Affordable Care Act

MMS weighs in on Better Care Reconciliation Act

Posted in Affordable Care Act on July 5th, 2017 by MMS Communications – Comments Off on MMS weighs in on Better Care Reconciliation Act

Henry L. Dorkin, MD, FAAP, President of the Massachusetts Medical Society, released the following statement regarding the Better Care Reconciliation Act.

“We do have serious initial concerns about the effect that this legislation would have on patients, especially those who are covered by Medicaid.

“Medicaid is an essential entitlement for the tens of millions of Americans who depend on it for their health, and even for their lives. This bill, just like the House bill, will permanently end Medicaid as an entitlement program, resulting in serious reductions in funding and access to care for to children, seniors and people with disabilities. Any cuts to Medicaid – even if they are delayed – will leave too many low-income, disabled, or elderly patients without the coverage on which they depend. Our health care system will be forced to return to one in which patients must choose between needed care and other essential expenses. The Massachusetts Medical Society stands by the principle that all Americans should have access to the health benefits that cover their needs.

“We cannot forget that patients who are covered by Medicaid are a part of the overall healthcare system. Dismantling the system that keeps them covered and able to access care will not only hurt them, it will represent a step back for the health care system as a whole.

“Moreover, now is not the time to impose dramatic cuts to funding for opioid treatment and recovery programs. As the opioid epidemic grows across the country – including here in the Commonwealth, where roughly 2,000 people died of opioid-related overdoses last year – we must invest in programs to stem the tide, not slash programs that can help save lives.

“We urge members of the Senate to reject this legislation and to work with their colleagues in the House to collaborate on legislation that would strengthen and sustain the Affordable Care Act, which has extended health coverage to record numbers of Americans. We thank the members of our Massachusetts Congressional Delegation for their unwavering support for comprehensive coverage for our patients.”

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





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

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.

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.

MMS Forum Spotlights the Past, Present and Future of Health Reform

Posted in Accountable Care Organizations, Affordable Care Act, Health Reform, Payment Reform on October 30th, 2013 by MMS – 1 Comment
David Gergen

David Gergen

On the same day that President Obama spoke at Faneuil Hall to defend and promote the Affordable Care Act, the Massachusetts Medical Society’s 14th annual forum on the State of the State’s Health Care focused on the consequences and future of state and federal health reform.

Calling the ACA “both a triumph and a tragedy,” veteran White House advisor David Gergen said the political firestorm currently surrounding ACA implementation – reports of consumers furious that their private insurance policies face cancellation – has seriously jeopardized the future of President Obama’s signature legislation.

Gergen, currently director of the Center for Public Leadership at Harvard’s Kennedy School of Government, recommended a major public information campaign and more transparency from President Obama to rally public support for the beleaguered law.

Stuart Altman

Stuart Altman

Stuart Altman,  chair of the Massachusetts Health Policy Commission, spoke about the need for states to become more aggressive about reining in total health care spending – not  just  the amount public money spent to care for low-income or elderly patients.

Because health care costs are disproportionately pushed onto the privately insured, the long-running cost-shifting model is unsustainable.  “It is simply impossible for private insurance to make up for shortfalls in Medicare and Medicaid rates,” said Altman, a Brandeis professor who currently chairs the state’s Health Policy Commission.

He predicted a noticeable decline in medical care nationwide if costs are not more quickly brought under control and tightly connected to quality and outcome data. “Not a `lights-out,’ but more like a `lights flickering,’” he said.

Altman, a supporter of physician-led ACOs and bundled payment systems in Massachusetts, said the state’s new innovated approaches strive to avoid the “mistakes” of 1990s-era managed care systems, such as micromanaging doctors, dumping too much financial risk on providers, and forcing unwilling consumers to join plans.

Control of post-acute care spending and an effective primary care system will be keys to the future success of Massachusetts ACOs, Altman said.

John Noseworthy, MD

John Noseworthy, MD

Mayo Clinic CEO John Noseworthy, MD, spoke about his system’s culture of teamwork and patient-centered care.  He said more work is needed in most other health care systems nationwide to reduce fragmented and uneven care – factors that drive up the costs of care dramatically.

The Mayo system struggles with downward pressure on Medicare reimbursement rates, and Dr. Noseworthy said he expected the ACA would likely cut them an additional 15 to 25 percent.

While Mayo has six campuses nationwide, Dr. Noseworthy said his system’s survival lies not in acquisitions or consolidation, but in scaling its practice knowledge and experience to affiliates at independent practices and hospitals.  “We hope that our network can be an integrator for groups without the culture of an integrated practice,” he said.

The program also featured a panel of Massachusetts health care executives: Tufts Health Plan CEO James Roosevelt Jr., Boston Medical Center CEO Kate Walsh, and Stuart A. Rosenberg, MD, CEO of the Harvard Medical Faculty Physicians at BIDMC.

Dr. Rosenberg said he felt one of the most pressing problems was a failure to use IT to transform health care and help patients manage chronic health issues in their own homes.

Roosevelt urged more collaboration between providers and payers to control costs, and said the state must be vigilant in monitoring provider consolidation to ensure better care for patients is the result.

In her comments, Walsh focused on BMC’s dramatic financial turnaround in the wake of major state funding cuts.

But, Walsh warned, the state must stay vigilant in monitoring the needs of its poorest citizens “or access will be slaughtered on the altar of costs.”

—     Erica Noonan