This is the transcript of my recent podcast interview with Joe Avellone , Democratic 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 Joe Avellone, candidate for Governor.
Joe, first question for you, 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?
Joe Avellone: Thank you, Dave. It’s a pleasure to be here.
Chapter 224 is a great step in the right direction for us in the Commonwealth. It does several things very well. First it allows for data collection, which is absolutely important in order to understand the true patterns of care. It also allows a process for setting targets. 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. In some other states, Oregon in particular, they moved too quickly to accountable care organization-type structures. There hasn’t been enough change in those organizations, and it may be setting them up for failure. We will avoid that in the Commonwealth.
There is more that the law could provide for. 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.
Williams: There are certain providers systems in Massachusetts that are reimbursed significantly more than others for the same services even though there are virtually no differences in quality. Do you think the state has a part to play in addressing these disparities?
Avellone: I think it does. We have a mixed model system, with private payers and public payers. But what the state should continue to do is have more transparency around these contracts, so that as consumers have the ability to choose among providers, they have a better undertanding [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.
Williams: There are more than a dozen state agencies that have a role in healthcare. Do you think there’s an opportunity to consolidate or rationalize them?
Avellone: Yes, there certainly is. There is ‘silo-ization’ in our state government, which is a natural thing that evolves over time, but 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. As we move towards a model that creates a new kind of delivery system between physical and mental health, we ought to address that from an organizational standpoint. Substance abuse has to have a higher profile in our Commonwealth going forward, as it’s a growing problem. We should think of it more as a medical problem than a criminal justice problem.
Williams: Government policy both at the federal and the state level has encouraged adoption of electronic medical records. However, there are many providers that complain about the systems and the benefits have been slow to materialize. Do you think state government should play a role in helping to realize the promise of health information technology?
Avellone: Yes, the state has a role. Despite the frustrations of implementing electronic medical records, they have a huge impact on both quality and cost of healthcare overall. [The Massachusetts] Health Policy Commission produced its first report and showed that somewhere between $15 billion and $29 billion of care is unnecessary and not adding value. A lot of it is because of lack of coordination in our system.
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. Even though there has been some frustration, all new doctors that are being educated and trained today grow up on the electronic medical record, in medical school and in residency programs. They’re completely used to it. In fact, it’s completely embedded in the way they collaborate and practice medicine.
There are incentives from the Medicare program, the federal program. 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. That’s the ultimate usefulness, when the information can reach across systems in a way that’s understandable.
Williams: Hepatitis C is three or four times more common than HIV. There are some new drugs that can cure the infection that 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?
Avellone: I’m going to be publishing my healthcare policy soon. There will be a strong component on public health, especially expanded programs for the modern killers, like obesity and smoking, and this will absolutely include Hepatitis C. This is a scourge that is going to be a huge problem for us down the road. There may be as many as 100,000 people in the Commonwealth that have this disease at this point, and as many as 75% – it’s an estimate – may not even be aware of it.
We do need to have a widespread use of testing. 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. Particularly in the Baby Boomer age group, which is judged to be the highest risk group. We definitely need to have much more widespread public education about this disease in more identified places for treatment.
Finally, I’m going to work with pharmaceutical companies for patient access programs, and other ways to bring these drugs into common use in the Commonwealth.
Williams: There are multiple healthcare-related ballot questions. What are your thoughts about them?
Avellone: Healthcare is becoming a bigger and bigger part of our lives in the Commonwealth and a bigger part of our political life. The most prominent ballot questions this year are the ones that deal with nurse staffing ratios in our hospitals. The time has come for that. I agree with the idea of the staffing ratios that are inherent in the ballot initiative, which is approximately four- to- one between nurses to patients, in the traditional wards. Then it moves up to one- to- one in ICUs in a graded way.
This is appropriate. There have been enough studies around the country to show that this is a safety issue. This does lock in safety in our institutions. 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. That’s where the true savings are. So I fully support this initiative.
Williams: Joe, you’ve had a long career as a surgeon and a healthcare executive. I’m wondering what you have learned during those experiences that will be useful as Governor?
Avellone: Well, it’s an interesting question, a lifetime of experiences. I have two that stand out for me. 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 all built around maintaining that inviolate doctor-patient relationship. That is at the core of our profession, and that always has to remain at the core of our health system. We have to make sure that whatever we do, we always protect that.
The second thing that I’ve learned over my career is 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 state is all of us collectively. It’s the state, and certainly will be in my administration, that is actively investing in public health measures.
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.
Williams: Joe, a lot of the emphasis in healthcare reform is on adult patients. But is there a need for a specific focus on children’s health?
Avellone: Yes. We all have to recognize that children are not just small adults. First of all, how their bodies develop is a huge issue that we are just beginning to understand. 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-often-forgotten part of our system, and as we improve the mental healthcare system, which I will be doing, we have to pay special attention so that adolescent mental health issues in particular are addressed.
Williams: Joe, I appreciate your willingness to answer all the specific questions I’ve laid out. But I want to give you an opportunity if there’s anything you’d like to add.
Avellone: Well, thank you, Dave.
Healthcare is becoming a bigger and bigger part of all of our lives. It 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. In all levels, it’s a bigger and bigger impact, not only in our quality of life, but our economy here in our Commonwealth and also our well being overall.
Williams: Joe Avellone, candidate for Governor of Massachusetts. Thank you very much.
—March 9, 2014