In this podcast interview, Martha Coakley, Attorney General and Democratic candidate for Governor of Massachusetts, discusses her views on healthcare with healthcare business consultant David E. Williams, president of the Health Business Group. This is the sixth 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?
“The legislation does a very good job at addressing, for now at least, the major issues [of] accountability and transparency.”
“This statute is the right way to go for now… It gives us the tools in the short run we need, but also gives us the flexibility that if we need to change it later… that is built into this legislation.”
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 developed the concept of total medical expenses and metrics to measure the value of what hospitals are doing, particularly in areas that you can measure… We needed to look at whether they were being reimbursed in a fair way for the total medical expenses involved in that service.”
Question 3: More than a dozen state agencies have a role in health care. Is there an opportunity to consolidate or rationalize them?
“One of the things we’re doing right now is looking at exactly how the state itself can be more efficient and effective in both changing and working with how the market is going, and doing the oversight on that. The statute, in setting up these two new commissions, the Health Policy Commission and the CHIA to look at what the market is doing in somewhat real time is an important place to be right now.
“One of the things that’s important to me as AG and would be as Governor would be to take a look at how we are structured at the state level both in terms of what the mission is of different agencies and other collaboratives or commissions.”
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?
“It’s pretty clear that we need to make an investment in technology that will let us have quicker information, and make sure that all of our providers are able to do this.”
“As we become increasingly technology-savvy, we’re also increasingly concerned about keeping information confidential, particularly in this area, where patients’ information is so crucial.”
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?
“That’s a good example, and it’s not the only one, of where new developments in drugs are helpful and pharmaceutical companies spent a lot of money investing in them. They have a patent. They want to get their return on the investment. But we also need to make sure that it is available to people who need it, and the state obviously has to play a role. And that’s the whole idea behind what we’ve done in healthcare reform. It’s making sure that people have the coverage they need and the access to go to doctors.”
Question 6: There are multiple health care related ballot questions. What are your thoughts about them?
On CEO compensation:
“We played a big role in looking at some of the compensation issues for CEOs and for boards in terms of not-for-profits. That discussion has begun a very healthy talk about what is the appropriate range for boards to make determinations. Boards of not-for-profits, which are most of our hospitals and healthcare institutions, have a very serious job to play in making sure that the assets of the charities are being used responsibly.”
On nurse staffing:
“I’m very sympathetic to nurses’ concerns about being able to perform their duties in the right timeframe, with the right resources and to be able to manage their patient care, as well as make sure that patients get the right treatment.”
“Trying to get a ballot determination on it may not be as easy as people think. But I certainly think the topic is a good one for discussion and continue to support nurses and frankly, others, who are saying, ‘we need more help, we need more support to do our jobs right.’”
Question 7: Are there specific things you learned about healthcare as AG that will be useful as Governor?
“Particularly in healthcare, it’s been a very interesting and rewarding journey for me to see how unique Massachusetts is and the relationship we have with our elected officials on both sides of the aisle, with our not-for-profit healthcare providers and insurance companies and our for-profit providers.”
“I think the next Governor of Massachusetts has a huge opportunity to continue to cut cost curves and look at better prevention, better coverage, and cutting cost drivers like diabetes and asthma.”
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?
“It’s incredibly important to focus on wellness and prevention for children.”
“We can save money down the road if we focus on pediatric issues and make sure that we provide kids good healthcare when they’re sick and good prevention to help them be healthy adults.”
Question 9: Is there anything you’d like to add?
“I would like to talk about the idea of mental health and behavioral health and how this is the time to try to reduce the stigma around getting help for people who have depression or bipolar or behavioral addiction and focus on that.”
“In 2014, Massachusetts, with our great doctors, with our advances in biopharmaceuticals should be able to both reduce that stigma and make sure people have access to care. As I mentioned earlier, both for kids and for adults, getting help for a mental or behavioral illness should be no different than getting help for diabetes.”
—-March 6, 2014