Extra! Extra! Twelve Points of Broad Agreement On Payment Reform!!

It may look like torpor, but it's actually unaccustomed harmony on health care payment reform.
It may look like torpor, but it's actually unaccustomed harmony on health care payment reform.

Naturally, as a member of the media, I am what Spiro Agnew called a "nattering nabob of negativism," and always lean toward writing about conflict rather than harmony. So I thought of beginning my report on today's meeting of the state panel on payment reform by pointing out the huge areas of continued contention.

But then I thought, "Wait, what makes news is the unexpected, the counter-intuitive, the "Man Bites Dog" headline. We all expect prolonged if not endless wrangling about the next stage of health care reform in Massachusetts, the daunting challenge of containing costs and revamping the whole system from "fee for service," in which health care providers are paid for each procedure, to global payments, in which they're paid a lump sum for a patient's overall care.

So today's big news is that, believe it or not, the state panel made up of all kinds of "stakeholders," from hospitals to doctors to patients to insurers, has actually reached a broad if not perfect consensus on twelve goals for payment reform. For the wonks among us, they're listed below, in near-final form still subject to tweaking.

Panel members actually sounded a bit disbelieving themselves as they thanked each other for all the hard work of the last four months and acknowledged that this was only a first step in a difficult process still to come. Dr. JudyAnn Bigby, the Health and Human Services secretary, said that the panel's ideas and points of consensus had "been heard" by Gov. Deval Patrick, who is expected to deliver a major speech on health care tomorrow.

Just a brief note on the lingering dissent, since that is not the flavor of the day. Several members pointed out that the consensus was possible because some of the hardest issues had been skirted, to wit: Will providers' participation in global payment arrangements be voluntary? What powers will a new global-payment oversight committee have, and who will be on it? To what extent will the state seek to set rates that global payment groups can charge? In sum, how sharp are the state's teeth going to be?

State Inspector General Gregory Sullivan said that in his opinion, the committee's consensus "does not include what I would consider the necessary elements to actually control the rising cost of health care.” Under current global payment plans, he said, rates keep going up for a total of 50% over the next five years. For Massachusetts families, that would translate into a rise in their average premiums from $16,500 now to $25,000 in five years, he said.

"That shoud not be a goal, that should be the goal of what not to allow to happen," he said. "What I think is missing from the current discussion is the enforcement mechanism that’s going to control the increasing premium rates that people pay insurance companies" for global payment plans.

Back to the sweetness and light. Below are the twelve goals:

Goals for Payment Reform Legislation

PREAMBLE: The purpose of any payment reform legislation should be to encourage the restructuring of health care delivery and payment methods, commencing upon enactment and to be completed at no later than five years, in order to improve the quality of care for all residents and decrease the total per capita health expenditures made within the Commonwealth.

Goal 1: Provide for the creation of payment methods that will decrease total per capita expenditures, and the rate of growth in total per capita expenditures, for health care in the Commonwealth and improve efficiency, effectiveness and quality of its health care delivery systems.

Goal 2: Encourage the transformation of health care payment methods from fee-for-service to global and other alternative payment methods for the provision of health care services.

Goal 3: Align, across all public and private payers in the Commonwealth, reimbursement principles such that they are based on the quality rather than the volume of services, and employ comparable approaches to clinical risk adjustment and payment methodologies for comparable patient groups.

Goal 4: Assure that health care cost savings are shared proportionally among consumers, providers, payers, employers and other purchasers.

Goal 5: Define, develop standards, and outline minimum functional capacities for Accountable Care Organizations, comprised of connected or integrated groups of health care providers tha achieve improved health outcomes and lower costs of care.

Goal 6: Optimize providers’ ability to engage in best practices and have knowledge of all health-related events and factors relevant to their patients’ care and well-being by providing data and information analysis needed for population management and promoting tools for communication, information sharing, contracting and integration of the health care delivery system.

Goal 7: Achieve transparency of payer and provider costs, provider payments, clinical outcomes, quality measures, and other information necessary to discern the value of health services; and ensure such information is accurate, relevant and publicly available.

Goal 8: All residents of the Commonwealth should have adequate information abut cost and quality to make informed choices about primary care clinicians, other providers and ACOs.

Goal 9: Improve and protect equal access to health care services for all populations.

Goal 10: Leverage state government health care purchasing to accelerate the transformation to less costly and higher quality health care systems by utilizing alternative payment methods and integrated care organizations for the delivery of publicly-funded health services under a competitive procurement process.

Goal 11: Ensure engagement of patients and consumers, purchasers, providers, and payers of health care services in the policies developed to achieve health care delivery system an payment reforms.

Goal 12: Support and evaluate pilot programs and other demonstrations or experiments in delivering integrated care under alternative payment models.

This program aired on February 16, 2011. The audio for this program is not available.

Headshot of Carey Goldberg

Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



More from WBUR

Listen Live