STATE HOUSE, BOSTON, JAN. 28, 2020....A plan Gov. Charlie Baker says would reshape the health care system in Massachusetts has roots in an avenue he pursued when he worked in the insurance industry in the early 2000s.
Pitching his legislation that would require additional spending on behavioral health and primary care, the former Harvard Pilgrim CEO told the Health Care Financing Committee Tuesday he had approached provider organizations in the early 2000s while leading the insurance company and proposed paying "disproportionately" more for primary care and behavioral health than other fields. He sai he proposed paying based on Medicare fee-for-service averages, "because I believe Medicare, as a formula doesn't value them."
"I tried this a lot, and the answer I got was no, we cannot agree to pay one group of our provider community a different percent of Medicare than the rest of them get paid," he said. "This was my first lesson in how hard it is to actually make investments in these areas I believe are underinvested in."
Baker said Medicare reimbursement rates are national policy, and he doesn't "know how else to break that other than to create some standard at the state level."
Among other measures, Baker's bill (H 4134) calls for providers and payers to boost their spending on primary care and behavioral health by 30 percent, while still keeping their overall spending growth within targets created under a 2012 cost control law.
"The idea here, frankly, is to force everybody to just get out of doing what they've always done," Baker said. He said solving the problem of rising health insurance costs won't be possible "until we change the way we deliver services."
"That's why we're doing something no one else has ever tried, which is to push back against the national model that doesn't believe in time and connection," he said.
Behavioral health and primary care doctors who testified at a hearing on the governor's legislation were generally supportive of Baker's call to focus investment on those areas, and speakers representing community hospitals and health centers asked that their facilities be supported.
Members of the committee, led on the Senate side by Chairwoman Cindy Friedman and on the House side by Vice Chair Dan Cullinane, spent more than an hour questioning the governor, and several expressed support for at least the goals behind the bill.
Senate President Emerita Harriette Chandler said she wanted to commend Baker for presenting a bill that didn't just "tinker around the edges" but instead "understands the weaknesses in our system" and "deals directly with them."
Rep. Bill Driscoll said he had a concern that providers might shift their care or referrals to higher-priced settings in order to meet the spending mandate, and Rep. Brian Murray said he wanted to "really try to cut into" the high health insurance costs that are burdening families.
Rep. Jon Santiago, an emergency room doctor, said a commitment to behavioral health and primary care was "really music to my ears." He said additional dollars in health care don't always translate to better outcomes, and asked if the bill offered any mechanism for tracking outcomes.
Baker called Santiago's a "super good question," and Health and Human Services Secretary Marylou Sudders said the 2012 cost control law created a set of common quality metrics that will allow for the tracking of outcomes over time.
Friedman said in a statement after Baker wrapped up his testimony that she looked forward to continuing to review the bill and "collaborating with my legislative colleagues, the Administration, and advocates on how we can better meet the health needs of our residents and ensure that they have access to the care they need at a price they can afford."
House and Senate Democrats couldn't reach an agreement on health care legislation last session. About six months of formal legislative business remain for the year.
"Anything could happen, but I came out of that feeling like we have a pretty good chance of seeing something happen before the end of the session," Baker told reporters after leaving the hearing.
The Massachusetts Medical Society, in written testimony, expressed support for more spending on primary care and behavioral health, saying the "importance of investing in primary care is perhaps only outweighed by the need to strengthen?the?behavioral health system in Massachusetts." But, the society said, there needs to be more detail on how the money would be invested, how spending would be evaluated, and what the overall impact on the health care system would be.
"For example, if this expenditure increase results in a zero-sum game with no additional investments, then certain high-value services would likely need to be cut," the society's testimony said. "MMS cannot support a proposal that robs a high-value specialty service to pay even the most deserving of primary care or behavioral health initiatives."
Sudders said Baker's bill also proposes additional funding for community hospitals and community health centers. Shoring up financially struggling community hospitals, which often receive lower reimbursement rates than larger teaching hospitals, was one focal point of the bill lawmakers could not get over the finish line in 2018.
Sen. Barry Finegold, an Andover Democrat, urged his fellow lawmakers to revolve their conversations around "the folks who rely on community hospitals," like Lawrence General in his district.
"This year this legislative body has proven that we believe in equity when it comes to education, but I'm not sure that we do when it comes to health care," Finegold said. "This is just not about finances, it's about economic and racial justice...and while we're debating many solutions, I want to be on record saying that a pot of money is not acceptable. To address this problem, we need a steady stream of funding -- either a floor for commercial reimbursement rates, or an increase of Medicaid reimbursements, and I just want to be clear on the record that if this bill stays as is, I cannot and will not support it."
Deb Wilson, Lawrence General Hospital's interim CEO, said Baker's bill would steer money from a $10 million Community Hospital and Health Center Investment Fund to community hospitals that do not have a corporate affiliation and are paid less than 90 percent of the state relative price. She said "directionally" that provision would benefit her hospital, which is the third-lowest paid in the state by commercial insurers.
"But we need health care legislation that builds on and goes beyond that," Wilson said, asking the committee to consider a designated reimbursement rate of 90 percent "for certain vital access hospitals such as ours, whose services are high value, but not sustainable without adequate commercial insurance rates."
Dr. Zirui Song, a Massachusetts General Hospital primary care physician testifying with a group of doctors from the Massachusetts Primary Care Alliance for Patients, suggested that lawmakers consider a move away from fee-for-service payments for primary care services.
He said a mandate to increase spending by 30 percent on behavioral health and primary care could potentially drive some provider organizations to raise their prices by 30 percent.
"Should that happen, that does not actually change the quantities or the substance of the care delivery on the ground," Song said.
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01/28/2020