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Health forum sees sacrifices for doctors, insurers

Health forum sees sacrifices for doctors, insurers
Industry profits, individual choice may be casualties in reaching goal, leaders say

By Robert Weisman
Globe Staff / December 1, 2010

Health care costs can’t continue to rise rapidly without crippling the state’s economy and public services. But efforts to rein them in will require new team-based health care payment and delivery approaches, which would demand sacrifices from hospitals, doctors, and insurers.

That was the consensus of industry and consumer leaders at a Massachusetts Health Policy Forum that drew more than 500 health care professionals to Boston’s Omni Parker House Hotel yesterday.

“We’re going to all have to give up a lot," conceded Gary L. Gottlieb, president and chief executive of Partners HealthCare System Inc., the state’s largest hospital system. “Hospitals throughout the area have made very substantial cuts. Clearly we’re going to have to go forward with fewer resources. . . . The autonomy of decision-making is going to be diminished on an individual level" and moved to teams.

“We’ve given up a [profit] margin," said Andrew Dreyfus, president and chief executive of the state’s largest health insurer, Blue Cross Blue Shield of Massachusetts, which lost money for the first nine months of this year because of state caps on the premiums it charges small businesses and individuals. “We understand that we’re in an environment where health plans will have to live with less."

Their comments came as pressure to contain costs builds from struggling employers and hard-pressed consumers. Health care costs in Massachusetts have climbed more than 10 percent annually for the past five years, making it harder for businesses to hire workers and state government to fund education and public works programs.

As part of its campaign to control health costs, Governor Deval Patrick’s administration is drafting a payment overhaul bill to be submitted to the Legislature next month. One aim is to create “global payment" plans that put doctors and hospitals on an annual budget for each patient’s care. Another is to create a regulatory framework for how health care providers can form partnerships, called accountable care organizations, to coordinate care and distribute payments.

“Massachusetts is really well positioned to be one of the breakout states in payment reform and in health care delivery reform," contended David R. Martin, director of health care policy at the Massachusetts Executive Office of Health and Human Services.

Even before the Legislature takes up the issue, pilot projects are underway in Massachusetts and across the nation on ways to deliver care more efficiently and less expensively while boosting the quality of services. They range from a government-sponsored program at Partners-owned Massachusetts General Hospital in Boston that cuts expenses and hospitalization time for the sickest patients to a Blue Cross “alternative quality contract" product that rewards care providers for health outcomes rather than doctor visits and procedures.

Martin said state officials will be encouraging “a lot of experiments" by hospitals, physician-led groups, and health plans in the coming years, with the successful experiments growing and evolving. But the parties have yet to agree on the elements of global payment plans, which are meant to supplant the current “fee for service’’ system. Among the bones of contention are whether state health care organizations will be subject to what Martin called a government “oversight entity."

If the new health care payment and delivery systems aren’t designed to improve efficiency and eliminate waste, the risk is they may wind up lowering quality, reducing access to care, and cutting jobs at community hospitals around the state, cautioned Stuart H. Altman, professor of national health policy at Brandeis University in Waltham.

Altman warned of a “health care brownout," a worst-case scenario where revenue is squeezed and government rate controls are imposed. “The implications of that are not good," he said.

Some of his concerns were echoed by other speakers.

Deborah Enos, president and chief executive of Neighborhood Health Plan, a Boston carrier that covers low-income patients insured by government payers Medicaid and Commonwealth Care, said she hoped the new health care systems would include “safety net" providers and payers. She also said she hoped they would cover dental and mental health as well as other medical services. “If we look at a system based on rates that have been historically inadequate, we can bundle them and we can globalize them, but they’ll still be inadequate," Enos said.

To be successful, new Massachusetts health care models must create “a different patient experience," suggested Amy Whitcomb Slemmer, executive director of Health Care for All, a Boston-based consumer advocacy group. “Putting consumers and patients at the center of the new enterprise is critical," she said. “Right now it can be a challenge to be a patient in our fragmented health care system.’’

Dreyfus, who took the helm at Boston-based Blue Cross in September, called on health care professionals to step up to the challenge of containing costs. “If we as a community don’t do something about it, then that decision is going to be taken out of our hands and government will regulate the entire system," he warned.

Robert Weisman can be reached at