INNOVATIONS IN MASSHEALTH AND OTHER INITIATIVES TO SUPPORT HEALTH CARE REFORM by JudyAnn Bigby, M.D.

Just over a month ago, Governor Patrick unveiled his budget for Fiscal Year 2009, which makes targeted investments in health care reform and primary care initiatives, as well as education; public safety; job creation; and partnerships with cities and towns.

Health care reform will not succeed with insurance reforms alone, and investing in health care reform and primary care are key priorities for the Patrick Administration. We must promote policies that ensure that people have the right care in the right place. Massachusetts must receive the best value from health care expenditures, while ensuring health care is safe, timely, efficient, effective, equitable and patient-centered.

We continue to support the goal of near-universal coverage, and the first year of this innovative program has been a success. More than 300,000 people who were uninsured now have health coverage. Yet even beyond continuing to support expanded coverage through Commonwealth Care and MassHealth, there is other important work to do. We need to focus more attention on health care costs and improved access to primary care services for all people in Massachusetts. Several initiatives in the Governor’s budget reflect these goals.

For example, we propose expanding pay-for-performance programs in MassHealth by extending performance based reimbursement to MCOs, nursing homes and primary care physicians. Implemented in a way that rewards health outcomes, pay-for-performance represents a shift away from a straight fee-for-service model that does not recognize the quality of care provided.

Expansion of chronic care management, focusing on the small percentage of patients who account for the majority of costs in the health care system, can improve care while decreasing costs through preventing avoidable hospital admissions, readmissions, and unnecessary emergency department visits. The Governor’s budget supports this, especially for MassHealth Primary Care Clinician Plan members. We are committed to supporting primary care physicians’ efforts to provide the type of care they want to provide for their patients in their practices by supporting a team approach to care management. As we move forward with the HealthyMass initiative, we plan to coordinate models to support a medical home across public payers.

Access to primary care is also a growing concern in the Commonwealth. Our budget includes $1.7 million to continue to support the Primary Care Workforce Development and Loan Forgiveness Grant program. This program enhances the recruitment and retention of primary care physicians at community health centers. In FY09, the Governor proposes to expand eligibility for this initiative to include primary care physicians recruited by community hospitals.

These are some of the many exciting and important health care reform initiatives supported in the Governor’s budget. We make recommendations that will maintain the expanded coverage enacted by Chapter 58, while also focusing on other areas that require improvement. These reforms are necessary to ensure the health of the Commonwealth.

JudyAnn Bigby, M.D.
Secretary for Health and Human Services