Governor Patrick Throws Down the Gauntlet on ACOs

Two days ago I described the current moment in Massachusetts Health Care Reform as "crunch time," with a number of tough choices to be made.

Yesterday, in his address to the legislature, Governor Patrick ran with the "tough choice" theme. Here's what he had to say about health care, with my comments interlaced in bold italics:

...The times demand that we face the hard choices before us with candor and courage, and that we act -- because doing so today will make us stronger tomorrow...We must demand more of ourselves than rhetoric that divides us and leadership that kicks every tough decision down the road. We must demand more not just of our public leaders, but also of our private ones – and of ourselves as individual citizens. Generational responsibility belongs to all of us. Every one of us owes a debt to the future payable only by making the kinds of choices today that build a better, stronger Commonwealth for tomorrow.

This is fine inspirational rhetoric. But if our state really wants to grapple with health care costs, we'll need a lot of encouragement and inspiration along the way. The governor will have to use his excellent communicative skills to help us understand what has to be done, why it has to be done, and how we can do it, again and again.

We can’t be satisfied until health care is as affordable as it is accessible. That means creating incentives for all providers to work together to deliver better care at lower cost, improving transparency in the charges for services, reforming the medical malpractice system, and getting excessive paperwork out of the way of the relationship between doctor and patient. It means a new emphasis on wellness and prevention.

If Governor Patrick can make real progress on these issues, he'll be a hero when he leaves office. Unfortunately, while health insurance is MUCH more accessible, health CARE isn't, especially primary care. Remedying that problem will not be a quick fix! "Better care at a lower cost" is the key sound bite here. I hope the reference to "medical malpractice reform" signals a real intention. While economists say that malpractice reform will only have a minor influence on costs, the liability system has a major influence on how physicians see the world. The impact is poisonous. The Democrats missed an important opportunity when they left malpractice reform out of the health care reform legislation.

And it means that we must change the way we pay for health care. So, we will file legislation in the coming weeks to address health care cost, including significant payment reform and simplification. This will be a challenge. There will be great debate and resistance to change. But working families, small and large businesses alike, and governments, too, need a solution – and they need it now.

The governor can propose legislation, but word on the street is that the legislature is not yet sold on the idea of payment reform. Legislators will be lobbied hard by constituents from their districts who are fearful about global payments. There will be strong temptation to kick the problem down the road.

Some steps we can take immediately without waiting for new laws. At my direction, MassHealth, the Health Care Connector and the Group Insurance Commission will implement pilot programs to demonstrate new, more cost-effective ways to buy health care. To get different results, we need to start trying different things. And we need to start now.

This is the approach New Hampshire is taking. It has launched a five year pilot of five Accountable Care Organizations. Next month I will have the privilege of meeting with the project steering committee to discuss the ethical concerns that will have to be addressed for ACOs to thrive. The "death panel" fiasco shows how vulnerable changes that are uncontroversial among physicians and nurses are to misunderstanding in the public arena.

We will work on these and other plans with our partners in the health care industry and in Washington, as well as with patient advocates. Everyone -- insurers, hospitals, physicians, nurses, and other medical professionals, and especially patients -- needs to be a part of this solution. But let me be clear: The time for talk is over. The time for action has arrived.

The governor is on target here. To achieve better care at a lower cost every stakeholder will have to take steps that scare them, and may have to make real sacrifices. Any one of the groups the governor names can block progress. Keeping stakeholders in a cooperative process is the key thing the governor needs to do.