Embarking on the Next Chapter of Health Care Reform

Massachusetts is about to write the next chapter of health care reform.

We have achieved near-universal access, which was the first step toward better health for citizens. The next steps are ensuring quality and managing the cost of care to sustainable levels. The leaders who facilitated the beginning of the journey understood that reform would have to be staged. Taking that first step was hard. The next steps will be even harder.

Health care costs are rapidly depleting state coffers and straining private employers’ ability to provide health insurance to employees. The current rate of spending is unsustainable.

The Payment Reform Commission issued its recommendations recently and called for the use of global payments. Global payments are a move away from the current fee-for-service — with its constant possibility of overuse or misuse of resources because providers can be paid more by ordering more visits and procedures — and toward giving providers adequate resources to care for ‘the whole patient.’ The new system should include quality measures that give patients confidence that decisions made about their care are patient-focused and not driven by the desire to save money at the expense of their health. It is critical, in fact, to create a link between quality and payment.

We have great faith in the possibilities of global payments combined with quality measures. Atrius Health — an alliance of Dedham Medical Associates, Granite Medical, Harvard Vanguard Medical Associates, South Shore Medical Center, and Southboro Medical Group — has years of experience with the benefits that global payments offer for patients. We know that global payments can help providers better allocate limited resources toward care that will ensure the best health outcomes. A well-designed system based on global payment will put primary-care physicians at the heart of health care, coordinating care for the patient.

We agree with the Payment Reform Commission’s conclusion that, as our physicians acquire the tools and skills needed to accept global payment, we will get closer to reaching universal access to high-quality affordable health care.

What made the first step in health reform possible was that all the stakeholders were willing to work together, even though they didn’t always agree. This willingness to work together will continue to be critical because achieving true reform is never easy and requires everyone to make sacrifices.

The Payment Reform Commission has taken a bold step forward, but there remains more work to do. Many details will be left to a new board that will undoubtedly be the subject of heated debate. The board will oversee formation of ‘accountable care organizations,’ which will be at the heart of payment reform. Who gets to form an ACO will be critical because the organization will control the distribution of the global payments.

As a provider with a long history of working with global payments, Atrius Health is one model. Undoubtedly there are others.

For payment reform to succeed, there are certain requirements. There needs to be a way to connect patients to primary care physicians so that payment is made to the organization providing the care. Optimal accountable care organizations will need to have a scale large enough to accept the risk of providing care on a fixed budget and the expertise and infrastructure to manage risk. Smaller physician offices will need to partner with other groups or hospitals.

An electronic medical record, access to claims data, and the ability to analyze the data are important to ensure quality outcomes while managing cost. Global payment will be more successful if all physicians have access to services that support great care, such as pharmacists, case managers, and nursing.

The work of those who led the Commonwealth to take its first step has given it the opportunity to envision and create its own future, to improve the quality of care for its citizens, and to reduce the rate of growth of health costs. Now we all need to embrace the change and help others move toward it. v

Gene Lindsey is president and CEO of Atrius Health.