"A Stronger Future for Cambridge Health Alliance" by Dennis D. Keefe and JudyAnn Bigby, MD

Lost amid the recent news of changes underway at Cambridge Health Alliance was a more important discussion about the long-term sustainability of our public hospital system and how governments can partner with health care institutions to safeguard critical medical access to those most in need.

While it is human nature to focus on what is lost during times of great change, behind the ambitious plan to reconfigure Cambridge Health Alliance is a broad collaborative strategy and story of self-determination that needs to be further explored.

Cambridge Health Alliance plays an important role in our region’s health care system by providing quality services, particularly to low-income residents. It is a safety-net hospital in the truest sense. For months, the Patrick Administration and the hospital have been working together to develop a shared understanding of the essential health care services to the diverse communities Cambridge Health Alliance serves, the limits of our resources, and how we can work together to ensure the hospital system’s future.

The comprehensive reconfiguration recently approved by the CHA Board of Trustees last month reflects a thoughtful, clinically-driven approach to preserving health care access and quality for its patients and communities given the need to respond to today’s financial challenges.

It could serve as a national model as other states continue to look to Massachusetts for guidance in crafting health care reform legislation to provide expanded insurance coverage while preserving the principles of caring for those most in need. Some have questioned the need for safety net hospitals in the era of health reform. Yet, it is clear from our collaborative effort that the safety net mission and goals will endure and are still very much needed, especially in mental health services.

We recognize that the proposed changes will not be painless. Cambridge Health Alliance has had to make difficult choices that will impact people’s jobs and lives. Transforming CHA’s health delivery system for sustainability will require consolidation of some inpatient services and six ambulatory centers as well as an eight percent employee reduction. Eventually, we believe our renewed partnership and the resultant plan will be seen as a notable achievement in improving the network’s financial outlook in an era of diminishing resources, while never veering from its vital mission of providing access and services to the poor, elderly, uninsured, and reducing disparities and barriers to health care.

The challenge of maintaining essential services while bolstering CHA’s finances were complicated in the face of the national economic pressures, which further jeopardized public resources and continue to this day. Yet the set of guiding principles that framed the development of our plan never changed. We sought to preserve critical health care services in each of the communities CHA serves, maintain excellence in health care quality and patient access, and continue the academic mission in community medicine, all while seeking opportunities for service delivery efficiency, cost savings and financial stability.

It was a tall order, but we think the plan preserves access to current and growing levels of ambulatory care, emergency room care, and medical-surgical care, albeit in fewer locations through merging services now offered at smaller sites. Creating greater economies of scale where possible was viewed as a much-preferred path to program closures. But the hospital’s innovative and healing mental health services will remain a focus, and, with 95 in-service psychiatric beds, CHA will continue as one of the state’s largest acute hospitals for such care. These services will focus on the communities that are core to CHA’s mission, emphasizing the need for integrated and coordinated care between the hospital and community providers.

Just as important, the plan is based on shared responsibility and an efficient use of all resources, including government dollars to sustain the hospital network’s mission. Soon, we hope to move forward with innovative models, including development of medical home and primary care demonstrations. CHA and hospitals like it with concentrated care to patients dependent on public health coverage will always need support from governments, even as the number of uninsured in the state has declined significantly. The unique services provided by safety-net institutions require special payments from government, and the Patrick Administration is committed to working with the hospital system and the federal government to make this possible.

Dennis D. Keefe
Chief Executive Officer
Cambridge Health Alliance

JudyAnn Bigby, M.D.
Secretary, Massachusetts Executive
Office of Health and Human Services