Digesting the health care compromise bill

Lawmakers are expected to vote Tuesday on a 350-page bill that would make Massachusetts the first state to impose limits on how much health care providers can spend on medical costs. It’s a complicated, far-reaching bill that depends on the state’s ability to collect massive amounts of data and to make it usable by regulators and consumers.

Leaders in the House and Senate prepared summaries of key provisions in the bill. Below, see some early reaction from consumer advocates and others.

The bill comes after more than a year and a half of negotiations on Beacon Hill. But the Greater Boston Interfaith Organization, which has served as a consumer advocate on health costs, urged people not to see the bill’s expected passage as an end to the debate.

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“We invite all stakeholders to meet with us publicly at a gathering of GBIO leaders on Tuesday September 17th, 2013—one year from now—to evaluate the progress in controlling costs and assess the effectiveness of this legislation,” President Rev. Burns Stanfield said in a press release.

The group lauded the bill’s allocation of $60 million for public health programs and its setting of a spending target:

Specifically, per person health care spending is targeted to grow no more than the Gross State Product during the years of 2013-2017. Then a more aggressive target of GSP minus .5% is established for the years 2018-2022.

These targets have the potential to establish a clear incentive to make real changes that will reduce costs; eliminate waste; and improve patient care. However, to accomplish these aims an enhanced enforcement mechanism will likely be necessary.

Eric Schultz, chief executive of Harvard Pilgrim Health Care, congratulated lawmakers on the bill, in an e-mailed statement:

While we continue to review its many complex elements, it is clearly a meaningful step forward in the effort to control health care spending. We look forward to working with our partners in state government and other key stakeholders to fully implement the law so that we, as a Commonwealth, are able to fully realize its potential to improve care and control the rate of increase in health care costs for Massachusetts consumers and businesses.

Lora Pellegrini, chief executive of the Massachusetts Association of Health Plans, called the bill “an important step toward improving the cost and quality of health care in Massachusetts” that builds off efforts already underway:

We are pleased that the bill includes measures to address the market power of certain providers and the prices they charge as highlighted by multiple reports and studies issued by the Attorney General and various state agencies over the last several years. Dealing with those issues is critical to the bill’s success by ensuring that price differences among providers are correlated to the quality, acuity and complexity of patient care and are not due to an institution’s or system’s size, brand recognition or geographic isolation.

Josh Archambault, director of health care policy at the Pioneer Institute, expressed dismay, saying the bill “rehashes failed top-down strategies” that give too much control to government.

“Real cost-containment is only possible when we encourage patients to reward low-cost, high-quality providers with their business,” he said in a press release. “Instead of providing financial incentives for individual patients to take charge of their own medical care, this legislation rearranges the system based on accountable care organizations (ACOs) and changes in payment methods. The legislation misses the mark by a long shot and will not lead to long-term, sustainable containment of health care costs.”

In an e-mailed statement, the Massachusetts Hospital Association said the bill lays out “difficult challenges” for its members. The group said it will look for rules implementing the bill to “support flexible and efficient changes” in the health care system:

While hospitals will do their part to get health care cost growth to the level of the economy, with increasing demands on health care such as the aging population and obesity epidemic, doing so by 2013 will be daunting. We remain opposed to the addition of costs on certain hospitals through the imposition of surcharge assessments and will continue to advocate that the additional cost of implementing the bill not be placed upon providers who are already working diligently to lower costs.

The final bill is very comprehensive and we are still reviewing the details and analyzing the impacts. In large part this legislation appears to achieve a balance that will advance meaningful payment and delivery system reform. Its focus on patient-centered care and transparency is in line with recent health care system developments and offers great promise.

As we look to improve the efficiencies in delivering care and stabilizing the delivery system, it is critically important for the state to fulfill its commitment to adequately pay for care that is provided to those enrolled in its programs. For struggling hospitals that rely to a great extent upon government payment for the care services they provide, there needs to be a permanent solution found, and quickly.

Rick Lord of Associated Industries of Massachusetts wrote on his blog that the bill “takes a measured first step toward slowing the runaway health insurance premiums that have impeded job creation and economic growth for a decade.” The group wanted a more aggressive target than the legislation calls for, though Lord commended Governor Patrick and legislative leaders. “Passage of the cost control bill will not change the fact that the Massachusetts health cost crisis will ultimately be solved by employers working through the evolving private health-care marketplace,” he wrote.

Amy Whitcomb Slemmer, executive director of consumer group Health Care for All, in an e-mailed statement called the compromise “historic legislation” and celebrated the public health money, changes to management of behavioral health, and other provisions:

This bill is good news for health care consumers in Massachusetts. By changing how doctors, hospitals, and other providers are paid, the bill aligns incentives to promote patient-centered care focusing on health and disease prevention, while lowering health care costs. By paying for quality, not quantity, our state’s health care delivery system will be better and more cost-effective.

The legislation improves the quality of care patients receive by encouraging the active participation of patients and their families in making health care decisions. A truly transparent and integrated system allows patients to make informed decisions about their care. We are particularly grateful for the legislators’ vision and requirement for strong consumer representation on the Health Policy Commission and individual ACO governance because it ensures that the patient voice will be represented in decision making.

We are pleased that the final version of the bill includes a number of provisions that put patients at the center of our health care system. Strengthening the roles of medical homes, community health workers, valuing chronic disease management, and providing for licensed alcohol and drug counselors in the delivery of services is both cost effective and will lead to greater consumer empowerment and better overall health.