Will Massachusetts resume the lead in health reform?

Deval Patrick’s first term as Massachusetts governor was somewhat disappointing from a health care perspective, especially the first couple years. That’s when the Executive Branch tried hard to squander the state’s lead in health information technology implementation by dithering over productive spending of funds allocated for e-health and wasting time and money on consulting fees instead. A weird interpretation of conflict of interest rules sent many of our in-state experts out of state to help others catch up.

Things improved in the past couple years as the state started to get serious about cost control –which is the only way to sustain the near universal coverage we now enjoy. Although it wasn’t pretty, Patrick’s attempts to rollback insurance premium increases for individuals and small businesses was a decent idea. It helped insurance companies get tougher with health care providers in their negotiations, causing those providers to think harder about how to save.

Better yet, a special commission on payment reform generated a near consensus on the need for global payments, basically a statewide implementation of capitation with a quality component. Accountable care organizations (ACOs), which can handle bundled payments are on of the more promising innovations in health reform (PPACA), and the consensus building in Massachusetts should enable us to move forward effectively on implementation.

Patrick should be congratulated for making such a strong showing in an election year that favored Republicans and featured serious antagonism to health reform at the national level. I’m encouraged to see that Patrick now plans to move forward in a serious way on implementing the global payment model.

Perhaps after 2012 the country as a whole will start copying us again.

November 8, 2010

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