First in Massachusetts

What We Learned About Health Care Reform and Our Members

That Could Help You

The Political Landscape After Universal Access• 2006: Access addressed; costs not addressed

(Chapter 58)• 2008: Anything and everything to do about costs:

The anticipated and the unanticipated (Chapter 305)

• 2010: Rate regulation (Chapter 288)• The Attorney General’s report• Medicare payment updates• Debt ceiling problem

Research and Process

• Comprehensive research: physician workforce, access to care, quality and the practice environment– Did not address the important issue of cost of care

• Feedback gathered from physicians on practice issues and patient concerns (surveys and interviews)

• Leadership forums with national experts ( e.g. Elliott Fisher, MD)

• Frequent discussions with MMS leadership and key stakeholder decision makers about universal access to care

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 201160.0

70.0

80.0

90.0

100.0

110.0

100.0

102.2100.9

98.396.3

94.5

92.191.0

86.4

83.9

80.8

78.476.5 76.4

74.6 75.374.2 73.5 72.8

100.0101.4

100.4101.8 101.1

99.3

92.991.6

88.7

85.984.3

81.7

78.977.8 77.0 77.6 77.8 77.9 77.6

MA INDEX

U.S INDEX

MMS Physician Practice Environment Index

MMS 2011 Physician Workforce Study

• Recruitment and retention of physicians in the state remain difficult – 55% of physicians had difficulty filling vacancies– 52% believe the pool of applicants is inadequate – 44% say time to recruit has increased– 38% reported retention becoming more difficult

• For the first time in the 10 years of the study, as many physicians are as satisfied (42.3%) with the practice environment in Massachusetts as are dissatisfied (42.3%)

Dermatology SevereFamily Medicine Severe General Surgery Severe

Internal Medicine CriticalNeurosurgery SevereOrthopedics SeverePsychiatry Critical

Urology Critical

Average New Patient Wait Time (days)

24

17

26

29

34

36

53

24

26

28

36

41

43

48

Pediatrics

Orthopedic Surgery

Cardiology

Family Medicine

OB/GYN

Gastroenterology

Internal Medicine

2011 2010

Accepting New Patients

46%

51%

80%

88%

88%

90%

95%

47%

49%

73%

82%

85%

95%

97%

Family Medicine

Internal Medicine

Pediatrics

Cardiology

OB/GYN

Gastroenterology

Orthopedic Surgery

2011 2010

MMS 2011 Physician Workforce Study

Internal Processes

• Task Force on Health Reform– 2005 to the present– Universal Coverage

to Cost Drivers

Internal Processes

• Task force principles– Support for universal insurance coverage– Support for individual and employer mandates– Bi-modal approach to expand public and private payer

responsibilities

• MMS served on state commissions• MMS leadership met with legislators &

administration

Internal Processes

• State asks MMS to gather physician feedback: focus groups on payment reform/global budgets

• One size doesn’t fit all• Voluntary participation

– Infrastructure support– Proper risk adjustment– Patient expectations– Patient incentives– Malpractice reform

– Transparency– Risk management skills– Good data from the payers– Anti-trust reform– Culture and leadership

Health Reform ContinuesWith the Focus on Costs• New commission on payment disparities• MMS asked to again hold focus groups with

physicians for solutions• MMS educational forums address cost of care• ACO Solution Center

– MMS creates new center to support physicians regarding the changing paradigm in health care reform

Getting the Word Out

Key Audiences

LegislatorsPersuade

MembersEducate

Our Membership

PCPsLoved It

SpecialistsNot so much

The Road Show

• Why it’s important• Share research • What it could mean

to them• The political realities

Key Driver: Private Sector Costs

100

150

200

250

300

350

400

450

500

550

600

Per Capita Health Expenditures Per Capita GDP

Average Wage and Salary CPI Boston

Per Capita MA Health

Expenditures:550 in 2020

Per Capita MA GDP:

337 in 2020

MA Wage and Salary:325 in 2020

MA Consumer Price Index

(CPI):224 in 2020

1991=100

Source: Payment Reform Commission/Mass. Dept. of Health Care Finance and Policy

Key Driver: State Revenues$

Bill

ions

Source: Mass. Taxpayers’ Foundation * EstimateFiscal year

Key Driver: Variation in Pricing

Source: Mass. Office of the Attorney General. Examination of Health Cost Trends and Cost Drivers. March 16, 2010

What We Used

The Commission Reports

On The Road Again

More Content

The Governor’s Pitch …

... and ours

Doctors’ Day

What We Learned …

• Getting the membership engaged on costs- Give them a voice (Focus groups, etc.)- Let them debate- Feed back to them what they say (Communications)- Convincing the members on issues that will/will not work- Repeat early and often

• Develop mechanisms to continuously evolve as outside forces change

• Engage external stakeholders on members’ issues• Coalitions remain important

Contact InformationCharles Alagero, Esq.VP and General Counsel(781) 434-7001calagero@mms.org

Elaine Kirshenbaum, MPHVP, Health Policy, Planning and Member Services(781) 434-7223ekirshenbaum@mms.org

Frank Fortin, CAEChief Digital Strategist and Communications Director(781) 434-7099ffortin@mms.org @frankfortin

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