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Massachusetts’ landmark health reform law, enacted in 2006, expands coverage for the uninsured and helps to control costs, improve quality and ensure that publicly funded health care costs are adequately reimbursed. Adults and children who receive care through Partners hospitals have benefited enormously as a result of health reform.
As the provisions of health care reform have been implemented, Partners has worked to anticipate the impact of each new component on patients and providers.
In addition to communicating health care reform benefits and changes to providers and patients across the Partners system, Community Benefit staff work closely with state agencies to clarify the effects of the new policies, and serve as a resource for questions related to health care reform. Staff are also closely monitoring the long term impact of health care reform, and paying attention to the need for solutions for patients who might continue to have no coverage options, for example, undocumented immigrants.
From a high in 2006 of nearly 30,000 patients without health insurance served at Partners hospitals, the number of patients without insurance has declined by more than half to 13,000. In FY2008, there were more patients covered by health reform’s Commonwealth Care than there were patients without insurance.
Improving Care
Massachusetts has embarked on a substantial effort to increase primary care capacity in community health centers through an education loan repayment plan to expand the state’s supply of primary care providers. Through May 2009, 92 doctors and nurse practitioners, serving an estimated 160,000 patients have made commitments to work in a community health center for at least two years. The loan repayment program was launched with a $5 million commitment from Bank of America, and an FY07 state budget commitment of $1.7 million as the first year of a planned three-year match for the bank’s commitment Partners is working closely with the Massachusetts League of Community Health Centers and providing substantial operating support. Neighborhood Health Plan and the Blue Cross Blue Shield Foundation of Massachusetts have provided additional financial support.
Improving Access to Care for Severely Ill Patients in Revere and Chelsea
The MGH Care Management Program (CMP) was launched in August 2006 to provide chronically ill patents with the focused care they need to stay healthy and avoid hospitalization. Funded as a demonstration project by the federal Centers for Medicare and Medicaid Services (CMS), the initiative is intended to develop an evidence base to determine whether case management for high-cost patients could reduce overall costs and improve quality of care and quality of life for these patients.
For the 2,200 patients in the program, hospital readmissions dropped 19 percent from 2007 to 2008, while hospital stays overall fell 17 percent, and emergency room visits dropped 15 percent.
Based on demonstrated success in helping to manage the care of severely ill patients, the CMP was granted a three-year extension by CMS in January 2009.
Using a care team model, the case management program core principles are:
- Assess patients and identify risks for poor outcomes
- Identify underutilized, needed, or available resources
- Coordinate care between providers and services
- Facilitate better communication and better transitions
- Collaborate with the primary care physician to work together in problem solving
- Participate proactively with the care team, encouraging creativity and independence
Cost Management
Partners is deeply committed to managing health care costs as part of health reform. While the primary driver of increased health care costs is medical progress, Partners is working to significantly slow cost increases. Four important elements of the solution are:
- Reimbursement reform. Partners recognizes the need to move away from fee-for-service reimbursement to systems where providers are paid for performance. Currently, Partners has pay-for-performance into contracts with all of the major payers and with the Medicaid program. Partners is also actively engaged in work on other reimbursement programs.
- Electronic medical records. Building and using an appropriate system of electronic medical records is critical to controlling costs and improving quality. Again, aided by the contracts with major payers, Partners is among the less than five percent of the nation’s health care providers where all primary care practitioners are on the electronic medical record.
- Disease management. Partners has started work on important disease management programs guided by the knowledge that 10 percent of people account for 70 percent of costs. All health care providers must do more to focus on organizing care more effectively for these sickest patients. Efforts at Partners include intensive support for at-risk low income patients, and a Medicare demonstration project with promising results.
- Establishment of effectiveness review bodies. There is increasing discussion at the national level of the need for establishing a body to review the effectiveness of new drugs and procedures as they enter the health care system. Although this ultimately may make the most sense to do at a national level there is no reason why Massachusetts could not begin the work to move down this path.
© Copyright Partners HealthCare System, Inc.
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