The Massachusetts Senate released a report “Working Together to Improve Our Health: Right Care, Right Place, Fair Price, Recommendations from the Senate Working Group on Health Care Cost Containment and Reform,” that focuses on both short and long terms goals on how to strengthen our healthcare system to lower costs, improve outcomes, and enhance access. The report and accompanying draft legislation is the result of a collaborative effort by a group of Senators to address the healthcare system by analyzing the best practices in other states and engaging stakeholders in a series of meetings over the last year.
Healthcare costs are continuing to strain the budget of working families, businesses, and government. The Senate has continued to push for reforms to the current system through diligent research, stakeholder engagement, and legislation. The working group of Senators, with the logistical support of the Milbank Memorial Fund spent the last year meeting with officials from seven states, healthcare experts, and stakeholders to examine best practices while lowering costs and improving outcomes.
“Massachusetts should continue to lead on healthcare, and having a robust economy depends upon on lowering costs for everyone without compromising quality or access. The recommendations in this report will help working families, businesses, and our state budget,” said Senate President Stan Rosenberg. “I’m very proud of the work the Senate did to craft a comprehensive report and draft legislation that touches so many aspects of our healthcare system and meets the needs of all engaged stakeholders.”
“This important legislation takes meaningful steps to both improve healthcare quality and outcomes, as well as contain costs,” said Senator Jason Lewis, who served on the Senate Working Group on Health Care Cost Containment and Reform, as Senate Chair of the Joint Committee on Public Health. “More deeply, this legislation furthers efforts to address the social determinants of health that are responsible for many health inequities in our system; and, innovative steps are taken to make prevention a more central component of our healthcare system, which will improve our quality-of-life and save money.”
The goals outlined in the report vary from more effective care delivery such as telemedicine and mobile integrated health to reducing emergency room visits to expanding provider versatility while also addressing price variation between larger hospitals and their smaller community hospital counterparts. The report outlines a series of recommendations that will achieve these goals and lower costs as a result of implementation.
The bill takes concrete steps to expand provider versatility to increase access to lower cost providers. It expands provider treatment authority for nurse practitioners, certified registered nurse anesthetists, psychiatric clinical nurse specialists, optometrists, and podiatrists; additionally, it establishes a mid-level dental therapist (DT) certification.
A DT would be able to perform procedures including basic tooth extractions, fillings, and taking x-rays, freeing up dentists to focus on complicated cases. Currently, in Massachusetts over a half-million residents live in dentist shortage areas as defined by the US Department of Health and Human Services, and in 2014 only 35 percent of dentists treated MassHealth patients. As a result, 44 percent of children on MassHealth (over 284,000) did not see a dentist in 2015. This bill is uniquely designed to target those living in dentist shortage areas by allowing DTs additional freedoms to operate under non-profits and in a licensed mobile dentistry program. By reaching out to underserved populations, the culture around oral healthcare can begin to change.
The bill also reauthorizes and updates the successful Prevention and Wellness Trust Fund (PWTF), and provides opportunities for new sources of funding, a major priority of Senator Lewis’. The PWTF funds community partnerships made up of municipal governments, healthcare providers, and local health and human service organizations, all working closely together to achieve a community-wide focus on prevention and wellness. Early results from an assessment conducted by Harvard Catalyst indicate that “to date, PWTF appears to be a very sound investment from the point of view of improving outcomes and controlling costs.”
The report aims to reduce hospital re-admissions and emergency department use through mobile integrated health and telemedicine as well as expanding access to behavioral health. Massachusetts Health Policy Commission has estimated that 42 percent of all Emergency department visits are avoidable.
Post-acute care in an institutional setting and long term care and supports (LTSS) cost the state an estimated $4.7 billion in 2015, a major cost driver for MassHealth. The report recommends increased transition planning for patients into community settings and strengthening coordination between providers.
Pharmaceutical costs have been a driver of increased healthcare costs for a number of years. The Center for Health Information and Analysis (CHIA) reported a 6.4 percent growth in pharmaceutical spending in 2016. Drug costs are making families choose between filling prescriptions and paying for other essentials like housing and food. The report recommends greater oversight and transparency in drug costs and encourages Massachusetts to enter into bulk purchasing arrangements, including a multistate drug purchasing consortium like other states, to lower costs and protect consumers.
The scope of the report encompasses the whole system from Medicaid to the commercial market, and makes additional recommendations on how to lower costs, address price variation, increase price transparency for consumers, leverage better federal funding opportunities, and many other recommendations. A copy of the report and draft legislation can be found online at https://malegislature.gov/Committees/Detail/S61/Documents.