Writing today in the Health Affairs blog, Harvard School of Public Health Associate Dean and Connector Board Member Nancy Turnbull posts a summary and analysis of chapter 224, the new payment and delivery system reform law.
Turnbull rightly focuses on the implementation challenge:
After a two-year gestation period for its payment reform and cost control bill, the Massachusetts legislature finally delivered … an exoskeleton. Time will tell whether the law will be transformed through the magic of implementation genetic engineering into an effective cost control creature with strong and vital organ systems. Some of the essential DNA is there but the challenges ahead are formidable. However, regardless of whether Massachusetts is ultimately successful at “cracking the code” on cost control, as Governor Deval Patrick and others hope, the state is going to learn a lot over the next few years, much of which will no doubt be useful to other states.
History suggests that the law will be revised, perhaps many times, in the next few years. But for now, attention shifts to the important implementation decisions that lie immediately ahead. In particular, the appointments of the 9 public members to the new 11-member Health Policy Commission will be critical, as will the selection of its chairperson and executive director. Unless the Commission becomes a strong and independent entity, the promise of the law cannot be realized.
Implementation of the payment reform and other provisions will spell the difference between success and status quo (or worse). HCFA will be looking to continue to play its role as the voice of consumers in the implementation process, much as we have done in the implementation of Chapter 58.
Turnbull concludes with some optimism, which we share:
We won’t know for several years how well the Massachusetts law will work, and whether it could be a model for other states or the nation. What is a model is that Massachusetts is again taking on, as it did with coverage in 2006, one of the most challenging and important health care issues in the country. While it’s very likely that the new cost control law will turn out to be less than is needed to solve the problem, it’s much more than is happening in almost any other state. And that’s a cause for celebration, and some hope.
Now it’s up to us, collectively.