Governor Deval Patrick Announces Comprehensive Health Care Reform Legislation in Massachusetts

Strategic Insights -

Governor Deval Patrick has proposed a bold health care reform bill to control rising health care costs and improve patient care in Massachusetts. Building on the success of the state's universal access to health care, the bill aims to ensure that health care is universally affordable. The legislation, which was filed by the Governor, establishes a structure and process to facilitate significant reforms to the Commonwealth's health care payment and service delivery systems over the next three years.

Key Takeaways:

  • The bill encourages the growth of "integrated care organizations" (ICOs), comprised of groups of providers that work together to achieve improved health outcomes for patients at lower costs.
  • The legislation provides benchmarks, standards, and guidance for the transition to integrated care and global payments, and allows the Division of Insurance (DOI) to consider more criteria when making the decision to either approve or reject rate increase requests from both carriers and providers.
  • The bill aims to expand the use of alternative payment methods and significantly reduce fee-for-service payments by the end of 2015, and ensures transparency of payer and provider costs, provider payments, clinical outcomes, quality measures, and other information necessary to discern the value of health services.
  • The legislation clarifies the Commissioner of Insurance's authority to reject premium increases where the underlying provider rates are excessive, and requires carriers to factor savings into premiums charged to consumers as provider rates decline.
  • The bill facilitates the use of pilot programs to test other solutions to reduce health care costs and creates an advisory committee to ensure an ongoing dialogue about solutions and assess progress towards the goal of cost reduction to consumers.
  • The legislation reforms the medical malpractice liability system to emphasize prompt resolution, de-emphasize "defensive medicine," reduce the number of costly lawsuits, and improve care.
  • The bill includes provisions to improve the quality of health care service, such as making providers' apologies inadmissible in evidence, establishing a 180-day cooling off period before a party may initiate suit, and creating a process for providers and aggrieved patients to communicate and exchange documents prior to litigation.

Statistics:

  • 98% of Massachusetts residents have health insurance (Massachusetts Health and Human Services, 2010)
  • The rate of increase in health care costs has outpaced growth in the economy and threatens the financial health of individuals and businesses (Massachusetts Health and Human Services, 2010)
  • Total health care spending in Massachusetts is projected to reach $123 billion by 2020, outpacing the annual rise in the GDP (Massachusetts Health and Human Services, 2010)
  • 99.8% of Massachusetts children are insured (Massachusetts Health and Human Services, 2010)
  • 400,000 people in Massachusetts had insurance as of June 2010, more than had previously been uninsured (Massachusetts Health and Human Services, 2010)

Sources:

  • Governor Deval Patrick, "An Act Improving the Quality of Health Care and Controlling Costs by Reforming Health Systems and Payments" (2011)
  • Massachusetts Health and Human Services, "Health Care Reform in Massachusetts" (2010)
  • Contify.com, "Governor Deval Patrick Announces Comprehensive Health Care Reform Legislation in Massachusetts" (2011)
  • Neotrope(R) Entertainment, "Governor Deval Patrick Announces Comprehensive Health Care Reform Legislation in Massachusetts" (2011)