Health care costs have become unaffordable to many Massachusetts families, individuals and small businesses.  This is not news to me – I have been talking about this for years.

The Massachusetts Health Care Reform law was intended to create more options for individuals, and make quality care more affordable for families, individuals, and for small businesses. Instead, because of the way it has been implemented, the state now has fewer products, more mandates, fewer options, and higher costs. 

I’m proud to have served as CEO of Harvard Pilgrim Health Care, one of Massachusetts’ largest non-profit healthcare insurers and the highest ranked health plan in the country for member satisfaction and clinical effectiveness for five years running.  In 2007, I led an effort on behalf of the Massachusetts Association of Health Plans to rein in rising health care costs, which included calling for annual public hearings to publicly discuss the rising costs. 

My experience in health care has given me a few ideas about what has to be done to control health care costs and here is where I would start:

 

 

1. Demand transparency on price and performance 




I believe that the lack of transparency in health care costs and quality contributes to the high costs of health care. 




In 2004, while I was at Harvard Pilgrim Health Care, I issued a report titled “The Cost of Not Knowing” which focused on how little information existed in the public domain about the cost and quality of health care services.  Since then, I have been pushing providers to publicly disclose detailed information about their medical services. 




I believe that giving patients access to this information is an important first step towards achieving lower health care costs.  I believe that if the state requires providers to make information about costs public, it will force accountability from them because their performance can be compared with other providers.  This idea is supported by the Massachusetts Attorney General and the Massachusetts Division of Health Care Policy. 

 

 

2. Reform Medicaid so that the state lives up to its promise to pay its fair share of expenses 




The state, through the Medicaid program, is the largest purchaser of health care services in Massachusetts.  The Massachusetts Health Care Reform law was supposed to increase Medicaid payments to providers so that private health plans would not have to pay physicians and hospitals higher prices to make up for the low Medicaid payments they were receiving from the state. 




Unfortunately, the state has not lived up to the commitment to pay more for Medicaid services.  As a result, a cost shift has significantly impacted small businesses and hospitals that serve low-income patients.  Hospitals have resorted to suing the state to restore the money they were promised. 




The state must live up to its end of the bargain and reform its Medicaid program so hospitals and small businesses are not subsidizing health care for low income Medicaid subscribers. 

 

 

3. Eliminate costly mandated benefits and permit mandate-lite and mandate-free options 




Mandated health insurance benefits in Massachusetts significantly contribute to the high costs of health care in this state.  In 2008, the state issued a report that concluded that 12 cents of every $1 paid for health insurance in Massachusetts goes toward 26 state-mandated insurance benefits.  The statewide cost of these benefits is $1.3 billion. 




The Patrick Administration made a policy decision to require mandated prescription drug coverage as part of the Massachusetts Health Care Reform Law.  This has added an even more to the cost of health care for small businesses.




Mandating prescription drug coverage is the latest in a string of public-policy decisions that are making health care more expensive than it was before the reform plan passed - exactly the opposite of what was promised when the bill was enacted.  Often, these benefits exceed what most members actually need. 




I support eliminating mandated benefits that are no longer effective.  I also support offering mandate-lite and mandate-free plans to provide consumers with an array of affordable plans so they can decide the level of coverage that best suit their needs. 

 

 

4. Require one open enrollment period and give small businesses group buying rights 




The way the state implemented and currently manages the so-called merged individual and small business market has significantly increased the cost of health insurance for small businesses and their employees. 




One solution is to establish one open enrollment period for individuals buying private insurance in Massachusetts.  This would prevent individuals from purchasing insurance for a particular medical need and then dropping the coverage when it is no longer needed.  This practice contributes to the high costs of health care since other payers into the system - including small business owners – are subsidizing this practice. 




The state also needs to consider allowing small businesses to band together as purchasing cooperatives to buy health insurance in bulk for employees.

 

 

5. Medical malpractice reform




I support medical malpractice reform.  The high medical malpractice premiums drive certain doctors, such as obstetrics and neurosurgeons, out of practice and limits patients’ access to this specialty care.  Medical malpractice reform will also help to reduce overall health care costs and must be part of a comprehensive solution. 

 

 

6. Increase the number of primary care physicians in Massachusetts




There is a shortage of primary care physicians in this state and throughout the country.  As a result, many patients rely on higher paid specialists and emergency room visits for their primary care needs, leading to avoidable increases in health care costs.  Increasing access to primary care physicians will change the focus to preventative medicine and early detection which, in turn, will result in lower health care costs. 




Primary care physicians should be paid higher rates.  This will encourage more residents to enter the primary care field.  It will also encourage existing primary care physicians to spend more time with their patients, thereby improving patient satisfaction and quality of care while lowering the cost of healthcare.