"Spending Wisely on Health Care" by Dr. Judy Ann Bigby

Some 20 years ago, the New England Journal of Medicine published an article called “Is the Genie Out of the Bottle?” The genie was coronary artery bypass graft surgery for people with coronary artery disease or blocked arteries. The problem was that the surgery had already become standard treatment before studies had clarified the circumstances in which it was appropriate.

Cutting-edge medical research and technological advancements are at the heart of evolving efforts to prevent and treat disease. Only through innovation have we been able to decrease deaths due to cancer and heart disease, manage diabetes and prevent devastating complications such as blindness from diabetes, and tailor treatment for individuals based on genetics.

But there remains widespread use of procedures, medications and other therapies before their benefits and risks are fully understood. As providers, payers and policymakers, we all contribute to this phenomenon. But, ultimately, everyday people bear the consequences: higher costs and lower quality in health and health care.

Take estrogen replacement therapy.

Postmenopausal women were once told that taking estrogen would prevent heart disease, but studies now show that estrogen replacement may actually increase the risk for some women and that women approaching menopause benefit more from going smoke-free, controlling high blood pressure, managing their weight and exercising.

Drug eluting stents for treatment of coronary disease have become widespread though their benefit is widely debated. And just last week, the FDA debated whether to take the diabetic drug Avandia off the market because of an increased risk of heart disease. Meanwhile, a cheaper diabetes drug that has been around for a while appears to be more effective.

Trends like these are some of the many factors that have contributed to rising health care costs. Unnecessary, ineffective or injurious medical treatments mean valuable dollars unwisely spent, not to mention less than outstanding patient care.

Each of us—whether a policymaker, provider, insurer, or consumer—plays a critical role in improving health care quality and controlling costs. As Secretary of Health and Human Services, one of my top priorities is investing in diverse and collaborative approaches to these efforts.

Addressing the over utilization of treatments and procedures is difficult because there are no standards to measure appropriate use. Paying for technology and the treatment of complications associated with preventable disease, while skimping on prevention and wellness, costs the Commonwealth hundreds of millions of dollars annually.

I have charged the Department of Public Health (DPH) to renew the focus on prevention and wellness. We can save our health care system millions if not billions of dollars by reversing the trends of the obesity and diabetes epidemics. Intervening at a population level, as opposed to one-by-one approach, increases the success of weight management and exercise programs. We will partner with employers to promote healthy personal behaviors such modified diets to decrease fat and increase healthier food choices and promote physical exercise.

We will promote wellness and chronic disease management in the MassHealth program by rewarding providers for meeting certain benchmarks for quality care and improving on those benchmarks.

Eliminating disparities is a key part of controlling costs and improving quality for everyone. Among our efforts is MassHealth’s Pay for Performance model, which provides incentives for acute hospitals to reward excellence and improvement in hospital quality and reduce racial and ethnic health disparities in the provision of health care.

These initiatives are only a handful of the Administration’s many efforts to ensure that people in Massachusetts receive high-quality, affordable and cost-effective health care. Our work has just begun, and we look to you—as leaders across the health care field—to be key partners in this work.

Judy Ann Bigby
Secretary of Health and Human Services for Governor Deval Patrick