Framingham State Representatives Tom Sannicandro and Chris Walsh joined
their colleagues in the Massachusetts House of Representatives this week in passing legislation that addresses the unsustainable cost of health care while allowing the health care industry to continue to provide world-class quality care.

This legislation seeks to reduce health care costs while allowing our world renowned health care system to thrive. It provides for several areas: Division of Health Care Cost and Equality, transparency, Patient-Centered Medical Homes (PCMH), Accountable Care Organizations (ACO), alternative payment methodologies, consumer protection, Health Information Technology (HIT), health care cost growth targets, price variation, smart tiering, medical malpractice reform, workforce development, Medicaid, and administrative simplification.

“This bill represents the next step in keeping costs low and making sure everyone has access to quality health care,” Sannicandro said in a press release. “Once again, we are leading the nation on this key issue.”

“Controlling the cost of healthcare in Massachusetts is probably the single most important issue in front of us today; this is a problem for families, for individuals, for our hospitals, our cities and towns and especially for our businesses, both large and small," said Walsh in a press release. “The bill we just passed includes provisions to simplify administrative procedures, provide for transparency in payments, common sense proposals to reduce litigation claims and the adoption of ground breaking methods for payment alternatives that foster wellness programs and systemsmalpractice reform, workforce development, Medicaid, and administrative simplification.

The legislation provides patients’ tools to make informed health care decisions. Under this legislation, consumers will gain access to detailed comparative price and quality information; they will also gain important information from providers about services and payment.

The bill promotes health information technology and the use of electronic health records that will bring efficiencies and cost savings. The implementation of a fully interoperable health information exchange by 2017 will allow for secure electronic exchange of health records amongst providers.

This legislation provides further support to patients by allowing patients and providers to voluntarily join an ACO and ensuring that the ACO providers will be responsible for helping patients make decisions on their health care needs, including long-term care and supports like home care, nursing home care, and palliative care.

This bill also seeks to reduce miscommunication and fragmented care by establishing patient-centered medical homes, providing a patient with a single point of coordination for all their health care needs. This bill also provides consumers with new protections, giving patients the right to appeal medical decisions made by their ACO doctors and giving patients the right to receive a second opinion from any provider.

This bill reduces medical spending by setting a target for health care spending to grow less rapidly than the gross state product and allowing consumers to spend out-of-pocket, or through supplemental insurance, for any service or procedure they deem appropriate.

In these tough economic times, this legislation also helps our local hospitals, many of which are struggling to stay afloat. This bill requires high-cost providers to show quality or unique service to justify their higher prices and creates a one-time assessment on payers and providers with more than $1 billion in reserves to protect our community hospitals through a Distressed Hospital Fund. Community hospitals may apply for a competitive grant from this Fund, allowing
them to thrive over the next 36 months before anticipated savings from the reform allow them to flourish on their own.

Under the bill, a number of functions will fall under the Division of Health Care Cost and Quality, which, like the existing Group Insurance Commission, will operate as an independent agency under the Department of Health and Human Services.

Other provisions of the bill include:

• The adoption of alternative payment methodologies such as global and bundled payments for acute and chronic conditions as the industry transitions away from the fee-for-service reimbursement system that promotes quantity rather than quality;
• The creation of a smart tiering system that makes services that are often unaffordable for some patients more accessible for patients by allowing payers to tier by service rather than facility and allowing patients to pay reasonable cost-sharing for more expensive unique services;
• The implementation of the University of Michigan Health System’s Disclosure, Apology and Offer program, which resulted in a decrease of litigation costs and a reduction of malpractice claims;
• The further development of a well-trained health care workforce through training, placement, and career ladder service programs, loan forgiveness grants for primary care providers, and residency funding in primary care settings;
• The improvement of the operation of the Medicaid program; and the simplification of administrative procedures in health care settings.