HCFA ED Amy Whitcomb Slemmer on the Promise of Payment Reform

In Massachusetts’ Decisive Move to Attack Health-Care Costs, published in The Atlantic, HCFA Executive Director Amy Whitcomb Slemmer explains how the just-signed health care delivery and payment reform law can transform care for patients in Massachusetts. Excerpt:

For the first time on a statewide scale, we will move away from the current fee-for-service system, which pays for every procedure, test, and office visit, but does not pay for phone consultations, e-mail exchanges, home visits, health education, or wellness and nutrition education. In short, the system pays when stuff is done to us, but it does not support efforts to keep us healthy.

Your doctor is paid when you have an office visit, but if you have a question about whether or not you need to be seen, she will not be paid for that phone conversation. And if you need to be seen after hours, what happens? You are sent to the emergency room, where you will receive the most expensive care in our system. Chances are that the treatment that you receive or the tests that are performed to diagnose you will not be reflected in your overall medical record: you will be responsible for self-reporting to your primary care doc, or more often than not, tests will be repeated in a different setting.

The law signed by Patrick will change the way doctors, hospitals, and other providers are paid so that they are paid to keep us healthy. If your doctor was able to save you a trip to the ER, to take just one example, they will be rewarded for saving the whole system money — as they aren’t now.

In the improved delivery system, the relationship between the primary-care provider and the patient is highly valued. The expectation is that providers will have more time with each patient, and we as patients will be more engaged in our care. Efficiency will come as doctors and other providers organize to deliver team-based care that is better integrated and patient-centered.

Our new law also establishes a first-in-the-nation Prevention and Wellness Trust Fund: a four-year commitment to community-based public health initiatives that have proven track records, as demonstrated in improvements in overall health statistics for participating jurisdictions. At Health Care For All, a consumer-advocate organization that has worked to guarantee high-quality health care to everyone, we expect this investment — a down payment on improving our populations’ health — to return rapid results.

She concludes that “But one thing we know: what we learn in Massachusetts will again provide valuable insight and success that the rest of the country would do well to emulate.” As with our Medicaid and kids coverage expansions of 1996, which became a model for the federal CHIP law, and the 2006 reforms which of course provided a template for much of the ACA, the law Governor Patrick signed yesterday will reverberate far beyond the Bay State.

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