Improving the Quality of Health Care and Reducing Cost Growth

The Office of the State Auditor was asked by the legislature to conduct a comprehensive review of the impact of Chapter 224 of the Acts of 2012 on the Health Care Payment and Delivery System in the Commonwealth and on Health Care Consumers, the Health Care Workforce, and the General Public. Chapter 224 is a law primarily intended to control health care cost growth and improve quality and access to health care services.

This transformative undertaking includes built-in monitoring and accountability mechanisms. It is the State Auditor’s responsibility under the law to objectively determine whether it produces the desired effects and what are its unintended consequences. The Auditor's final report on Chapter 224 is due to the Legislature in 2017, but the work is happening now. On this page you learn more about Chapter 224 and the Office of the State Auditor's Evaluation.

What is Chapter 224 and what does it do?

Chapter 224 was signed into law in 2012. With its passage, the Legislature and Governor Patrick set in motion a number of initiatives and administrative changes intended to achieve a several health care goals, primarily to control the growth of health care costs, to improve health care access and quality, and promote public health.

Key strategies of Chapter 224 include:

• “The creation of new commissions and agencies to monitor and enforce the benchmark for health care cost growth, placing new scrutiny on health care market power, price variation, and cost growth at individual health care entities;

• Wide adoption of alternative payment methodologies by both public and private payers, including specific targets for Medicaid;

• Increased price transparency for consumers;

• A focus on wellness and prevention, through public investments and adoption of workplace wellness programs;

• Expansion of the primary care workforce;

• A focus on health resource planning;

• Financing and otherwise supporting the expansion of electronic health records and the state health information exchange;

• Medical malpractice reforms; and

• Numerous other provisions including ones pertaining to mental health parity and integration, administrative simplification, and health insurance premium rates”.

(From the Blue Cross Blue Shield Foundation, 2012)