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Massachusetts Exceptionalism -- A Forum on Costs

Posted by John McDonough  September 17, 2013 10:07 PM

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Tonight was unusual. Sitting in a large meeting room in Temple Israel on the Boston/Brookline border were about 250 members of the Greater Boston Interfaith Organization (GBIO), in a meeting with four major hospital CEOs, four major health insurer CEOs, state officials, and sundry others to talk about rising healthcare costs. 

The CEOs were heavy hitters: Gary Gottlieb of Partners, Ralph de la Torre of Steward, Kategbio images.jpg Walsh of Boston Medical Center, Kevin Tabb of Beth Israel Deaconess, Andrew Dreyfuss of Blue Cross Blue Shield, Jim Roosevelt of Tufts Health Plan, Jay Gonzelez of Celticare, and Deborah Enos of Neighborhood Health Plan.  Each had four minutes to explain to the audience what they were doing to reduce costs and improve quality. 

Sitting in the audience were the Executive Director and three members of the new Massachusetts Health Policy Commission which is charged with enforcing the new state-mandated limit on health care cost growth. 

Many GBIO members had real and serious concerns, such as Marvin Miller who runs his own small business and has seen his company's insurance premiums rise from $70,000 in 2003 to $200,000 last year, even with 15% fewer employees; his per employee health insurance costs have risen from $2060 to $6900 even as deductibles have skyrocketed. 

The evening easily could have been a formula for anger, yelling, and finger pointing.  And it didn't happen.  What happened instead was intense listening, polite applause, and a pumped-up commitment to stay on top of the issue by all in the room.

How come?

Here are some reasons why, I believe:

First, the CEOs at the front of the room tonight all live and work in Massachusetts and run state-based organizations, six of eight of them non-profits.  This is not true in most other states where national for-profit hospital systems and health insurers rule the land. 

Second, every one of the eight companies has stories to share about tackling rising costs and improving their care systems; every CEO mentioned how they are moving away from fee-for-service reimbursement fast, toward global payment and accountable care. 

Third, the GBIO members in the audience care about costs and care about access, and they also care about health care quality and the institutions that provide the care.  Many of these members are medical care professionals who work in the institutions of the CEOs at the front of the room.  GBIO is a consumer group -- though it's a consumer group that recognizes the complexities and nuances of this issue.  That realization would make some consumer groups run away, and it's a credit to GBIO that they face the issue, complexities and all.

Fourth, Massachusetts is no longer fighting about what to do.  That was settled settled in the summer of 2012 with the passage of Chapter 224 and the new limits in that law on health spending growth.  The hardest work for the new Health Policy Commission is yet to come -- when they have to enforce the actual limits beginning in 2015.  At this point, everyone is pulling to help them succeed.

That's what makes Massachusetts different.  Our intelligent and compelling health care cost conversation continues.  And because groups like GBIO are staying involved and attentive, the issue is far less likely to wither away.  But it's not just a conversation -- it's a conversation with consequences.  And no other state right now is close to having this kind of conversation. 

That's worth noting and celebrating.
This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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