Health
Care Costs
- Health care
premium increases are moderating. Median premiums for individual coverage
rose 4.4% in 2011, compared to 8.3% and 7.3% the previous two years
- Total medical
expenses in 2010 rose 3%
- Year-to-year
increases in spending on medical claims has fallen steadily from
approximately 12% in 2003 to less than 5% in 2010
- Health reform in
Massachusetts “had little negative impact on private sector employment in
the state” relative to other states.
Health
Care Coverage
- 439,000 more
residents have gained health insurance coverage since 2006
- Only 1.9% of
Massachusetts residents are uninsured (U.S. average: 15.7%)
- Employer
coverage has increased from 70% to 76% since 2005 (U.S. average: 60%). During
the same time period, their financial contribution toward individual coverage
has risen from 77% to 78%.
- Fewer adults
have unmet health care needs due to cost (12% in 2009 vs. 16% in 2006),
though patients with serious illness report that cost remains a barrier to
care
- 68% of Massachusetts
adults support the state health reform law. 63% support the federal health
reform law.
Key
Features of Massachusetts Payment Reform and Cost Control Law
The
state legislature passed comprehensive payment and cost reform legislation in
July 2012. Key features included:
- Encourages movement to global payments. Participation
in ACOs or other alternative payment methodologies is voluntary.
- Establishes benchmarks for annual increase in
health care spending, based on the annual growth in the state’s economy (Gross State
Product). In 2013, the benchmark is 3.6%. From 2014-2017, the benchmark will be
equal to the growth in the Gross State Product. Provider groups
whose spending exceeds the target may be required to file a performance
improvement plan.
- The state may
conduct a "market impact review" of any provider whose costs exceed
the state target. The attorney general may investigate to determine if the
provider is engaging in anti-competitive behavior.
- Most provider groups
who carry downside financial risk must register with the state. Appears to
exempt groups without financial risk who have fewer than 15,000 patients or
less than $25 million in net patient service revenue.
- Providers must
report their cost and quality information to the state annually. Requirements
for who reports will be determined by regulation. The state will collect and publicly report cost and
quality data provided by provider groups.
- Malpractice reform: Patients must give 182-day notice before filing a claim
following an unanticipated medical outcome. Encourages “early offer” to injured
patients. Apologies are not admissible as evidence in a judicial proceeding.
- Standardizes prior
authorization processes across all health plans statewide.
- Requires uniform
quality measures.
- Establishes various
loan repayment, loan forgiveness and primary care training programs to address
health care workforce shortages.
Sources
