The Role of States & Medical The Role of States & Medical Societies in Reforming Societies in Reforming

Health CareHealth CareThe Massachusetts Experience

B. Dale Magee, MD, MSPresident

Massachusetts Medical Society

Quality Requires AccessQuality Requires AccessThe 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%

100-200%

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

4%

6%

Private Uninsured

Fair/Poor

Source: Blue Cross Blue Shield Foundation of Massachusetts

Massachusetts Before Access Law

6.0%

14.8%

5.1%4.4%

13.0%12.0%

Uninsured Unemployed % of Jobs in healthcare

MAUS

2006 dataSources: 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-stateFree Care poolCollaborativeMassachusetts 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 Who are the MA uninsured?uninsured?

72,160 22%

55,760 17%

85,280 26%111,520

35%

< 100% FPL 100-200% FPL 200-400% FPL >400% FPL

2006 dataSource: MA Dept. of Health Care Finance and Policy

Access Law TodayAccess 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 TodayStatus Today

64,43276 %

27,61429%

2,5002%

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

<100% FPL 100-300% FPL >300$ FPL

Enrolled Unenrolled & targeted

Total enrolled and percent of target achievedSource: Commonwealth Connector

Tota

l num

ber i

n in

com

e br

acke

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Quality & Cost CouncilQuality & Cost CouncilInsurersPayersPublicProfessional Standards Review

OrganizationInstitute for Health Care

improvementAdvisory Council with MMS &

other physician groups

Purpose of the CouncilPurpose of the CouncilCollect data

◦Define content◦Standardize collection

Provide reports to the public◦Cost & Quality

Track change

ChallengesChallenges

Modern Health Care is:◦Complex: multiple co-morbidities◦Distributed: numerous providers

involved (different locations, different times)

◦Data driven (when possible)

ChallengesChallenges

Barriers to communication:◦It is not the standard…◦Information technology is in its

infancy Numerous systems computerizing records eHealth Collaborative NO intersystem connectivity

ChallengesChallenges

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 What is the Medical Society doing?Medical Society doing?Principles for Universal AccessEducationInformation technologyWork with IPAsData:

◦Plans◦Purchasers◦State

In the EndIn 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