1. 1 Ensuring Sustainable Health Reform in Massachusetts May 19, 2008 Matt Fishman Partners HealthCare

2. 2 Key Ingredients in Continued Success Strong operational and administrative elements in place Strong commitment and leadership from Senator Kennedy, Governor Patrick, House Speaker DiMasi, Senate President Murray Other indicators of success: –Insurance coverage is up –Demand on uncompensated care pool is down –Employers are maintaining their commitment to coverage –Individual mandate is in effect Broad-based coalition that can identify options and solutions Strong focus on making this legislation work on the ground.

3. 3 Bank of America and Commonwealth of MA medical and nursing school loan repayment Year 1 results: 47 primary care providers (35 MDs and 12 NPs) have committed to practice in community health centers, providing access for more than 84,000 newly insured patients.

4. 4 Uncompensated Care at Partners Hospitals is Declining Uncompensated care costs at Partners hospitals (Brigham & Womens, Faulkner, Massachusetts General, Newton-Wellesley, and North Shore Medical Center) have declined by 17.5% since 2005.

5. 5 Partners Patients Moving from Free Care to Commonwealth Care * Effective 10/1/07, those eligible for Commonwealth Care could no longer choose to remain on Free Care. These patients will eventually become self pay patients unless they enrolled in Commonwealth Care. 10/1/07 Free Care Eligibility Change

6. 6 Key Strategic Decisions (1 of 2) Focused on coverage first –Common ground for all stakeholders – agreed that it was the first step to take. –Shared responsibility as key principle. Developed a comprehensive plan that many constituencies could agree on –Did not look at reform elements in isolation – instead, took a comprehensive approach Coverage Financing Insurance market reform Cost & quality (initial steps only)

7. 7 Key Strategic Decisions (2 of 2) Have continued to actively engage constituencies throughout implementation –Issue advertising and polling –Developing the first affordability schedule and minimum creditable coverage definitions. – Business-organized educational meetings on legislation Ongoing working sessions on shared responsibility and other issues.

8. 8 Current and Upcoming Challenges (1 of 2) State financial commitment Tracking the number of uninsured Recent and pending adjustments: increased consumer cost-sharing, proposed tobacco tax increase Covering those left out 3 year §1115 waiver extension

9. 9 Current and Upcoming Challenges (2 of 2) Health system cost containment –Several cost management proposals under consideration in legislature HCFA, MAHP, Murray; House expected in June –Brandeis cost management seminars –Healthy Mass. Compact –RAND study –Quality & Cost Council –Possibility of business-led coalition

10. 10 Assets Strong engagement from political leaders Broad-based coalition that can identify options and solutions Strength of implementation effort to date Intellectual capital Recognition of need for action on costs Strong network of community health centers