In this podcast interview, Joe Avellone, Democratic candidate for Governor of Massachusetts discusses his views on healthcare with healthcare business consultant David E. Williams, president of the Health Business Group. This is the seventh in a series of nine in-depth interviews with the candidates. For a complete schedule and an explanation of the questions visit the intro post.
Excerpts from the interview are below. The full transcript is available here.
Question 1: Does Chapter 224 represent the right approach to addressing rising health care costs? If not, where does it miss the mark and what would you do differently?
“It does several things very well. First it allows for data collection, which is absolutely important to understand the true patterns of care. It also allows a process for setting targets. That’s an important thing as well. It calls for corrective action plans to bring outliers back towards the targets, which is also very important.”
“Something that will occur more down the road is the idea of having accreditation for these large integrated organizations. As they take on new kinds of contracts, global payments, and bundled payments, this will be incredibly important.”
“The Health Policy Commission could have a more active role in ascertaining appropriate levels of care in these larger systems. They should continue to take on a vigorous role in taking a hard look at the cost impact of mergers as they occur in our systems over time.”
Question 2: Certain provider systems in Massachusetts are reimbursed significantly more than others for the same services even though there are virtually no differences in quality. Does the state have a part to play in addressing these disparities?
“We have a mixed model system, with private payers and public payers. What the state should continue to do is have more transparency around these contracts, so as consumers choose among providers, they have a better understanding [of the contracts]”
“As a companion with the pricing, we should continue to focus on building up the quality measures, even with all of the challenges around that, so that people can do more value pricing, and choose more on the basis of value than just the straight price itself.”
Question 3: More than a dozen state agencies have a role in health care. Is there an opportunity to consolidate or rationalize them?
“There is ‘silo-ization’ in our state government. We have to continue to look at it, especially as we’re moving towards a more integrated approach to healthcare.”
“What I see are disconnects between our mental health system and our substance abuse capabilities of the state, which are in the public health department.”
”Public health itself is pretty much divorced from health and human services. We ought to address that from an organizational standpoint.”
“Substance abuse has to have a higher profile in our Commonwealth. We should think of it more as a medical problem than a criminal justice problem.”
Question 4: Government policy has encouraged adoption of electronic medical records. However many providers complain about the systems and the benefits have been slow to materialize. Should state government play a role in helping to realize the promise of health information technology?
“Despite the frustrations of implementing electronic medical records, they have a huge impact on both quality and cost of healthcare overall.”
“Electronic medical records create the means by which doctors can operate and collaborate in teams, in which better planning for after-discharge of the hospital can be done. It’s absolutely important for the future.”
“The state ought to continue to be supportive and push for full use of electronic medical records. The state should continue to push for inter-operability, so that the systems can talk to each other.”
Question 5: Hepatitis C is 3 or 4 times more common than HIV. New drugs that can cure the infection are coming on the market this year but they are very expensive. What role should the state play in ensuring that residents are tested, linked to care, and have access to these new medications?
“This is a scourge that is going to be a huge problem for us down the road.”
“In my administration I’m going to propose widespread access to testing, perhaps even anonymous testing, like was done in HIV to encourage people to get tested.”
“We definitely need to have more widespread public education about this disease and more identified places for treatment.”
Question 6: There are multiple health care related ballot questions. What are your thoughts about them?
“I agree with the idea of the staffing ratios that are inherent in the ballot initiative.”
“The way to save money in our healthcare systems is not to jeopardize the safety of patients and hospitals by understaffed wards. It’s really to take the inefficiency out of the delivery system itself and coordinate the care more.”
Question 7: What have you learned as a surgeon and health care executive that will be useful as Governor?
“Having been a practicing surgeon, I understand the absolute sanctity of the doctor-patient relationship. Even though we talk about the health system all the time, it really is built around maintaining that inviolate doctor-patient relationship. That is at the core of our profession.”
“I’ve learned the importance of preventive medicine – it actually works. It’s very difficult for most organizations to invest in it because of the long-term time horizon, but the state is the appropriate level.”
“The modern killers are obesity, especially childhood obesity, smoking, and Hepatitis C. The state is the only entity that can really make the appropriate investments, given that the return in health and all the cost to all of us is far down the road.”
Question 8: Much of the emphasis in health care reform is on adult patients. Is there a need for a specific focus on children’s health?
“We all have to recognize that children are not just small adults. What that means for drug treatment or other kinds of therapy is still an active area to learn about. We have to make sure that our health system understands and is sensitive to that.”
“In our Commonwealth we’ve underserved children in mental health needs, especially adolescents. This is a too-forgotten part of our system, and as we improve the mental healthcare system we have to pay special attention that adolescent mental health issues in particular are addressed.”
Question 9: Is there anything you’d like to add?
“Healthcare is the most intimate and important of all services, and it’s something that affects everybody, from birth to death and all of our families. It’s also becoming a bigger and bigger part of our political life.”
“The health profession itself, all aspects of it, needs to understand that they have to get engaged in the political process, that people like me need to run for office and participate in it.”
—-March 9, 2014