a situation where I think we are now –  where despite all of the best intentions, the burdens add up for those on the front lines where care is given or received.

If people don’t feel like they’re being heard, if they don’t feel like they have a voice, and if they don’t feel like the changes make sense for their practice, it can be incredibly demotivating.

We have approached the implementation of MACRA with the belief that physicians know best how to provide high quality care to our beneficiaries.  And we have taken an unprecedented effort to draft a proposal that is based directly on input from those on the front line of care delivery.  Before drafting the Quality Payment Program proposal, we reached out and listened to over 6,000 stakeholders, including state medical societies, physician groups, and patient groups to understand how the changes we are proposing may positively impact care and how to avoid unintended consequences.

The feedback we received shaped our proposed rule in important ways—and the dialogue is continuing. Based on what we learned, our approach to implementation is being guided by four principles, which I think are also consistent with the goals of the MACRA legislation.

  • One is to keep the patient at the center, always.
  • Two, give physicians more flexibility to control their own destiny and to control what gets measured, how it gets measured and have a little bit more say in how things work, because I think that flexibility is a critical ingredient to some of the issues that we talked about.
  • Three, is simply to do less. Find opportunities wherever we can to reduce the burden. It’s as simple as that.
  • Fourth is simplify, simplify, simplify. That is something we try to take an opportunity to do in every place we could, whether it’s in the use of technology, whether it’s in taking this patchwork of programs and consolidating them and, it will be in how we ultimately implement many of the other components. We have an opportunity to really make a big change. What we’re going to have to do well is continue to listen, provide as much flexibility as possible and simplify.

At the end of the day, after thoughtful and skillful execution, it will be time that tells us how well we have done.

MMS:  You also talk about user-driven policy design. Can you talk about what that means and how it influenced the new Meaningful Use rules now called Advancing Care Information?

MR. SLAVITT: Sure. It’s actually not that radical a concept in the real world. In the real world it might be called “talking to your customers about what they want.” Perhaps in Washington, though, it is a bit of a new concept.

A great example of user-driven policy design would be the visit that you led us on when we were in Massachusetts: Sitting down and listening to what people who deliver care say about the impact of our work at CMS. There is no magic to it: just listen; translate needs into actions; create and deliver; communicate and seek further input; continue to iterate.

In a nutshell the big trap when doing public policy is to do it from your desk. The opportunity we all have – and it’s quite exciting for the people in the agencies – is to really get out there and think about what it feels like at the kitchen table of the American family, what it feels like in the clinics where people get care and how to improve on that. It is a wholesale different way of approaching this work.

When we implemented ICD-10, we used a bit of this approach, I think successfully. We are attempting to roll it out more significantly with the Quality Payment Program. I think you’re exactly right, the Advancing Care Information proponent of MIPS is a critical aspect which we took in a significant amount of input on.

And like I said, continuing to listen and iterate is a very important aspect of user-driven policy design. We are in the phase now of listening to input. And even after we publish the final rule, we will listen and iterate.

MMS:  You’ve also compared the new MACRA proposal to the rollout of an iPhone. So if you’ll forgive me for expanding on that analogy, even in Massachusetts there are physicians who are still using flip phones. You’ve also said, and I’m paraphrasing, that it’s okay to have payment models that aren’t perfect as long as we learn from them. How do you see these perspectives fitting into the implementation of MACRA, e.g., opportunities for physicians who are not used to taking on risk, learning how to bear more risk without fearing that they’re going to lose their practices?

MR. SLAVITT: It’s really important to put in context what payment model and incentives are supposed to do. I have never met a physician, nor do I hope to meet a physician, who makes decisions on patient care based upon how they’re going to get paid. I don’t think that’s how physicians are wired.

The role of payment models and incentives is simply to reinforce what the clinician believes to be the right way to deliver care. If incentives are done well and done right, clinicians will get reinforcement financially; and the payment system gives them the opportunity and the dollars to invest and reinvest in the kinds of things that they believe are right for their practice and for their patients. We have to make sure it is clear that we know it is the clinical and cultural leadership that improves quality, not public policy.

The point I was making about the iPhone is that we are in early generations of some of these payment models. The clinicians who participate should be aware that models are meant to reinforce the good practice of medicine, but the models are not going to be perfect. The models are going to have to get better over time based upon how they get used in the real world and improved upon. For instance, in our second generation models we have made changes, like adding telemedicine or adding patient incentives to make sure that the patient is aligned with their physician in staying healthy.

And where did the changes come from?  They came from listening to physicians and patients. The physicians tell us this model would be better if it could do this, if it could do that. And that’s the thinking that has to continue. So, like any other good, user-driven program, we want an ongoing dialogue so that year over year the program improves for patients and clinicians.

MMS:  So on to interoperability, which I know is one of your concerns. You know it’s one of the physicians’ greatest frustrations. Secretary Burwell has said 90 percent of EMR vendors are committed to interoperability, which is great. I think I can hear physicians nationally groaning because they think they’ve heard this before. So what is it that CMS can do and HHS can do to make it real?

MR. SLAVITT: Let’s talk about what interoperability really is. This is such an important ingredient to improving health care. But interoperability in some respects needs to just be as simple as this: how can we collaborate for the best outcomes when a patient is going to experience different parts of our fragmented health care system? What we want out of interoperability is simple: having a patient referred for other care and understanding what happens at that visit; or communicating with the physician when a patient is discharged from the hospital to make sure they are taken care of and are healing at home.

As you mentioned, Secretary Burwell announced that companies representing 90 percent of EHRs are committing to three vital steps to real interoperability. I thank the many who have made this commitment. It has the potential to set us on a new course, but we all need to be more committed than ever to making sure that the substance of this pledge translates to reality.

And you’re exactly right about physicians groaning; we are not talking sending a man to the moon. We are actually expecting technology to do the things that it already does for us every day. So there must be other reasons why technology and information aren’t flowing in ways that match patient care.

Partly, I believe some of the reasons are actually due to bad business practices. But, I think some of the technology will improve through the better use of standards and compliance. And I think we’ll make significant progress through the implementation of API’s in the next version of EHR’s which will spur innovation by allowing for plug and play capability. But the reason that the pledge is important is because the private sector has to essentially change or evolve their business practices so that they don’t subvert this intent.

In some respects, you can look at me and you can look at the government and say, “Why don’t you just mandate that people do this?”  We have very few higher priorities, but the reality is that if we really want change, we need everybody to put pressure on people in the system to make the technology work. So, if you are a customer of a piece of technology that doesn’t do what you want, it’s time to raise your voice. We’re doing everything we can to make sure that the technology vendors stop focusing on meeting the regulations, so they can start focusing on their customers and their users, and design around the physicians’ needs, the caretakers’ needs, the patients’ needs.

MMS:  We reached out to other medical societies nationally to get some questions for this interview, and they’re all interested in MACRA’s Quality Payment Program, including MIPS and APMs. Many of the questions had a pretty common theme: Physicians are willing to be held accountable for what they’re doing and they know they’re going to be graded on it, so to speak, but they’re concerned about being held accountable for things that are not under their control, whether it’s care that’s not under their control or let’s say a non-compliant patient for whatever reason. The other part of it was registries; how can the medical community be more involved and engaged with CMS in the development of these registries. So your thoughts on those two issues?

MR. SLAVITT: They’re very good questions. First, I’ll just go back to my earlier comment, which is that these payment models are intended to be strong signals about the kind of activities that improve patient care. And so, yes, a physician will feel like there are some things that they’ve got to really influence and pieces of the puzzle that they don’t control; we are interested in hearing about those and making sure that those make sense.

However, patient compliance is a tough but critical part of the process, and efforts to communicate to patients and so forth are obviously part of what physicians do and have been doing for a number of years. At the same time, we’re hearing amazing stories from physicians in small practices and rural, underserved communities.  Motivated and driven with a passion for patient care, they are redesigning their care teams around their patient needs in ways that are having dramatic impacts in patient compliance and health outcomes.  Meaningful impacts, such as significantly improving A1C levels – even as practices expanded to take on sicker, under-insured patients – and significant increases on follow through for referrals on behavioral health and addition referrals.  These are improvements that matter in our communities and in our homes.  And we’re hearing physicians say, “This is incredible! We’re practicing medicine again!”

We work very hard to create what we call a core set of measures, which means that we want to be on the same page with every other payer that’s in a physician’s office so that a physician can focus on one way of doing things.

For specialists, we’ve done a lot of work and a lot of collaboration.  Eighty percent of our measure sets are specialty specific, and the vast majority of those measures come from physician leadership outside of CMS where people are saying this is the evidence-based state of practice, this is what we want. We spent a lot of time engaging the clinical community – medical societies and front-line physicians – to design a program that’s equally meaningful to a wide range of specialties that practice in very different settings.  There’s plenty of ways to be successful within the Quality Payment Program. In addition, for small practices, we’ve designed our proposed rule to provide support and flexibility that match their circumstances, including increased technical assistance, exemptions for small volume practices, allowances for medical home models, and a continued focus on reducing reporting burden.  Our teams are set up to evolve these rules and the clinical community needs to continue to be a strong partner in this process.

MMS:  You are in charge of the most powerful agency in the nation to effect changes in health care in this country at the time of greatest change in health care. So what do you see as your role in this position and the role of CMS in helping shape the future of health care?

MR. SLAVITT: I think it’s really to listen to and absorb the voice of the people that are doing great care every day. We have 140 million consumers that are a part of Medicare, Medicaid and the Children’s Health Insurance Program, and the Marketplace.

If you start with that, let’s talk about what their life is like. They’re increasingly mobile. They’re connecting to an often fragmented system where they’re not anchored. Many of these 140 million, the vast majority are on modest incomes or fixed incomes. They may have family-care needs, both with parents and with children. They worry about how they’re going to pay for the next prescription drug or about missing their bus to their next dialysis appointment. They worry about whether health care is going to become too expensive to manage.

So if you keep it at that fundamental level, it makes, I think, our job pretty clear: represent the needs of the people we serve and to make sure those needs are getting met. CMS will continue to shape health care by making sure these programs are preserved, as well as evolve to meet the needs of the patients.

The wrong way to do that is to put a bunch of policy ideas together in a black box and try to implement them.

The best way – and it is very exciting – is to manage these programs by capturing both the voice of the patients and of the voice of the clinicians, represent those the best we can, and drive towards the delivery of high quality care.

MMS:  Is there anything else you want to say?

MR. SLAVITT: I want to thank you all at the Mass. Medical Society for the visit we had in Boston in the physician’s office. It is so important that we figure out how to connect public policy to what happens on the ground and in the real world. It’s invaluable. And we have to keep it up. It’s not one-off. It must be a cultural commitment. In fact, in the month of May alone, we have 35 scheduled events to hear from a wide range of stakeholders and this outreach will remain an important ongoing part of our work. I personally have been meeting regularly with physician groups, including smaller and rural practices, and have spoken to thousands of physicians in different parts of the country about their work, the opportunities and challenges they face, and what this proposal means for them and their patients.

The second thing I’d say is for physicians who are looking at these new regulations, to please get engaged. There is no possible way, for all the thinking our team can do, that we can anticipate every consequence of what we are working on. And as we aim to provide you with meaningful flexibilities, reduce your burden, and simplify how things get done, please help us think about how these programs can fairly and objectively reward you for the quality of care you delivery.

With all of the work that went into the proposal, it is critical that we receive direct feedback from physicians and other stakeholders. We rely heavily on the feedback for people to say, “I see your intent but what is happening is there’s an unintended consequence or there is a better way to lead us.” If physicians don’t get engaged, then consequentially they will feel the impact of things that they really could have influenced, and we want them to see that we are listening.

I know Washington can feel so distant, policy-making can feel so distant, and I think people are just, sheer exhausted for good reason, so sending in feedback can feel too difficult or pointless. But if this is truly able to be moved forward with all the input of the people who take care of all the beneficiaries (who I like to think actually run Medicare every day), then these new improvements will go so much better, and the Medicare program, the patients in these programs, and the practice of medicine will be the better for it.

I recognize that it’s not the talk, but how we act together, that moves things forward. Which is why I think the change from Meaningful Use to this new, much simpler, much more flexible program of Advancing Care Information is so important because it’s intended to be, among other things, a proof point that we’re not just talk. We are willing to look at things that aren’t working and fix them because it’s for the good of our patients, your patients and for the good of the practice of medicine.

 

Annual Oration: Doctors Need to Reshape the Value Agenda

Posted in Affordable Care Act, Health Reform, Interim Meeting 2015, MMS Oration on December 4th, 2015 by Erica Noonan – Comments Off on Annual Oration: Doctors Need to Reshape the Value Agenda

Physicians need to take a leadership role in reshaping the approach to value in health care reform for the system to see more cost-savings and quality improvements, said Ashish K. Jha, MD, MPH, in his 2015 Annual Oration address, delivered Friday at the 2015 MMS Interim Meeting.

The prevailing wisdom among policymakers that providers are being reimbursed incorrectly has driven a set of value metrics that have not yet resulted in significant improvements, he said.    jha2

Current approaches to value — such as measuring hospital readmission rates and mortality rate — have not markedly improved outcomes for patients. Furthermore, some of the measurement have penalized hospitals that care for the sickest and poorest patients, said Dr. Jha.

“There will winners and losers in a value-based world, depending on how you define value,” he said.

His address, “Getting to Value in High-Value Health Care,” was the 204th MMS Annual Oration, a Society tradition that dates back to 1804.

Accountable Care Organizations and Medicare’s Shared Savings Program are still quite new, but so far have also not showed the impact on cost and quality that many health care reformers had hoped. “If these are going to work, it’s going to take a lot more time,” Dr. Jha. “It is not going to be the panacea to fix American health care.”

To get better value measurements, physicians must be active in advocating for measures “that matter.”  They must refocus the conversation around patients and engage policymakers who are too often making decisions without enough input from practicing physicians.

“We are on a long journey towards higher value health care,” said Dr. Jha.

Watch video of the Annual Oration here.

Erica Noonan

Innovation, Disruption Themes of MMS State of the State Health Care Leadership Forum

Posted in Health Reform, Public Health, State of State Forum on October 23rd, 2015 by Erica Noonan – Comments Off on Innovation, Disruption Themes of MMS State of the State Health Care Leadership Forum

By Erica Noonan, Vital Signs Editor

Turning his health system into a patient-centered institution on a retail model meant a top-to-bottom reworking of every area, including the shocking move of eliminating wait time for doctor visits and waiting rooms,  said David Feinberg, MD, MBA, president and CEO of Geisinger Health System.

Now when patients call, the first thing they are asked “Would you like to be seen today?” And when they arrive, a smart card in their car alerts the office that the patient will be entering the building in several minutes. Upon arrival, the patient is greeted by a staffer who says “We’ve been expecting you,” and escorts them directly to an exam room where a doctor will meet them.

“Waiting rooms add no value to care,” said Dr. Feinberg, a featured speaker at the 16th Annual State of the State’s Health Care Leadership Forum held Oct. 22 at MMS headquarters in Waltham.

Geisinger calls its initiative “Proven Experience,” and even offers a money-back warranty where patients are asked for detailed feedback on their experience, and unhappy customers are asked how much money they would like refunded. Billing statements are as simple as a restaurant receipt, he said.

“Most patients are much more interested in giving feedback they think will be valued than getting money back,” said Dr. Feinberg. He admitted the unconventional model is “about patients, not doctors.”  He said, “We are here to serve patients, not protect organized medicine or protect doctors.”

The forum also featured Mass. Attorney General Maura Healey, Mass. Public Health Commissioner Monica Bharel, MD, and CVS Health Chief Medical Officer and Executive Vice President Troyen A. Brennan, MD. It was moderated by Jim Braude and Margery Eagan, co-hosts of WGBH’s Boston Public Radio.

Healey spoke about the state’s move to demand more cost and price transparency from health care providers and its impact on the delivery of care. Despite the state’s impressive insurance coverage rate of 96 percent, citizens without coverage remain overwhelmingly Latino and poor, she said. And despite moves to publish price differences between various health systems, unwarranted price variations unrelated to quality measures persist across Massachusetts. “We have more work to do,” she said.

Dr. Bharel spoke about public health trends and persistent health disparities, even in a city with world-renowned medical care. Premature death rates are 50% higher in the Dudley Square neighborhood of Boston than in more affluent suburb of Arlington, just two miles away. “Access isn’t enough,” she said.

Dr. Brennan discussed the expansion of CVS Health Minute Clinics nationwide and how its acute services aim to integrate with traditional practice care via EHRs.  The clinics have no intention of replacing medical practices, he said, but rather “meet a very specific need and we’re very good at it.”

The ongoing push towards integrated care and global budgets may see physicians sending patients to a Minute Clinic near their homes for hypertension monitoring, ensuring medication compliance, or even collaborating with a CVS nurse via telemedicine tools,” he said.

“We are trying to integrate care, not disintegrate care,” said Dr. Brennan.

See  the presentations from the MMS’ 16th Annual State of the State’s Health Care Leadership Forum here.

Ethics Forum: Pay for Performance

Posted in Ethics Forum, Health Reform, Interim Meeting 2014, Payment Reform, Tiering on December 5th, 2014 by MMS Communications – 1 Comment

Since its introduction some ten years ago, Pay-for-Performance (P4P) has been the object of much confusion, conversation and scrutiny in the medical industry.

Such programs have raised a host of practical questions: What criteria do you use to objectively judge performance? How do you develop incentives for accomplishment and penalties for falling short? What principles do you use to guide such programs?

Practical considerations aside, the payment system has also raised some important ethical questions, and those were the focus of the Ethics Forum at the 2014 MMS Interim Meeting on Friday, December 5 presented by the Committee on Ethics, Grievances and Professional Standards.

Offering their perspectives on the topic of Ethics of Pay for Performance were Alyna T. Chien, M.D., M.S., a pediatrician at Boston Children’s Hospital and the lead investigator in four different projects focusing on the effectiveness of payment and quality incentives, and Sachin H. Jain, M.D., M.B.A., Chief Medical Information and Innovation Officer at Merck and Lecturer in Health Care Policy at Harvard Medical School.

“We are in a revolution,” said Dr. Chien, “as the entire organization of medicine is changing, progressing to one of integrated health care.” She noted that most incentives move from the payer to the hospital or physician practice, and that most of the data regarding the impact of P4P programs exists at the organizational level. There’s little data on how it works at the individual physician level.

Dr. Chien believes these performance programs can have one of three effects in delivering care: a neutral effect, where the status quo is preserved; a narrowing of care, where more attention is paid to quality and more programs are tailored to patients; or a widening of care, where gaps will occur between rich and poor and physicians will selectively pick their patients.

Dr. Jain acknowledged that the public perception of the profession has changed and that physicians should be at “a point of soul searching and questioning where we are in society.” He offered a scenario of physicians as either “knights” (motivated by altruism and being the ultimate champion of the patient), “knaves” (driven by self-interest and financial gain), or “pawns” (pushed by rewards and penalties of the system in which they operate).”

While he pointed out that such a framework can also be applied to others (for example, patients, health plans, pharmaceutical companies, nurses, and hospital executives), Dr. Jain believes organized medicine has focused too much on reimbursement and that physicians are perceived not to be trusted to do what’s right unless there’s a carrot or stick approach.

“We are losing our more intrinsic value in favor of pay-for-performance,” Dr. Jain says, “and the intrinsic motivation of doing what’s right for the patient must be preserved. It is what differentiates us from other professions. It is what tells others that we will do the right thing whether we get paid or not.”

His prescription is direct: a proper system of reimbursement must offer a reasonable salary, reject incentive contracting, focus on clinically meaningful measures, make it easy for physicians to do the right thing for patients, and find ways to honor and reward the intrinsic motivation of what’s best for the patient that most physicians have.

Presentations at the Ethics Forum may be viewed here.

The ACA Really Does Matter This Election Season: Blendon

Posted in Affordable Care Act, Health Policy, Health Reform, State of the State: 2014 on October 8th, 2014 by MMS – Comments Off on The ACA Really Does Matter This Election Season: Blendon

 

The Affordable Care Act is still a major election issue this year, particularly in states whose voters will ultimately decide who controls the next U.S. Senate, according to a leading health policy analyst from the Harvard School of Public Health.

Robert Blendon, ScD., speaking at the MMS” annual State of the State of State’s Healthcare conference, said anti-ACA messaging and advertising is very heavy in the 14 competitive state races, and most of those states tend to be conservative, Republican, or both.

After the ACA: Some Successes, and Lots More Work to Do

Posted in Accountable Care Organizations, Affordable Care Act, Health Policy, Health Reform, State of the State: 2014 on October 8th, 2014 by MMS – Comments Off on After the ACA: Some Successes, and Lots More Work to Do

 

David Blumenthal, MD, president of The Commonwealth Fund, told attendees of the MMS State of the State conference yesterday that while federal health reform has fostered many important improvements in our health care system, there are still big gaps in access to care, affordability, and health status.

Dr. Blumenthal said the U.S. is still “Two Americas,” where on the most metrics, the northern half of the country is generally much better off than the southern half. For example, he asserted that middle income people in the South are in no better a situation than low-income people in the Northeast.

However, the Affordable Care Act has been the primary reason for “historic” improvements on several fronts. In the attached video clip, he outlines some of those changes. Then he reviews the experience so far in Massachusetts.

Transforming Health: The Need for an Innovation Ecosystem

Posted in Accountable Care Organizations, Health Policy, Health Reform, State of the State: 2014 on October 7th, 2014 by MMS – Comments Off on Transforming Health: The Need for an Innovation Ecosystem

 

How do you transform the health care system in mid-flight?

Victor J. Dzau, MD, recently named president of the Institute of Medicine, argues that health care organizations have the ability to create an ecosystem that encourages the creation of ideas, nurtures them through experimentation, and then disseminates them to the rest of the health care system – up to and include commercialization.

His video clip begins with the wry observation that “innovation was not invented in the United States,” and can arise from anywhere.

His comments today were part of the 15th annual MMS  State of the State of Healthcare Leadership Forum.

Cleveland Clinic’s Lessons for Health Care Transformation

Posted in Accountable Care Organizations, Affordable Care Act, Health Policy, Health Reform, State of the State: 2014 on October 7th, 2014 by MMS – Comments Off on Cleveland Clinic’s Lessons for Health Care Transformation

 

The CEO of the Cleveland Clinic provided a persuasive and moving case study today of how a health care organization can tackle the transformation of health care.

Delos M. Cosgrove, MD, said the Cleveland Clinic has made significant improvements in the areas of affordability, access and quality.

But he noted that none of these are important if a fourth critical item is missing: empathy.

Dr. Cosgrove’s presentation was part of the MMS’ 15th annual State of the State’s Healthcare Leadership Forum.

View video clips from the conference’s other presentations.

Mass. Health Care Costs: Evidence, Testimony, and Scrutiny

Posted in Global Payments, Health Policy, Health Reform, Payment Reform, Payment Reform Commission on October 6th, 2014 by MMS Communications – 1 Comment

“We’re not interested in just saving money, we’re also concerned aboutMassachusetts State House quality and access, but we need to do it in a way that we have the capacity to afford it,” said Stuart Altman, chairman of the Massachusetts Health Policy Commission, as he opened two days of hearings on health care cost trends in Massachusetts at Suffolk University Law School this morning.

Billed as an “opportunity to present evidence and testimony to hold the entire health care system accountable,” the Annual Health Care Cost Trends Hearing represents the first review of the state’s performance under the health care costs growth benchmark established in Chapter 224 in 2012. Over two days, the Commission is examining cost trends for public and commercial payers as well as hospitals and other providers.

Along with health care policy experts making detailed presentations, nearly 30 individuals – a list that reads like a “Who’s Who” of Massachusetts health care – are providing testimony on such topics as meeting the health care cost benchmark, transforming the payment system, coordinating behavioral health and post-acute care, and insurance market trends and provider market trends in promoting value-based health care.

The mood among the HPC commissioners and morning’s presenters as the session began was generally upbeat, as the Center for Health Information and Analysis (CHIA) last month released the first report on the Commonwealth’s performance. With the health care cost growth benchmark set at 3.6 percent, CHIA found that total health care expenditures increased by 2.3 percent , 1.3 percent below the benchmark. Total expenditures reach $50 billion statewide.

Governor Deval Patrick, one of the first to speak and declaring that “health is a public good,” said that “by any measure, Massachusetts health care reform is a success,” at the same time cautioning that even after eight years of health reform “there’s plenty of room to innovate” and “constant refinement” will be needed. Patrick added that challenges remain, chief among them the delivery of primary care.

Jeffery Sanchez, Chair of the legislature’s Joint Committee on Public Health, the second public official to speak, was also upbeat but cautious as well. “Let us continue to show the nation we continue to be a leader,” he said, at the same time expressing concern about behavioral health, alternative payment systems, and reaching underserved populations. He noted that minorities have difficulty navigating the health care system, and that it is imperative to “make sure the health care system is accessible and effective for all.”

Morning presentations included those from David Seltz, executive director of the Health Policy Commission; Aron Boros, executive director of CHIA, and Michael E. Chernew, Ph.D., Professor in the Department of Health Care Policy at Harvard Medical School. Other expert speakers scheduled include Alan Weil, J.D., Editor-in-Chief, Health Affairs, and Thomas Lee, M.D., Chief Medical Officer of Press Ganey Associates.

The hearing concluded at the end of the day on Tuesday. Written testimony, agency reports, and expert presentations are available on the HPC’s website at www.mass.gov/hpc. Live streaming of the hearing is also available from the website.

News coverage of hearings:

Health care stakeholders size up cost-control bid
State House News Service via Worcester Business Journal, October 7, 2014