Q&A: MA Lawmaker on Cost Containment
Q. What provision of S 2400 provides the biggest opportunity to reduce healthcare costs?
A. There are a couple of things. We set a statewide goal to bring healthcare costs in line with inflation, but it's up to the providers who deliver that care to figure out how they are going to meet the requirement.
We don't direct them to follow a specific course. But if they aren't meeting the goals, they will be asked to develop a specific plan to meet the goals. The law is designed as an opportunity to let the market respond to the need to get costs under control and to squeeze out clinically unnecessary or duplicative services.
We promote transparency by asking providers to identify expected out-of-pocket costs for the patient. That effort, combined with quality measures developed under a plan we passed in 2010, will help patients become better educated health consumers.
We're also pushing for programs like Medicaid and the state employee's health plan to shift from fee for service to global payment and coordination of care. We want to move away from FFS as much as we can.
We modeled our malpractice reforms on a plan Michigan has used for more than a decade. It provides for more of a mediation process between patient and provider. Most malpractice cases are settled so they never go to court and there's usually a confidentially agreement as part of the settlement. We want to learn what happened and be able to do a root cause analysis to see what can be done to minimize the chance of that situation occurring again with other patients.
We have a provision to monitor whether the reforms will reduce defensive medicine, which increase health costs. We want to make sure providers aren't ordering procedures just to cover their butts.
- Anthem Blue Cross, 7 CA Health Systems Create New Challenger, Business Model
- Data Points to Boom in Private HIX
- Few Winners Among MSSP Participants
- Technology Lights Up Health Innovation Forum
- EHR Systems 'Immature, Costly,' AMA Says
- Interstate Medical Licensure Effort Advances
- Hospitals and doctors fail patients by passing the buck on insurance rules
- A new way insurers are shifting costs to the sick
- NCQA Releases Annual Health Plan Rankings
- Malnourishment 'Epidemic' Plagues Hospitals? Really?