DISPARITIES COUNCIL Legislative Working Group Hank J. Porten Steve Shestakofsky Camille Watson

2 Assignment Using the Massachusetts Health Care Quality and Cost Council’s Roadmap to Cost Containment, identify areas where legislative emphasis can be placed to focus and improve access and quality of care to disparate populations or communities.

3 A Roadmap to Cost Containment Recommendations Comprehensive payment reform Support of system-wide redesign efforts Widespread adoption and use of HIT Implementation of evidence-based health insurance coverage informed by comparative effectiveness research (CER) Implementation of additional health insurance plan design innovations to promote high-value care Development of health resource planning capabilities Enactment of malpractice reform and peer review statutes Implementation of administrative simplification measures Consumer engagement efforts Emphasis on the prevention of illness and promotion of good health Increased transparency

4 Legislative Working Group Recommendations The Disparities Council should consider influencing the Quality and Cost Control Council through either informal discussions or through legislative emphasis focusing on: Comprehensive payment reform Support of system-wide redesign efforts Widespread adoption and use of HIT Develop health resource planning capabilities Implementation of administrative simplification measures

5 Comprehensive Payment Reform: Concern/Implementation Recommendation... Any payment reform must be carefully risk adjusted to take into account the higher cost of serving patients with greater needs, particularly those already facing disparate negative health outcomes. A failure to do so could reduce access as providers may seek to avoid serving those patients for economic reasons.

6 Support of System-wide Redesign Efforts: Concern/Implementation Recommendation... Planning for system redesign must assure that all patients are provided with culturally and linguistically competent care to all patients. Data must be collected to assure that racial and ethnic health disparities are measured. Resources must be provided to assure that disparities will be addressed.

7 Widespread Adoption and Use of HIT: Concern/Implementation Recommendation... Ensure all health systems and providers have the resources to use electronic information tools for care coordination, information exchange, tracking and analysis of outcomes. Implement privacy and security mechanisms to protect information and clearly communicate protection of consumers.

8 Develop Health Resource Planning Capabilities: Concern/Implementation Recommendation... In the area of health planning, legislative emphasis should be placed on ensuring that adequate workforce is available to care for the disparate patient, i.e., physicians, nurses, technical and support staffs. In addition, attempts should be made to ensure that the right community has the right resources at the right time. During the development of the health resource planning process, legislative emphasis should be placed on disparity issues like economic, cultural, etc. to ensure resource allocation needs are met. The scope of services and capital planning should be used to establish resource allocations to communities and ensure the rational use of available facilities and proposed facility expansions. This thought process should consider disparate population needs during the planning phase.

9 Implementation of Administrative Simplification Measures: Concern/Implementation Recommendation... Considering the limited financial resources available to the state and its healthcare partners, additional funds will be necessary to ensure that appropriate services are delivered to the disparate population. Some of these much needed funds could be obtained by reducing administrative costs. Efforts should focus on costs like: – Chapter 305 of the Acts of 2008 where the Department of Insurance (DOI) is required to establish uniform billing requirements by payors – Healthy Mass Compact/Employers Action Coalition for Health (EACH) are focused on reducing administrative costs related to eligibility verification for both commercial and public payors. Some experts anticipate that as much as 11% of healthcare costs could be reduced if administrative simplification is aggressively addressed. While simplifying administrative processes, we cannot eliminate the need to capture and maintain necessary databases that monitor the disparate population and/or measure the progress or barriers that still exist in the delivery of healthcare services.

10 Next Areas of Interest to Consider Enactment of malpractice reform and peer review statutes Increased transparency Much of the Legislative Working Group’s review is based on the Roadmap to Cost Containment, and once this effort is adopted and more details are clarified, the group could expand its recommendations. The Legislative Subcommittee recommends: 1.That selected members look for opportunities to influence the Quality Cost Council’s (QCC’s) Roadmap Planning Process in the five areas of interest. This can be accomplished by selected members of the Disparities Council meeting with the leadership of the QCC or asking to be put regularly on the QCC’s agenda to discuss key points of interest expressed by the Diversity Council. 2.The Council set its sights on the legislative session and have its Legislative Working Group review the subject areas raised, e.g., workforce development, planning, HIT and administrative simplification to set the stage for drafting legislation that would be endorsed by the Council, filed by the Council’s co-chairs and co-sponsored by the other legislators on the Council.