MassAHU comments on Payment Reform Commission Report

| October 9, 2009 | Comments (0)

The Massachusetts Association of Health Underwriters (MassAHU), a membership organization of professional health insurance brokers, consultants and other professionals, shares the concern for affordability of health care in the commonwealth of Massachusetts.  Through the Payment Reform Commission appointed by Governor Patrick, recommendations have been submitted for the restructuring of the health care payment system.  According to this commission, the goal is to make recommendations to reform the current payment system in order to “provide incentives for efficient and effective patient-centered care, and to reduce variations in quality and cost of care”. 


While we appreciate the incredible effort that went into this commission’s research, MassAHU is extremely concerned that a small appointed board will determine what payment reform will be without the necessary, vigorous research needed to support this direction.   In keeping a historical perspective on provider payment models of the past, multiple approaches in the market have led to the current prevailing methods.  Some payment methods have disappeared (i.e. the capitation approach) while others have flourished.  This is not to say that the predominent fee for service method works; we share in the perspective that payment reform is needed.  But we do not share in the position that a global solution should be mandated by the state based on a small appointed board.  Instead, we support the enabling of payers and providers to come up with payment reform to meet these goals with appropriate incentives.


Health care reform has thus far dealt with accessibility of insurance to all citizens, affordability of insurance through increased subsidies, and minimum insurance coverage standards.  MassAHU feels that before we proceed in sweeping reform of health care payment system, we need to focus on the underlying issues that were identified by the reform commission’s study, as well as other statistical studies, and the initial goals of health care reform in general:


Lack of sufficient primary care access in the state, which contributes to other issues including low compliance on preventive screenings and management of chronic illness in adult population, as well as overuse of emergency room for non-emergency and/or preventable symptoms

Lack of transparency in both cost and quality data for consumers

Lack of meaningful medical malpractice reform

Lack of incentives for consumer engagement in healthy lifestyles/wellness

While the commission’s recommendations may indeed work for some providers and payers, MassAHU is concerned for the impact on employers and consumers we work with in designing  quality, affordable health insurance programs.  Without addressing the above named issues first, we will not be able to improve the quality of care or the runaway cost of care.  Through the history of our payment system, we have moved so far away from accountability – that is accountability for your own health as a consumer, and accountability for the cost/results as a provider – that it is time to make this a priority and build on payment reform in cooperative partnerships.   Without addressing the cost of care, we cannot impact the cost of insurance, and without relief in the cost of insurance, we will end up with fewer employers and consumers having insurance.  The ‘bottom line’ in payment reform must be to reduce the cost of insurance to consumers, but we cannot pass such sweeping reform as is included in this commission’s recommendation without further vetting out the potential pitfalls of such reform.

Category: Featured, Position Statements

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