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The health-care landscape is shifting

Posted by Marjorie Pritchard  December 21, 2011 02:13 PM

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By Gene Lindsey

The tremors you feel are not after-effects of this summer’s earthquake, but the healthcare landscape shifting beneath us to create better and more efficient care.

Headlines highlight daily a high-stakes game of affiliations and mergers happening at a breakneck pace. New ways of providing care and paying providers are being tested. The Blue Cross Blue Shield of Massachusetts Alternative Quality Contract is no longer “alternative” as a majority of the Commonwealth’s providers are participating. As part of the Affordable Care Act, “Accountable Care Organizations” (“ACOs”) will launch nationally for Medicare beneficiaries in 2012. This legislation also funded the Center for Medicare and Medicaid Innovation (CMMI) with a mandate to explore alternative delivery and payment models.

In this shifting landscape, it is clear that Massachusetts will be a national leader. Under CMMI’s leadership, Medicare has taken the first steps to ACOs nationally by selecting a small group of organizations, “Pioneer ACOs,” to demonstrate quickly what is possible when health care leaders are given the right incentives to create better systems of care. These ACOs are groups of doctors and other healthcare providers who believe that by working together with Medicare and coordinating closely with hospitals and other health care facilities that they will be able to give patients enhanced service and care.

Massachusetts has a big share of this Pioneer ACO Program, as noted in the recent announcement from CMMI. Atrius Health is proud to have been selected as one of these provider organizations in Massachusetts. This program is earthshaking in significance, as Medicare is taking a substantial step to promote a truly sustainable, high quality, patient-centered delivery system.

This advancement of the ACO movement at a federal level, adding to the efforts at a state level, is especially good news for the Commonwealth.

It’s no secret that the state leads the nation in health innovation. The landmark Chapter 58 reforms of 2006 created universal access to health insurance and formed the basis for national reform. Contrary to media reports, recent public opinion polling shows the vast majority of Massachusetts residents support the measure as well as further initiatives by state government to control spiraling costs.

In 2008 the state’s Special Commission on the Health Care Payment System boldly recommended replacing the broken fee-for-service reimbursement methodology with a system of global payments administered by physicians; endorsing what is now being recognized as the ACO model of care.

Now, Medicare is testing the ACO model. So what’s next for the state?

State lawmakers and policymakers should make good on the promise of ACOs this session. If that happens, the Commonwealth will again lead the nation on reform, and progressive providers will have support from both state and federal government to make necessary changes toward a truly sustainable, high quality and patient-centered delivery system.

Providers are beginning to step up to the challenge of reducing the growth in healthcare expenses, but that is not happening fast enough. Thoughtful legislation that allows physicians to lead the transition to accountable careis a necessary step. Providers shouldn’t wait for legislation when many practices can start the transition to a higher quality and more efficient healthcare system now.

Atrius Health, the largest independent non-profit physician group nationally, has been operating like an ACO for years. By creating a culture dedicated to continuously improving quality and efficiency under the ACO model, we decreased the growth in costs against prior trends by $64 million in 2010 while overall quality has increased.

Hopefully, the combination of state reforms and success with the new Medicare ACO Model program will soon give even greater impetus to providers across the Commonwealth to find better ways to deliver care. If we can make that progress, then once again Massachusetts will set the example for the rest of the country.

Gene Lindsey is president and CEO of Atrius Health

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