The Role of States & Medical Societies in Reforming Health Care The Massachusetts Experience B. Dale Magee, MD, MS President Massachusetts Medical Society

Quality Requires Access The price of being uninsured Mortality increased by: Cancer of the colon: Cancer of the breast: Cancer of the prostate: Cancer of the lung: Myocardial Infarction: Acute injuries: 10-15% 25-50% % Sources: Fowler-Brown, J Gen Intern Med. April 2007; McDavid, Arch Intern Med. Oct 2003; Volpp, Health Services Research April 2003; Haas, American Journal of Public Health, Oct 1994

State of Health by Insurance Status Source: Blue Cross Blue Shield Foundation of Massachusetts

Massachusetts Before Access Law 2006 data Sources: Blue Cross Blue Shield Foundation of Massachusetts; CDC; MA Exec. Ofc. of Labor and Workforce Development; US Department of Labor; US Department of Commerce 2005

Most managed care not for profit, in-state Free Care pool Collaborative Massachusetts Medical Society principles ◦ Non-disruptive and evolutionary ◦ Politically, economically viable and sustainable ◦ Includes quality and public health components ◦ Comprehensive and affordable ◦ Individual and employer mandates Massachusetts Before Access Law

Who are the MA uninsured? 2006 data Source: MA Dept. of Health Care Finance and Policy

Access Law Today Individual Mandate Employer Mandate Insurance sources: – Expansion of Medicaid – <300% FPL (~$30,000): subsidized Medicaid Mgd Care – >300% FPL: Connector with several levels of service (must cover preventive care and drugs)

Status Today Total enrolled and percent of target achieved Source: Commonwealth Connector Total number in income bracket

Quality & Cost Council Insurers Payers Public Professional Standards Review Organization Institute for Health Care improvement Advisory Council with MMS & other physician groups

Purpose of the Council Collect data ◦ Define content ◦ Standardize collection Provide reports to the public ◦ Cost & Quality Track change

Challenges Modern Health Care is: ◦ Complex: multiple co-morbidities ◦ Distributed: numerous providers involved (different locations, different times) ◦ Data driven (when possible)

Challenges Barriers to communication: ◦ It is not the standard… ◦ Information technology is in its infancy  Numerous systems computerizing records  eHealth Collaborative  NO intersystem connectivity

Challenges How we learn: ◦ Traditional teaching by example, stories ◦ Evidence base thin ◦ Research conflicting ◦ Guidelines vary in strength ◦ Literature may be translated into practice prematurely

What is the Medical Society doing? Principles for Universal Access Education Information technology Work with IPAs Data: ◦ Plans ◦ Purchasers ◦ State

In the End Universal access is necessary to improve the quality of the community’s health care Access cannot be sustained without cost control Complex systems require shared vision, values and tools