Q&A with the State Health Policy Commission's Carole Allen, M.D.

State Update

Vital Signs recently caught up with Carole Allen, M.D., to learn about her first year with the Commonwealth’s Health Policy Commission (HPC), the new state agency tasked with establishing the annual health care cost growth benchmark and examining the impact of changes on providers and access.

A retired pediatrician from Arlington, Massachusetts, with 37 years of experience in general pediatrics, Dr. Allen was the director of pediatrics for Harvard Vanguard Medical Associates. She received the Special Award for Excellence in Medical Service from the MMS in 2011 for providing “exceptional care and dedication to the medical needs of his or her patients and the general public."

Vital Signs May 2014 - Carole Allen

 We first interviewed Dr. Allen just over a year ago, shortly after her appointment to the HPC. Back then, she told Vital Signs that her goal was to help the commission set up a system to collect information and engage in cost containment and quality initiatives while not being overly intrusive on health care providers.

VS: After a year, what is your perception of the work of the Commission?

ALLEN: The Commission has been extremely active in a number of domains. Executive Director David Seltz has hired amazing staff who are knowledgeable, energetic, and incredibly hardworking. I think we have made significant progress, considering the complexity of the task at hand. We have tried to solicit input from and be responsive by listening to the health community, providers, payers, purchasers, consumer representatives, and external experts. We’re hoping to help practices become efficient and responsive to patients while creating a happier professional environment for physicians.

VS: Do you have concerns that the complexity of the information sought by the Commission will make it difficult for the contribution of small physician groups to be accurately conveyed?

ALLEN: I hope not. For example, with the patient-centered medical home initiative, our aim is to engage a variety of practices and help them all develop skills to move them on a continuum toward more efficient care at lower cost. Small practices are struggling and we hope to help them move forward. I don’t think our actions will contribute to harming small practices.

VS: Today’s hearing concentrates on defining patient-centered medical homes. The HPC is going over ground here that has been covered by the National Committee for Quality Assurance (NCQA) and others. Will this create competing systems?

ALLEN: Our goal is for our state certification to be consistent with the requirements of national certifying bodies such as NCQA, with less administrative burden for the practice. We are striving to identify the highest value elements of a patient- or family-centered medical home (e.g., care coordination) and emphasize these.

VS: How do you see the goal of administrative simplification working with these new reporting systems, particularly on the information groups must provide on their internal structures and contracts?

ALLEN: We have made a promise to minimize new administrative requirements, while acting within the terms of the statute, and it is my sincere hope that we are able to do that. Whenever possible we will seek data from other sources in order to burden practices as little as possible.

VS: Overall, part of the goal of Chapter 224, at least for some legislators, was to fight consolidation among provider groups. However, complex reporting favors existing groups with the infrastructure to comply with new requirements. Is this an area of concern?

ALLEN: I don’t think it will necessarily play out that way. So far it is the largest groups with the greatest market power that the commission has scrutinized the most.

VS: Final thoughts?

ALLEN: Recently at the American Academy of Pediatrics leadership forum I was impressed with the young physicians I met. They are interested in social determinants of health and they are thinking in diverse ways of how systems should work in the future. So I see a lot of hope for their practices and patients.

—William Ryder, ESQ
MMS Legislative Counsel

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