Bigby: Finding the Balance between Regulation and Innovation

One of a series of reports on the October 21 MMS forum, “Toward a Shared Vision of Payment Reform.”

JudyAnn Bigby MDGovernor Patrick’s point person for health care told attendees at the MMS payment reform program this week that that best role for government is to provide the right balance between regulation and flexibility, and to provide protections for both health care consumers and providers.

JudyAnn Bigby, MD, is secretary of the Massachusetts Executive Office of Health and Human Services and chairs the state’s Health Care Quality and Cost Council. She also leads the large committee of government and health care leaders that is now debating the principles for payment reform.

They’re looking what such issues as the kind of ACOs that should exist, the kind of oversight they need, the rights of patients and providers, and more. These discussions will inform any legislation that would be filed in next year’s session.

Bigby said she favors a balance between regulation and flexibility. The role of regulation, she said, is to protect both providers and consumers. She added, “This transformation has the potential could harm certain providers in a way that would be harmful to the health of the community.”

On the issue of flexibility she said, “We believe ACOs should very diverse.”  She said an ACO could consist solely of primary care doctors, could be an integrated delivery system, or virtual networks of providers.

But she added, “We do want to set baseline parameters for how ACOs function, so we don’t wake up one day and say this isn’t what we were anticipating.”

She said, “There is recognition that you can’t move providers from one form of payment to another overnight,” and that it takes investment not only in infrastructure, but in understanding that if some quality objectives are achieved, it could represent revenue losses for some providers, “and we need to acknowledge that.”

One attendee later asked Dr. Bigby how much control the government will want to exert over health care under a new payment system.

She said, “The [oversight] board is not bow viewed as having a centralized approach to managing health care or medicine. It’s seen as an instrument to make sure that the payments are not disadvantageous to providers or patients, and that we have the best opportunity to control costs.”

She added, “I believe there has to be a lot of diversity, not only in how payment reform is done, but also in the definition of ACOs. … Diversity and flexibility is the theme I keep promoting.”

“Payment reform in and of itself is not the goal,” she said. “We all have other things we want to achieve” namely, universal coverage, broad access to care, and controlled growth in health care costs.

This forum was co-sponsored by the Massachusetts Medical Society and the Commonwealth Fund.

Video excerpts from Dr. Bigby’s presentation:

Download her slide presentation. (.pdf, 13 pages)

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