Senate Passes Health Care Bill

We passed the health care cost control bill tonight. Please see the press release below from the Senate President’s office. It now goes to the House.

I believe it is a good bill — the right basic strategy to control costs. The central idea is clean — measure costs, set statewide targets, create incentives to meet the targets and leave it up to management how to do it. In addition, encourage a transition to accountable care organizations by using the state’s own bargaining power to favor them.

There are a number of other issues addressed by the bill — medical malpractice reform and investments in prevention and electronic medical records may be the most notable.

In addition to playing a role in the single payer conversation, I sponsored the following amendments for concerned organizations:

  • Give patients in accountable care organizations a right to an external appeal if care is denied.
  • Include cancer institutes (like Dana Farber) in accountable care organizations.
  • Include regional planning organizations among the entities eligible for prevention grants>

Senate Approves First-In-Nation Payment Reform Bill

BOSTON – Crunching through 265 amendments during two full days of public debate, the Senate on Thursday capped a framework of nation-leading health care reforms with landmark cost-control legislation that will save the Commonwealth $150 billion in the next 15 years while improving the quality of care and increasing the transparency and accountability of the state’s entire health care system. The bill passed 35-2.

Health spending is projected to double from 2009 to 2020, outpacing both inflation and growth in the overall economy. Massachusetts residents, businesses, and state and local government continue to struggle with increasing premiums and other health care cost sharing.

“The most important goal of this legislation is to reduce the cost of health care while providing access and quality outcomes,” Senate President Therese Murray (D-Plymouth) said. “Massachusetts spends 15 percent more per person on health care than the rest of the nation and 40 percent of our state budget is spent on health care. This bill will reel in health care costs, without harming our number one industry or patient care, and remove a major roadblock to long-term job growth and essential investments in education and transportation.”

“The Senate today took bold action to address one of the most serious threats to our economic recovery and strength, and did so in a thoughtful and deliberate manner,” said Sen. Richard T. Moore (D-Uxbridge), lead sponsor of the bill. “This proposal will result in billions of dollars in savings for consumers and small businesses across the Commonwealth, and it will ensure that patients receive the highest quality of care which they expect and deserve. The Senate recognizes the importance of our innovation economy, and sought to pursue reforms in a collaborative manner with those stakeholders responsible for implementation. This legislation completely alters the landscape of our deliver system, and does so with a desire to seek the greatest value at the most reasonable cost for the residents of the Commonwealth.”

The approved bill, for the first time in the nation, establishes a statewide health care cost growth goal for the health care industry equal to the projected growth of the state’s gross state product (GSP) plus .5 percent from 2012 to 2015 and equal to the state’s GSP beginning in 2016.

This change will result in an estimated $150 billion in savings over the next 15 years which will be passed on to businesses, municipalities and residents of the Commonwealth who are struggling with increasing premiums and other health care costs.

In an effort to carefully balance the need to transform the health care industry without harming the number one employment sector in Massachusetts, the bill supports health care professionals in developing innovative payment and care delivery models and establishes tools to help providers meet the targets in the bill through market-based solutions.

The bill also requires the state’s Medicaid program, the state’s employee health care program and all other state-funded health care programs to transition to new health care payment methodologies by 2014. These payment models incentivize the delivery of high-quality, coordinated, efficient and effective health care.

To support the development of “best practices” for care delivery and payment reform models, the legislation establishes a certification process for health care provider systems dedicated to cost growth reduction, quality improvement and patient protection. These “Beacon ACOs” will receive a contracting preference in state-funded health care programs.

Additionally, the bill also establishes independent oversight of the health care industry by reorganizing the existing Division of Health Care Finance and Policy to become an independent state agency and serve as the designated health care data collection, dissemination and analysis agency of the Commonwealth.

To aid consumers in making health care purchasing decisions based on comparative cost, the bill requires health care payers to disclose up-front, through a toll-free number or a website, the total cost sharing a member will be liable for in receiving a specific service from a specific provider.

Current trends indicate the cost from preventable forms of chronic disease will reach $62 billion by the year 2023 which must be addressed in order to meet the long-term health care cost growth goals. The bill includes several wellness initiatives including $100 million over the next five years in community-based prevention, public health and wellness efforts, expanding an existing wellness incentive program for small businesses to provide a subsidy of up to 15 percent of premium costs and requiring the Department of Public Health to develop a “model” guide for wellness programs for businesses.

The Health Care Quality and Cost Containment bill of 2008 established Massachusetts as a national leader in the statewide adoption of electronic medical records. The bill passed today builds upon that legislation by dedicating $100 million in the next five years to accelerate and facilitate the ongoing statewide adoption of the interoperable electronic health records by the year 2015. It also establishes a Health Care Workforce Transformation Fund to invest in the training, education and skill development programs necessary to help workers succeed and flourish in the health care system of the future.

In addition, to reduce unnecessary litigation and malpractice claims costs, the bill creates a 180-day cooling off period while both sides try to negotiate a settlement, and it allows for providers to offer an apology to the patient.

The bill also does the following:

• Expands the role of physician assistants and nurse practitioners to act as primary care providers in order to expand access to cost-effective care;
• Expands an existing workforce loan forgiveness program to include behavior and mental health providers;
• Requires the development of standard prior authorization forms, which would be available electronically, so that providers would use only one form for all payers;
• Streamlines data reporting requirement by designating a single agency as the secure data repository for all health care information reported to and collected by the state;
• Charges the Attorney General to monitor trends in the health care market including consolidation in the provider market in order to protect patient access and quality; and,
• Develops a process to track price variation among different health care providers over time and establishes a Special Commission to determine and quantify the acceptable and unacceptable factors contributing to price variation among providers.

The bill will now go to the House of Representatives for further action.

Since passing the omnibus Health Care Reform Act of 2006, used as the model for national health care reform, the Senate has led reforms in 2008 enhancing primary care access and e-health initiatives and in 2010 helping individuals and small businesses reduce the costs of health insurance plans.

Published by Will Brownsberger

Will Brownsberger is State Senator from the Second Suffolk and Middlesex District.