This is the transcript of my recent podcast interview with Jeff McCormick, independent candidate for Governor of Massachusetts. Visit the original post to listen to the podcast and read a summary. This is part of a series of interviews with all nine candidates for Governor. The full schedule is available here.
David E. Williams: This is David Williams from the Health Business Blog. I’m speaking today with Jeff McCormick, candidate for Governor. Jeff, thanks for being with me today.
Jeff McCormick: David, thanks so much for having me.
Williams: Jeff, does Chapter 224 represent the right approach to addressing rising healthcare costs. And if not, where does it miss the mark and what would you do differently?
McCormick: Overall, it’s at least intentionally going in the right direction. We have to see how effective it is because the devil is in the details. Changing of payment methodologies, investing in the system for community-based care and community hospitals and expanding the role of physician’s assistants, nurse practitioners in primary care, all that is definitely going in the right direction.
This is a comprehensive law with a comprehensive approach. Not only the cost, but the access to care and focus on preventative medicine, which is absolutely what we need to do with primary care, all of which is critical to bringing down cost. That’s a big part of what we need to focus on, and of course, maintain the outcomes.
We do need to focus on those outcomes, and it seems to me that we’re so heavily investing in the old system, rather than creating and pushing new technologies that will create a new system. I’m not sure you can migrate from one to the other very easily because these are complex, established legacy systems. That’s something that needs to be further investigated and I don’t see that in 224.
Lastly, the constant monitoring and flexibility is critical. This is not the end. This is the beginning of a lot of change, and we need to make sure that we have a cycle, that we’re constantly improving. This is a very big ship that we got to turn around, and we’re not going to do it with a quick about-face.
Williams: There are certain provider systems in Massachusetts that 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?
McCormick: The state can play a part, but prices need to be available to the consumer, and consumers need to essentially shop around and act like consumers. We have to figure out ways to align the interests of patients and providers. Over time, this will bring down costs as consumers have more information and transparency regarding healthcare choices.
Healthcare is a curious industry in that often patients have no idea what they’re paying for services, and sometimes the providers don’t. So, 224 changes that dynamic somewhat, and more information is always a good thing when it comes to consumers making choices.
We also have to recognize that there are inherent cost differences between, say, teaching hospitals and non-teaching hospitals. Teaching hospitals are extremely important to the future of healthcare, not only in educating our future providers but also particularly in the Commonwealth because of our outstanding teaching hospitals. We have to make sure that we align the interests of the patients and the providers.
Understanding these disparities is not always a result of looking at profit margins and revenues and such. When you’re asking if the state should take a step and truly manage the rates, market forces usually do a pretty efficient job once we break down some of these other barriers. We need to continue to refine the system, and this is going to be a long series of changes, but we’re going the right direction.
Williams: There are more than a dozen state agencies that have a role in healthcare. Is there an opportunity to consolidate or rationalize them?
McCormick: This is something that we need to look at, not just in healthcare, but across a number of different areas within the state. We want to avoid redundancies and excess bureaucracy whenever possible. Whether it’s consolidating the agencies or just making sure that there are no fiefdoms being created in territorial battles that you see in government, where one agency isn’t talking to or working well with another agency, because no one is served well when that happens.
So it’s the integration. A lot of this can be done through technology. That needs to take place. Like almost anything, when you do that, you tend to find efficiencies and you also drive better outcomes. So, that’s something that clearly needs to be looked at carefully.
Williams: Government policy, both at the federal and the state level, has encouraged adoption of electronic medical records. However many providers complain about the systems and the benefits have been slow to materialize. Should the state government play a role in helping to realize the promise of health information technology?
McCormick: The state can incentivize the adoption of certain health information technologies and needs to work with the players in the space to create some standards to get people on the same page. We can offer economies of scale, where it lowers the implementation cost and allows for record sharing across different platforms. There are some legacy systems out there that really need to be upgraded. That is something that we should take a look at. There are many other areas where government has done a pretty good job of creating systems standards.
The government certainly has helped standardize forms, and we can do that with healthcare IT to get it on the right path. There are huge cost savings when you talk about an area as huge as healthcare. We’ve got to try and drive that and make sure that the systems are integrated, and that they can communicate with each other. We don’t want these redundant efforts every time people are going in to the same systems, maybe with a different hospital, and are just repeating the same work over and over and again. That adds up very quickly.
The VA Hospital model of medical records is an example of how that kind of standardization can help reduce cost and approve efficiencies.
Williams: Hepatitis C is three or four times more common than HIV. New drugs that can cure the infection are coming on the market this year but they’re very expensive. What role should the state play in ensuring that residents are tested, linked to care and have access to these new medications?
McCormick: Back at the early 80s when I was doing graduate work in molecular biology, I worked with Hepatitis C and HIV. I realized where we’ve gone in both of these indications. With Hep C, we need to look at what we could do to control that within a population.
Not unlike what happened with HIV, you have a situation where the cost can be prohibitive. What we need to do is work with some of the manufacturers to make sure that they can realize a return for their work in research and development. On the other hand, we should make treatment as affordable to as many people that need it as possible.
There is a very interesting case study with HIV, especially in Africa, with the Clinton Global Initiative. I know some people who led that effort and made it available in a way that, a drug that was prohibitively expensive to that population, was able to be manufactured and distributed in a way that worked for both the pharma companies involved, and also the local markets and the patients.
It’s very innovative thinking in leadership. We ought to look at that kind of strategy on issues like Hep C. One solution might have to do with just extending patent life, so that these companies can recoup their R&D cost. They don’t have to do it in such an aggressive frontloaded way, just because they don’t have a long enough time on the patents. That’s something we need to think about. That’s a much bigger change than something we could do just at the state level.
Williams: Jeff, there are multiple healthcare related ballot questions. What are your thoughts about them?
McCormick: The questions have to do with greater financial transparency, limiting hospital margins, nurse-patient ratios, et cetera. We need to be very careful that we don’t get in the business of legislating the internal management practices or contracts between hospitals and their nurses. The nurses need to be at the table.
I’ve been through a very personal experience at Brigham & Women’s, them essentially saving a one-pound one-ounce baby, if you can imagine that, a 23-weeker that we had. That was my foray into fatherhood. I think of them as saints. Perhaps I’m a little biased here in my feelings towards nurses. But they do want to provide great care. There’s a way that all of those players can work together without legislators believing that they know what’s in everyone’s best interest.
Williams: Your campaign platform mentions improving efficiencies and promoting preventive medicine. Are there specific steps you would take to achieve this?
McCormick: First of all, you have to get everyone at the table. You have to get some of the larger providers to the table. There’s extraordinary evidence that primary care pays for itself many times over. The closer you can get to families and communities [the better].-We nee to look at it holistically, too. Unfortunately we tend to dismiss some of the social work needs and some of the mental health issues.
One area that we have to take to the next level is nutrition. We all know that there is rampant obesity in our country, which has massive downstream effects in diabetes. There are issues in cardiology, hypertension, et cetera. So we have to push in that direction.
There are for-profit companies that do that very well and the return on investment is fantastic. That’s something that achieves better outcomes and reduces cost. That is a very logical place to go. Some of our largest, best known players in the Commonwealth are moving in that direction, but we need to do everything we can to encourage it.
Williams: Jeff, much of the emphasis in healthcare reform is on adult patients. Is there a need for a specific focus on children’s health?
McCormick: Absolutely there is. We don’t focus on children’s health as much as we should in certain areas like childhood obesity, which we know is absolutely going in the wrong direction and creates huge problems.
In fact, that’s one of the reasons my wife and I got behind a local playground, a play space in the Esplanade in Boston, just to improve children’s strength and reduce obesity. That really was what it was about. The child issues like asthma, overall health and fitness, they’re going to lead to higher cost. So we need to encourage healthy habits.
On the drug development side, it’s very common that there’s not even an arm for children in a clinical study. Yet ultimately the drug will be prescribed to children. Obviously, they tempered those down because of weight issues, the children weigh less than adults. Still, we’re not compounding the way we should and there’s a lot of opportunity in that area for children’s health.
Williams: Jeff, I very much appreciate you answering all my specific questions. I want to give you an opportunity in case there are other topics that you’d like to address that we haven’t covered.
McCormick: Well, there’s a number of others we can get into but I sincerely appreciate your talking to me about these topics. And I just want you to know that with my background of 25 years of building companies in this area, some of them in healthcare and biotech, I do want to bring a new set of eyes to identify these problems and solutions and not do more of the same old, same old.
This a very complicated business and I do believe we all need to focus relentlessly on lowering cost and driving outcomes to be better and better. I know that’s what I’ve done in my business. Some of it through technology, a lot of it through innovation of one sort or another. And that’s what I want to continue to do and be successful as the next Governor. So, thank you again for having me.
Williams: Jeff McCormick, candidate for Governor of Massachusetts. Thanks again for your time.
McCormick: All the best. Bye now.
—March 4, 2014