"Coming Together on Chronic Disease" by Michael V. Sack

If there was one thing that struck both observers of, and participants in, the creation of the Massachusetts health care reform law, it was how many seemingly diverse groups came together to make the unwieldy law work. Yes, there were disputes – and they continue today. That can be expected from a law that affects literally everyone in the Commonwealth. But in general, hospitals, insurers, physicians, regulators, consumers, religious groups, and others united and have remained together – a rarity in any state, but especially so in our often fractious Commonwealth.

Now that the reform law is well on its way of achieving its main goal – insuring the uninsured – its remaining challenge of lowering health care costs will require the same sort of collaboration. I’m happy to report that this May, the hospital community, under the leadership of the Massachusetts Hospital Association, brought together 80 key individuals to discuss diabetes management – a big cost center in our state’s health care system.

It was called a “charette” – an architectural word referring to brainstorming to develop solutions to a design problem within a limited timeframe.

EOHHS Secretary Dr. JudyAnn Bigby was there to present her take on the issue, as was Lynn Nicholas, MHA’s president, and the following: Nancy Turnbull, Harvard School of Public Health; Amy Boutwell, M.D., Institute for Healthcare Improvement; Gary W. Gibbons, M.D., Quincy Medical Center; Melinda Maryniuk, Joslin Diabetes Center; Robert J. Master, M.D., Commonwealth Care Alliance; Anne Metzger; Tufts Health Plan; Jeremy J. Nobel, M.D., Harvard School of Public Health; Leslie Schultz, Rapid Improvement Program; John M. Auerbach, Department of Public Health; and Terri Mendoza, DPH’s Diabetes Prevention Control Program.

They came together united by the understanding that chronic disease is the largest challenge to the affordability of health care and an increasing burden on society. The goal was to find ways to improve the management of patients with chronic disease in order to improve the public’s health and achieve long-term cost savings. Each leader presented 3-5 specific ideas and recommendations on the role that hospitals could play in chronic disease management. Then they voted to create a Top 10 list of recommendations. MHA then presented five to its Board of Trustees, on which I sit, and we discussed a plan on how to roll them out.

Two of the five were grouped into a sort-of Phase I: improve diabetes management in hospitals, and undertake aggressive and systemic glycemic control of patients. These two are directly within a hospital’s control and there’s strong scientific evidence showing they’ll improve the lives of patients. Later we can expand to outside of the hospital with: ensuring effective transitions from the hospital to post-acute care settings (such as ambulatory care and nursing homes); ensuring continuity of care after discharge by establishing systems for communicating with primary care providers and linking people with pre-diabetes and diabetes to community resources and services; and finally requiring timely follow-up care in the post-discharge setting.

The state’s Health Care Quality & Cost Council is undertaking some aggressive chronic disease management, elements of which are also contained in Senate President Therese Murray’s cost control bill. Secretary Bigby has also announced a concerted focus on the issue. So once again it seems that Massachusetts health care is coalescing around a single goal. If we can make it work this time, patients will certainly benefit and we may be able to reduce health care costs significantly. Stay tuned and, better yet, join us!

Michael V. Sack
President and CEO, Hallmark Health