Consumers Organize for Payment Reform The Massachusetts Campaign For Better Care January 2010 Brian Rosman

1.Pre-History 2006 Health Reform 97.3% of residents covered 2

Health Costs Top Agenda 3

2008: Cost / Quality Bill Pharma Gift Restrictions and Disclosure Academic Detailing E-health mandate Hospital Patient/Family Councils Infection reporting Hearings on cost drivers Nurse Practitioners as primary care 4

and... Special Commission on the Health Care Payment System 5

Commission Recommendation: … that global payments with adjustments to reward provision of accessible and high quality care become the predominant form of payment to providers in Massachusetts within a period of five years. 6

Current Fee-for-Service Payment System Patient-Centered Global Payment System The Problem Care is fragmented instead of coordinated. Each provider is paid for doing work in isolation, and no one is responsible for coordinating care. Quality can suffer, costs rise and there is little accountability for either. The Solution Global payments made to a group of providers for all care. Providers are not rewarded for delivering more care, but for delivering the right care to meet patients needs. SpecialistPrimary Care Home Health Hospital $ Primary Care Hospital Specialist Home Health $$$ $

Whats Consumer P-O-V? Is This Just Capitation? Uh … No. Quality incentives Risk adjustment We add: Transparency / Oversight Patient Activation / Patient Engagement + other stuff 8

Our 10 Principles 1. Transparency 2. Protect Vulnerable 3. Consumer Voice 4. Shared Savings 5. Accessible Care 9

6. Evaluation and Monitoring 7. Patient Activation and Empowerment 8. Consumer Protections 9. Public Health 10. Patient-Centered Primary Care 10

Our Dilemma: How Do We Organize Consumers Around Payment Reform? the average person looking at your fact sheet would not understand a single word 11

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Caring. Health You Can Afford. 13

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Right now, patients dont get enough time with their doctors, there are too many duplicate and unnecessary services performed, and care is often not coordinated. HCFA is leading a growing network of consumer advocates who are working to reform the payment system while ensuring that all patients receive quality care and doctors and hospitals are rewarded for keeping you healthy. 16

Improving your care can drive down the price of health care. We need to make your co-pays and premiums more affordable so that everyone can get the care they need. HCFA has organized a Massachusetts Campaign for Better Care to be the voice of patients in the Massachusetts payment reform debate. We will speak out to legislators and state officials, and push for payment reform that improves quality and promotes health. 17

Next Stop? 18