Payment Reform Commission

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 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



Comments On the State’s Road to Payment Reform

Posted in Payment Reform, Payment Reform Commission on December 13th, 2010 by MMS – 3 Comments

By Lynda Young, M.D.
MMS President-Elect

Lynda Young, MDEarly next month (Jan. 5), the ad hoc committee advising the state Health Care Quality and Cost Council about payment reform legislation is scheduled to meet again, perhaps for the final time.

We expect that the committee will use the meeting to finalize its recommendations to the full Quality and Cost Council, which meets two weeks later. The committee’s discussions have illuminated the tensions, shortcomings and – dare I say – strengths of our health care system. If Massachusetts moves forward with payment reform, we must not only address these shortcomings, but also preserve what is already excellent.

I was appointed to the committee for two reasons: I’m going be president of the Medical Society next year, and I’m a pediatrician at a small practice in Worcester. This gives me a perspective that differs greatly from many members of the committee, so I saw my role as helping to ground the discussion in reality. As people spoke, I tried to think of the parents and children I see every day, and how the ideas floated at those meetings might affect my patients and their families.

I spoke of how, despite the obvious shortcomings in health care today, most people want to keep their doctors and their hospital. They want the best for themselves and their family, as we all would. And they treasure the freedom of choice that they currently enjoy. If payment reform threatens any of this, I doubt that patients will support it. And if patients don’t support it, failure is likely.

The committee’s work began in September. Discussions were framed by four separate documents prepared by the staff of the Executive Office of Health and Human Services. Some of the work was designed to focus discussion on such issues as state oversight of payment reform, and the rights of physicians and patients. Others sections seemed to be trial balloons, to test the reaction of committee members.

Many submitted written comments on each discussion item. Nobody pulled punches; many were strongly critical of some of those ideas, my organization included. Still, what struck me was the high degree of consensus among health care providers and health plans.

For example:

We agreed that Legislation must not force health care providers to join or form an ACO; it must be a voluntary act. While some physicians could move to a new payment system over a period of time, many will never be able to do so. Enforcing this by law would certainly worsen our physician workforce shortages throughout the state. There is too much diversity in our health care system to expect that a cookie-cutter approach will work. And when I mean diversity, I’m thinking of both physicians and patients.

That’s why flexibility is critical, on several fronts. We must foster the development of many kinds of ACOs, multiple payment methods, and multiple practice arrangements. One model won’t work for everyone. There must also be a willingness to make big mid-course adjustments when the unexpected occurs. Given the experimental nature of payment reform, I could almost guarantee you that there will be surprises, and some may not be pleasant.

That’s why state oversight should be exercised carefully, with flexibility and a light hand. We all recognize that the state must ensure fairness and a level playing field, to protect both patients and providers. The state is also the best entity to measure progress to achieving better cost efficiency, preserve access to care, and improve quality. But there is a very small body of evidence to guide us, and much of it isn’t likely to transfer well to Massachusetts. The best measure of success will be the results we see on the ground in our state, produced by many different approaches.

What will happen after the committee’s work is done? Clearly, we’ll see legislation at some point next year. But rather than marking the end of the dialogue, I really hope that it is the continuation of a critically important conversation that we have only begun.

This is an incredibly complex challenge, and the need to reduce costs is urgent. But last spring, the Legislature stopped short of submitting legislation, after realizing the enormity of the task. Health care hasn’t become any less complex since then. But thanks to the committee’s discussions, we have identified both common ground and important issues to discuss further. Let’s keep talking so that we produce a reform proposal that is responsible, evidence-based, and brings out the best in our health care system.

What are your thoughts? Please comment below.

Payment Reform: Not This Year

Posted in Global Payments, Health Policy, Health Reform, Payment Reform, Payment Reform Commission, Uncategorized on July 4th, 2010 by MMS Communications – Comments Off on Payment Reform: Not This Year

The push to payment reform for health providers has apparently stalled, at least for this year, according to a report in today’s Boston Globe, which described the main reason for the delay as “disagreements among key officials, legislators, and providers over how best to control health care spending.”

Despite consensus among many that the current fee-for-service system contributes to escalating costs, and a recommendation from a state commission one year ago that the state adopt a new payment system quickly, Senate President Therese Murray told the newspaper that she will not file legislation to change the system this year as she originally planned. Ms. Murray attributed the delay in part to the “logistical and political complexity of changing a system that has been in place for decades,” according to the Globe report.

The Special Commission on the Health Care Payment System (which included current MMS President Alice Coombs, M.D. as a member) has recommended that the state move away from a fee-for-service system to one of  “global payments,” which offers providers a set payment for all of a patient’s care for a year.  Yet Ms. Murray told the Globe that global payments may not be right for all providers. Health care “is a huge portion of our economy and workforce, and we don’t want to negatively affect our economy,” she said.

According to the Globe story, drafts of legislation on health care cost control have been passed between the Patrick administration and Senate leaders, but full agreement is yet to be reached on specifics.

The Globe story also said that the Massachusetts Hospital Association “plans to release a detailed plan this month for establishing a board to oversee the transition to a new payment system.”

Global Payments: How We Did It, and What Works (Third of 3)

Posted in Capitation, Global Payments, Payment Reform, Payment Reform Commission on January 8th, 2010 by MMS – Comments Off on Global Payments: How We Did It, and What Works (Third of 3)

This video is the last in a series of three videos by physician leaders in Massachusetts, who discuss how practices can succeed under a global payment system.

Earlier this week, Barbara Spivak, and Richard Lopez spoke about their practices’ experiences implementing and delivering care in a global payment framework. Today we hear from one of the largest physician networks in Massachusetts.

Speaker: Richard Parker, MD, Medical Director, Beth Israel Deaconess Physician Organization

Beth Israel Deaconess Physician Organization, with 1600 physician members in eastern Massachusetts, has extensive experience delivering care under capitated arrangements.

Key quote: “Health care in the U.S. is a great success and failure at the same time. The financial failure that’s busting the budgets of the entire economy cannot be allowed to go on the way it is, so doctors must recognize that change must happen.”

Among the issues he addresses:

  • Creating a culture that prepares a practice for global payments
  • Making a successful transition
  • Alleviating patients’ concerns
  • Whether global payments are the “right” answer for Massachusetts

Global Payments: How We Did It, and What Works (Second of 3)

Posted in Capitation, Global Payments, Payment Reform, Payment Reform Commission on January 6th, 2010 by MMS – Comments Off on Global Payments: How We Did It, and What Works (Second of 3)

This video is the second in a series of three videos by physician leaders in Massachusetts, who discuss how practices can succeed under a global payment system.

Earlier this week, Barbara Spivak, MD, spoke about the experiences at the Mount Auburn Cambridge IPA. Today we hear from one of the pioneers in this area.

Speaker: Richard Lopez, MD, Chief Physician Executive, Atrius Health

Atrius Health is the parent company for five practice groups in eastern Massachusetts, employing nearly 700 physicians. Its founding practice group, Harvard Community Health Plan, was one of the pioneers of a capitated payment system in the late 1960s.

Key quote: “You have to think about it as a journey. It’s going to take several steps to get there.”

Among the issues he addresses:

  • What physician groups need to be successful in a global payment system
  • The differences in delivering care in a global payment system
  • Whether global payments are the “right” answer for Massachusetts

Coming Friday: Richard Parker, MD, of the Beth Israel Deaconess Physician Organization.

Global Payments: How We Did It, and What Works (First of 3)

Posted in Capitation, Global Payments, Payment Reform, Payment Reform Commission on January 4th, 2010 by MMS – Comments Off on Global Payments: How We Did It, and What Works (First of 3)

This video is the first in a series of three video by physician leaders in Massachusetts, who discuss how practices can succeed under a global payment system.

Speaker: Barbara Spivak, MD,President, Mount Auburn-Cambridge IPA, Cambridge Mass.

The Mount Auburn Cambridge Independent Practice Association, with nearly 500 physician members, began operating under a form of global payments 10 years ago. Its physicians are on staff at Mount Auburn Hospital and the Cambridge Health Alliance (Cambridge Hospital and Somerville Hospital).

Key quote: “Focusing on quality helped get people to accept us in their offices more. … [Physicians] accept that we’re working for them, not for the health plans, and that we’re working for their patients.”

Among the issues she addresses:

  • How her practice started with global payments, what physicians learned
  • The patient’s  experience
  • Whether global payments are the “right answer” for Massachusetts

Coming Wednesday: Richard Lopez, MD, of Atrius Health

Health Care Reform in Spotlight as MMS Interim Meeting Opens

Posted in Health Reform, Interim Meeting 2009, Payment Reform Commission on December 4th, 2009 by MMS – Comments Off on Health Care Reform in Spotlight as MMS Interim Meeting Opens

Mario Motta, MMS President Waltham may not be Washington, but the conversations about how to overhaul health care were as impassioned here as in our nation’s capitol, as the MMS House of Delegates opened its 2009 Interim Meeting.

During his report to the House, Society President Mario Motta, M.D., called on physicians to stay engaged in all facets of the state’s fledgling payment reform process.

“We simply cannot afford to sit on the sidelines and let others define the problems or the solutions,” Dr. Motta said. “It is inconceivable to have health care reform without physician input and participation.” Dr. Motta also called on doctors “to do a better job managing our complex patients, “ and to “support programs – and payment systems – that help us work better together.”

Following the opening session, Dr. Motta and MMS President-Elect Alice Coombs, M.D., summarized the current status of federal and state payment reform and the Society’s present and future advocacy strategies. As delegates broke to attend reference committee hearings, many headed for Reference Committee A, where five resolutions related to health system reform were up for debate.

The full House meets again Saturday morning to debate the resolutions.

We’ll report on the deliberations on this blog, the MMS Twitter feed, and the MMS Facebook page.

Federal Health Reform Slides

To view the slides, click the arrow. To download, click “menu.”

Payment Reform Slides

To view the slides, click the arrow. To download, click “menu.”

At the State House, MMS Leaders Urge Caution and Pilot Projects for Payment Reform

Posted in Payment Reform Commission on October 8th, 2009 by MMS – Comments Off on At the State House, MMS Leaders Urge Caution and Pilot Projects for Payment Reform

Massachusetts Medical Society physicians joined several health care providers Thursday in urging the State Legislature to move carefully in adopting a new payment model for physicians and hospitals.

MMS President Mario Motta, MD, said, “If we move too quickly and rattle the tree too abruptly, you’re going to have physicians fall out of their practice like leaves on a tree.” His comments came during a three-hour hearing held in a packed committee room in the basement of the State House.

Motta said that while some physicians work under a global payment system, it’s never been tried before on a system-wide basis. “There are many unknowns and unpredictable effects that could happen,” he said. “For that reason, we are strong advocates for establishing pilot projects for these innovations.”

But, Motta noted, “Coordinated care is better than fragmented care. We want to support innovations that move us in that direction. It’s better for the patient, and it’s better for our health care system.”

MMS President-Elect Alice Coombs, MD, was a member of the commission that studied alternative payment models in the state. She said, “A new payment model is worth looking into if, and only if, there is adequate time, support and preparation for physicians making this enormous transformation.”

Coombs told the committee about the concwerns she’s heard from physicians statewide about global payments. “Most of all, physicians have been saying, We’ve tried this before. It was called capitation, and it didn’t work.”

She said physicians ask how they will be protected against undue financial risk, whether physicians will get adequate resources to provide the right care, and whether patients will trust a global payment system. She said the Legislature must address these and other issues before implementing a new payment model.

Coombs also added an “urgent plea” for naming practicing physicians to any oversight authority for payment reform. “One thing we learned at the commission,” she said, “is that the voice of the practicing physician is absolutely essential to developing a system that will work.”

Most other health care providers testifying also urged a careful, deliberate implementation, including representatives of family physicians, Cambridge Health Alliance, and the Massachusetts Hospital Association.

Others disagreed. The outgoing secretary of Administration and Finance for the state, Leslie Kirwan, said, “Standing still or inching forward is in fact falling back.” Marylou Buyse, MD, president of the Massachusetts Association of Health Plans, said, “We don’t have the luxury of five years.”

Dolores Mitchell, executive director of the state agency that purchases insurance for state employees, said payment reform “may be our last best hope” for controlling health care costs.

Watch Dr. Motta’s testimony (Length: 7:56).

Watch Dr. Coombs’ testimony (Length: 6:40)

Payment Reform Hearing Set for Thursday; MMS to Testify

Posted in Payment Reform Commission on October 7th, 2009 by MMS – Comments Off on Payment Reform Hearing Set for Thursday; MMS to Testify

The state legislature's Joint Committee on Health Care Financing meets Thursday afternoon to hear general testimony about the payment reform commission's recommendations on global payments. The MMS will testify, along with many other specialty societies, hospital leaders and other health care stakeholders.

There has been no legislation filed yet, so there are no specific proposals for implementing the commission's recommendation. It's expected that each speaker will provide general thoughts about global payments. Undoubtedly, some will offer specific ideas for the legislation

We'll report on the hearing here tomorrow, and post our testimony to the MMS website.

Last Sunday's Boston Globe previewed the hearing with a front page story by Liz Kowalczyk. It outlined about the recommendations concerns from hospital and physicians leaders, including MMS President Mario Motta, MD. 

can’t be forced on everyone,’’ said Dr. Mario Motta, a cardiologist in
Salem and president of the Massachusetts Medical Society, a lobbying
organization for the state’s physicians. “You’ll force [doctors] out of

“This plan will never happen for everyone in five years; that’s an unrealistic dream,’’ he added.

For background information on the commission and its work, visit the payment reform section of the MMS website at

Payment Reform: What Physicians Need

Posted in Payment Reform Commission on August 3rd, 2009 by MMS – Comments Off on Payment Reform: What Physicians Need

This post originally appeared on WBUR's guest blog "Commonhealth" on July 29, 2009.

The state payment reform commission has a vision of a new payment system for Massachusetts – a global payments system. The commission’s report is an important contribution to the debate over health care reform for Massachusetts, and for the country, as we strive to provide affordable care with reliably high quality. However, our state’s movement to such a model should be careful, deliberate and mindful of the errors of the past.

This new payment model would mean a dramatic change in how practices and hospitals organize themselves around patient care. Any business leader who has attempted a change of a similar scope will tell you that the process is slower, more difficult and more costly than initially expected. When you consider that we would be attempting payment reform at the same time that people are still becoming sick or injured, this task becomes even more daunting. It’s like trying to fix an airplane while it’s flying. You have to do this carefully – very carefully.

If physicians sound cautious about proceeding with this transition, it’s with good reason. Like everyone else, we have long memories. We remember past failed experiments, like capitation in the 1990s, which was rushed into implementation without proper safeguards, checks and balances. Under capitation, patients accused doctors of withholding necessary care, while physicians felt they were being saddled with untenable financial risk.

I’m pleased that the commission took these and other concerns quite seriously. This was largely due to the terrific work of the physician and hospital members who sat on the commission, including Dr. Alice Coombs, an officer of my own medical society. I also want to acknowledge the wise comments of the dozens of physicians who attended the commission’s outreach meetings this past winter and spring.

It’s been noted that 20 percent of Massachusetts physicians are already compensated under a kind of global payment system. This is often taken as evidence that the global payment goal is achievable. By the same token, 80 percent of physicians are paid under the current fee-for-service model, and their readiness to move to a new model varies greatly from practice to practice. Their needs cannot be taken lightly.

If payment reform is to succeed, physicians will need lots of time and support to get there. Without such support, we risk failure, and inflicting even more harm to our health care system. Some have called this need for support a complementary strategy, but I believe it is essential to success.

The commission outlined a transition period of about five years. From my standpoint, this is possible, but optimistic. There must be flexibility to make adjustments if reality doesn’t meet expectations. What kind of support to doctors need? Some examples:

Financial: Very few practices have access to the capital required to build the technical and logistical structures required by a global payment model. The federal government is promising substantial subsidies for implementing electronic health records, but that’s at least three years away, and only after the systems are installed and meet “meaningful use” criteria that are still undefined. So, even assuming the federal money is still available in five years, practices need help getting to that point.

Technical: As anyone in an IT department will tell you, any big project will take longer and be costlier and more difficult than expected. This is doubly true when installing an electronic health record system, a young, evolving technology that is the underpinning of a global payment system.

Legal: Our laws and regulations need lots of changes before a global payment model can achieve its promise. Anti-trust laws must be revised. Administrative processes need to be reinvented; most paperwork today is costly and adds little or no value. Malpractice laws must be reformed, in order to discourage the costly, maximalist care that the malpractice system implicitly requires.

Finally, this cannot be accomplished without a similar careful transition for patients. If they fear their care will be compromised by this new system, it will fail in the blink of an eye. Doctors do not want to be gatekeepers again. This was one of the most distasteful outcomes of the capitation era, and we don’t want to return to that scenario. How we get to the point where patients trust this model is a very big challenge.

Time and again, during the commission’s final meeting, its members acknowledged there is a lot of work remaining. They’re right. It’s up to everyone – government, insurers, businesses, providers and patients – to do their part to make this vision become a reality.