A Look At 'The Next Big Experiment' In Health Care Reform In Mass.

Paying for health care coverage is becoming more and more difficult. Health care costs have been rising two, three or four times faster than inflation in Massachusetts for more than a decade.

Next year, however, Massachusetts becomes the first state to try to keep health care in line with the rest of the state's economy.

WBUR’s Martha Bebinger spoke with Sharon Brody on Tuesday’s Morning Edition about what many people say is the next big experiment in health care reform.

Sharon Brody: Massachusetts was the model for trying to make sure most residents have health insurance and now the state has a new law that may create a model for controlling costs. How does this work?

Martha Bebinger: One of the main things this law does is set a target for how much health care costs can rise, and next year that target is supposed to be 3.6 percent, and so in order to meet that target the state is saying doctor’s and hospitals are going to have to change the way they get paid for care, to put them on a budget, make them operate more efficiently.

There’s a lot of emphasis on prevention, to try to keep people out of hospitals. And also in this law – this is a law that covers a lot of territory – there’s a push to make sure that mental health is just as important as our physical health. And there are also a lot of things in the law that try to turn you and I into more active or engaged consumers or patients with a lot more information on where to go to get care and how much it costs.

And easily decipherable information?

Not yet, no, not at all. This is all very much work in progress. The governor signed this law in August. Many of the things patients won’t see for a couple of years to come.

Does it look like the state will keep health care cost in line with the increase in heating bills, or housing, or wage increases next year?

In the first year we’re supposed to not grow health care costs faster than 3.6 percent, but you might remember there’s been all this consternation lately about the state’s economy not growing as fast as people thought. So it’s not supposed to grow faster than about 2.3 percent at least in the first year. So health care costs are already supposed to be squeezed even more. But at the same time we know that health care premiums are growing more along the lines of 5 percent, so no we’re not going to meet it the first year. And one of the law’s key authors says it’s just a sign that we know this is going to be a very difficult task. This is state Rep. Steve Walsh:

What we need to do is stay focused, stay vigilant, and continue to work together with providers, with payers, with consumers and health care patients to make sure we can get the best services when we can – the highest quality when we need it most – but also at a very affordable and fair price.

So in the first few years of the law, nothing happens if hospitals and doctors don’t make that target that the state will set, but a few years down the line they will have to submit corrective plans on how to rein in that cost if they are spending above the target.

This is for now out of the Legislature’s hands. Who is supposed to make sure the state does stay on track?

We have a new entity in the state called the Health Policy Commission. They just had their second meeting last week, and they have a new executive director, David Seltz. I asked Seltz what he’s most worried about as he looks at this job of trying to be the first state to really get health care costs under control:

I think the thing that will keep my up most at night is thinking about the ways that we’re going to be encouraging change that will affect patient care, and the mandate that we do so in a way that we are working towards a better health care system in Massachusetts.

There really is a sea change happening here. Patients are starting to feel it but you see it in hospitals merging, with all these new reporting requirements they have, and new ways of being paid, and that is going to start to rumble to the surface for you and I.

So what will patients see in the coming year?

With all of these new hospital networks that are forming, they’re going to want to keep you and I within their network. So on the one hand it may seem like there is less choice – your doctor is going to say, 'Go to this provider because he or she works for the same people I do.' The good side of that for people who think ‘I don’t want any limits on my choice’ is that you are in theory going to get a lot more attention for you as an individual patient, a lot more attention on your preventative care, a lot more attention to keeping you out of the hospital and making sure you stay healthy — and even a lot of things we think of more in the retail world like valet parking or somebody who makes appointments for your or somebody who comes home to check on you. So there's a lot of shifting going on and it'll be really interesting to see whether patients buy in.