From the Summer 2011 For Your Benefit newsletter pdf format of fybsummer2011.pdf

One of Governor Deval Patrick's major goals for his second term is health care payment reform and cost containment. In the last ten fiscal years, growth in state spending for health care, including the GIC, has increased by 76%, while higher education, public health, and environmental programs have suffered major cuts, according to The Massachusetts Budget and Policy Center. The GIC supports the Governor's efforts, not only because it will help with our own and members' costs, but also because it will free up funds for these other important programs.

The GIC's Executive Director, Dolores L. Mitchell, is a member of the Massachusetts Payment Reform Commission that originally recommended ending the fee for service payment system and replacing it with global payments. Currently most doctors, hospitals, and other care providers receive payment for each test and procedure they perform, which rewards volume over efficiency. With global payments, groups of doctors, hospitals and other providers, get a fixed fee for taking care of a patient for a period of time. This change would mean that providers would get paid for health outcomes and coordination of care. Federal health care reform supports similar initiatives.

A much discussed method of delivery under payment reform is an Accountable Care Organization (ACO), a strategy to create an organized, integrated system of care for the patient that offers doctors and hospitals financial incentives to provide good quality care while keeping down costs. Bundled payments, where there is a set amount to treat certain conditions, such as for a heart attack or knee replacement is also under consideration, either as an options on its own or as part of a global payment system. "Over the next few years, there will be a competition of approaches to integrate payments that support the health care delivery system," says Ray Campbell, Executive Director of the Massachusetts Health Data Consortium.

So, what changes might patients see under payment reform?

  • Better coordination of care and reduced increases in costs.
  • Primary Care Physicians will take on a greater role - coordinating your care with nurses, hospitals, psychologists and nutritionists.
  • The doctor's office will call you with test results instead of you needing to call the office.
  • No need to get the same test four times at four different offices - test results will be shared when needed between providers with electronic medical records.
  • Less need to go to the Emergency Room at 5 PM as doctors' offices will be open later.
  • Different ways to communicate with your doctor instead of only in person, such as via telephone and computer.

This information provided by the Group Insurance Commission .