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September 2009 St@teside

Massachusetts Payment Reform Commission Recommends Global Payments

The Massachusetts Special Commission on the Health Care Payment System, which was established by the state legislature as a part of a comprehensive 2008 bill to promote quality and reduce costs in the health care system, has released its recommendations.  The Commission’s final report calls for a five-year transition to risk-adjusted global payments with performance-related financial incentives for efficient providers and for those who meet quality and access goals.  This payment system would be used by all public and private payers.  The recommendations have been given to the legislature, which will consider enacting these sweeping reforms in the 2010 legislative session.

The 10-member Commission was constituted in January 2009 with individuals selected by the Governor and the legislature.  The committee began by outlining 10 principles (see pages 8-9 in this document).  After reviewing a broad range of payment models, the Commission concluded that global payments represented the best chance for controlling future cost growth while maintaining quality of care.  They recognized that their final goal of all providers being able to form Accountable Care Organizations (ACOs) in order to accept global payments and manage the appropriate amount of care-related risk will take time.  Therefore, they suggested establishing a Transition Oversight Board or Advisory Committee.  This committee would operate in an open and transparent environment, and it would recommend specific policy choices about the nature of the payments, monitor implementation milestones, and provide infrastructure supports and technical assistance that will be needed by providers and other groups. 

The Commission recognized that many of the key aspects of ACOs that will determine success, including an emphasis on advanced primary care, and care coordination and integration, align closely with the development of patient-centered medical homes (PCMHs).  Therefore, the state has also been moving forward with a PCMH initiative.  Secretary of Health and Human Services Judy Bigby is leading a multi-stakeholder group whose purpose is to jointly design and implement payment models and practice transformation strategies to support a large-scale roll-out of public-private multi-payer patient-centered medical homes (PCMHs) across the Commonwealth. The PCMH Initiative Coordinating Council was launched in June 2009 and has since met four times as of September 2009.