For many years Massachusetts Health Quality Partners (MHQP) has collected and published information on the patient experience of care in Massachusetts. The outputs have been revealing and very helpful for physician groups seeking to improve and for patients trying to identify the best places to receive care.
But Medicaid (aka MassHealth) patients have never been included. Considering that Medicaid serves more than one million patients and is the biggest item in the state budget, it’s about time to at least understand what’s going on.
MassHealth has contracted with MHQP to conduct a large-scale patient experience survey of Medicaid patients. It was a big enough deal to merit front page, lead article placement in yesterday’s Boston Globe (edging out stories about the shutdown and the Patriots) so it has people’s attention.
The state government will have access to the full results and promises to make some of the findings public. Frankly I hope they’ll publish everything so the general public, physicians and MassHealth patients can learn as much as possible. The more widely the information is publicized, the more likely it will be to have an impact.
I’m looking forward to reviewing and writing about the results of the first survey, which should be available around the start of next year.
I have long predicted (Goodbye Obamacare? More like hello single payer) that if the GOP succeeds in undermining the Affordable Care Act it could hasten the move toward single-payer. Well, the undermining has been reasonably successful. And I think 2019 will shape up as the year that formerly taboo proposals like single payer health insurance go mainstream.
Despite what opponents say now, the Affordable Care Act was a moderate bill that sought to work within the existing system and incorporate bipartisan elements, including 188 Republican amendments. Before the individual mandate was pilloried as a threat to freedom, it was upheld as a virtuous plan of personal responsibility by the Heritage Foundation and American Enterprise Institute. Democrats tried to get Republican votes for the ACA. It was a GOP strategy to refuse.
When Republicans tried Repeal and Replace, they didn’t even pretend to include Democrats in their solutions. And of course, Candidate Trump’s promise to replace Obamacare with “something great” was a lot of nonsense.
With all this history, mainstream Democrats are feeling freer to jump to more radical and comprehensive proposals. After all, the ACA was complicated, messy, and full of compromises largely because of its attempt to be bipartisan and incrementally change the existing system. Why not jump to something purer and simpler that doesn’t need GOP input?
As the race for President gets underway, Democrats will start to feel their way on healthcare. Defense of the ACA is a pretty modest, minimum requirement. You can expect to hear calls for Medicare for All, which is a way to offer a popular benefit to more people without creating a whole new system.
But I’m also on the lookout for more radical approaches and it looks like we won’t even need to wait for the Presidential campaign to heat up in order to hear about them. Newly installed California Governor Gavin Newsom is ready to take on Donald Trump directly, calling for a single-payer system, mandatory coverage, expanding access for undocumented immigrants, and regulating drug prices. California is holding an early primary this cycle, so the ideas Newsom is setting out now will influence the debate.
I’d like to see serious discussion of Medicaid for All (rather than Medicare for All). Medicaid pays providers and drugmakers less and is also more comprehensive than Medicaid and better suited for younger adults and children. It’s a more affordable way to provide coverage, provides discretion to the states, and would drive down overall costs by driving down reimbursement rates. Medicaid for All would be a mixed bag for providers and pharma, so would unleash a very passionate debate.
A likely compromise is to offer Medicaid to everyone as a fallback, while retaining commercial and Medicare coverage for those who are eligible and want it.
In this end-of-2018 edition of #Caretalk, Carecentrix CEO John Driscoll and I banter about Amazon, drug pricing, immigration, home health, Russia, the ACA and more. I wanted to call this episode “If You Want to Destroy my Healthcare” but was told the Weezer reference was too obscure.
An under-appreciated consequence of the BI-Lahey merger is that Partners now feels it can act with impunity. Until recently, Partners HealthCare dominated the Eastern Massachusetts market. As such it was the focus of government and public sector scrutiny and was somewhat constrained in its ability to act.
But now, Beth Israel Deaconess Medical Center and Lahey Clinic have received approval to consummate their merger. BI-Lahey and Partners are similar size, so now the pressure is off Partners to show restraint. In fact, it is taking the opportunity to catch up in some areas where’s it been lacking.
Partners chief financial officer Peter K. Markell said the merger didn’t trigger Partners’ plans to open new clinics. “I think we would have done it anyways — but it doesn’t hurt,” he said in an interview.
Partners and other hospital systems often charge facility fees at their outpatient locations.
“People like to talk about how big we are, but if you look at us geographically, we’re not well-rounded,” Markell said.
“We’re going to put a lot more focus on ambulatory growth,” he added.“That’s where we think the marketplace is going.”
I’m quoted in the middle of the article
“Partners is expanding in the most lucrative lines of business that they can — putting outpatient facilities in high-income suburbs,” said David E. Williams, president of the Boston consulting firm Health Business Group. “This is a very good way to make money. Previously, Partners might have faced more scrutiny for making these kinds of expansions, but now with BI-Lahey, they won’t get as much pushback as they might have gotten before.”
Partners is quite happy with the BI-Lahey merger. Those paying insurance premiums and healthcare bills are going to be a little less enthusiastic.