Mayor Menino on Payment Reform: More Primary Care, Invest in Prevention and Protect Vulnerable.

Boston Mayor Tom Menino jumped into the payment reform this week, devoting his weekly column to the topic.

The Mayor echos many of the policy concerns raised by the Campaign For Better Care, GBIO and HCFA, hitting 3 critical points:

  • Access to high quality, culturally competent primary care is at the heart of any successful payment reform regime. Because of this, changes to our health care payment system must also address the primary care gap.
  • Nearly 75 cents of each health care dollar each year is spent on treating chronic diseases, such as diabetes, cancer and high blood pressure, while only 5 cents or less of every dollar goes to preventing these diseases. Research demonstrates that community-based prevention efforts – such as creating more equitable access to healthy foods, preventing asthma hospitalizations among high-risk children and preventing tobacco use among youth – has a big impact on reducing high health care costs, by keeping people healthy before they ever need treatment…. Legislators should incorporate the concept of a prevention trust fund into the final payment reform legislation to ensure an ongoing investment in prevention and public health.
  • We must protect our most vulnerable residents by maintaining the health safety net and emphasizing strong consumer protections in the healthcare marketplace. In this new system that rewards providers for keeping patients healthy, we must be sure not to create incentives for providers to discriminate against patients who are sicker or who need more care than others. Safety net institutions, because they care for patients who are disproportionately burdened by social and economic inequities as well as chronic disease, should receive reimbursements that recognize these additional costs.

We applaud the Mayor and welcome his efforts to assure a strong payment reform bill. In his column, the Mayor recognizes that risks and rewards: “Payment reform legislation, which will restructure the way healthcare providers are paid for their services, has the potential to reduce waste, save healthcare costs and boost quality of care all at once. But while there is great promise in this new cost-saving strategy, it is not without risks.”

We urge the legislature, which is now drafting payment reform legislation, to closely follow the Boston Mayor’s lead.
-Brian Rosman

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