Getting to the Better Care: Spring Teaser Edition

Campaign for Better CareWith the release by the Governor of his payment reform proposal, action now moves to the legislature. The bill, H. 1849, was referred to the Joint Committee on Health Care Financing. Next step will be hearings, but no date has been set.

The Campaign For Better Care (hcfama.org/bettercare) will be reviewing the bill closely, to see how it tracks with our payment reform principles (pdf). Other stakeholders are busy doing the same thing.

While the process moves forward, here’s our next batch of interesting links and clicks on how to get to better care:

  • A latest Kaiser health tracking poll showed a slight uptick in public support for the Affordable Care Act. Yet the public remains very uninformed about the law – 22% said they thought the law had been already repealed, and another 26% were unsure. If you’re curious how the ACA will affect you, there is a new website called HealthCareandYou.org. It is a fast-and-easy way to receive a straightforward explanation about how the new law will impact the health care you receive.
  • WBUR’s CommonHealth blog continues to be the go-to source for payment reform updates. Last week Carey Goldberg wrote about and video interviewed Phyllis Minsky, an 82-year old with complex medical issues. She is enrolled in the Mass General Care Management Program, which provides her coordinated, integrated care, focused on keeping her healthy. Her nurse care manager keeps constant tab on her health, making a “vast difference” in her health. The program’s managers present the key lessons learned, including how “incredibly difficult” the job of a nurse care manager can be.The week before, Goldberg interviewed Dr. Marc Bard, from consultant Navigant’s health care practice. Bard is optimistic about how ACOs can transform medical care, looking towards lower costs and more team-based care.
  • Last summer’s cost control law (chapter 288) called on the state to develop standard quality measures. The Governor’s payment reform amplifies that call, and directs payers to use standard quality measures. Two bloggers looked at the issue from a patient’s point of view. Herb Fillmore’s post emphasizes that process and compliance measures (like cancer screening) are not enough, since most providers meet the targets. These measures are best used to punish the bad guys, not reward good care. In Rich Keller’s follow-up, he points to an study by Christine Bechtel and Debra Ness on what patients really want: whole person care; communication and collaboration; patient engagement and support; and ready access. These are the things that must be measured and tied to payment if we are to get to better care.
  • Tiered copayments, where insurers make patients pay higher copays for providers that are deemed more expense or poorer quality, are expanding in Massachusetts. We’ve always been skeptical of these arrangements, since the patient is usually poorly equipped to make an informed choice based on the cost and quality of the care, and often isn’t able to make any real choice. The quality measures rarely include critical components like patient engagement and collaboration. A Kaiser Health News article looked at the issues raised by the practice.
  • The successful asthma initiative at Children’s Hospital Boston has been lauded for showing the power of moving to an integrated patient-centered total care model. But the financial issues are pointed out in the title of a recent HealthLeaders Media article, A Hospital Prevents Readmissions, but Threatens Revenue. The savings accrue to society, not to the hospital. The article reminds us that payment reform is critical to align incentives that will lead to better care.

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