The Bay State may have moved from “aspiration to action” in passing sweeping health-care reform, but there are four “substantial, interrelated steps” the Commonwealth needs to consider taking to wipe out high health-care costs for its constituents, Blue Cross Blue Shield President and CEO Andrew Dreyfus said today.
“If health-care reform is a marathon, I believe we are probably already at mile 22 — past Boston College. On the coverage issue, and quality, we’re probably at about that mile 15, crossing Wellesley at Route 16, but with those steep Newton hills still ahead,” Dreyfus said during a Greater Boston Chamber of Commerce Executive Forum this morning. “But when it comes to cost, we’re barely to Framingham, with a long, challenging race ahead of us.”
Though Massachusetts has succeeded in broadening health-care coverage and improving clinical care quality from a decade ago, the state can achieve greater value in health care by looking at it as a “unique interconnected ecosystem” and taking several more steps — hastening the redesign of the way the state delivers and pays for care; the promotion of health to spend less time and money treating illness; empowering patients to play a central role in their care; and bridging several historic divides that have subverted affordability efforts in the state again and again, Dreyfus said.
To address the first challenge, Blue Cross is working to avoid a “fee-for-service” model by making “value-based” payments to a majority of its physicians. Three-quarters of the health plan’s HMO members are also covered under an Alternative Quality Contract, allowing physicians to spend less and improve quality more quickly, Dreyfus said.
“Part of the secret, I believe, is that we don’t tell physicians how to redesign care,” Dreyfus said. “Instead we mutually agree to a budget and a comprehensive set of quality goals and then we allow the practices to adapt to meet their patient needs supported with extensive data and consultation by Blue Cross.”
Results from a federal pilot program at Massachusetts General Hospital that led to better care and lower spending for high-cost Medicare beneficiaries and early AQC adoption have also helped the state become home to five of the nation’s 32 Medicare “Pioneer” projects, which are designed to save money and improve care in part by directing patients away from expensive emergency rooms and hospitals to more comprehensive primary care in physician offices, Dreyfus said.
Renewed focus needs to be placed on the health of 5 percent of patients with multiple chronic illnesses such as diabetes and coronary artery disease, renal disease and depression who account for 50 percent of all health-care spending, Dreyfus said.
“By putting our focus on the health of the 5 percent, we can help them live healthier lives and reduce costs for all of us,” he said.
Yet the state must also reduce the prevalence of chronic illnesses by investing in wellness at the individual, employer and community levels, said Dreyfus, who praised such initiatives as Shape Up Somerville and Mayor Thomas M. Menino’s challenge to residents to walk 10 million miles and lose 1 million pounds.
Blue Cross has created a new insurance product especially for small businesses called Healthy Actions, which provides financial incentives to employers, employees and physicians who work together to assess and improve employee health.
Patients who participate in clinical decisions are following regimens more closely, while treatments tend to be more effective and, at times, less expensive, Dreyfus said.
“We must strike a careful balance here,” he said. “We don’t want to create financial barriers to needed care, but we should encourage patients to consider the relationship between the choices they make for their health care and the cost of that care.”
Starting in 2013, Blue Cross members will receive a “completely revamped” explanation of benefits to help them better understand “in plain English” how their coverage works, Dreyfus said.
“The Commonwealth can also achieve more affordable health care by recognizing that government regulation and market competition can be mutually reinforcing; business and clinical sides of medicine can support one another; and that collective stewardship of the state’s health-care system can improve, rather than undermine, individual care,” Dreyfus said.
“If we can unite these opposing ideas, we have a unique opportunity to create a health-care system in the Commonwealth where patients have a strong voice, where clinicians are trusted advisors and practitioners and where oversight and private action support better, more affordable care,” he said.
Dreyfus added a major public education campaign undertaken by the state’s business community, hospitals and health plans can help people better understand how health care works statewide.