I think there is a clear answer, and unlike the coverage reforms in the ACA, it doesn’t provoke bitter partisan debate. We need to get to work on health care quality and affordability.
My first-hand experience with health reform has been in Massachusetts, where a bipartisan effort produced the nation’s first comprehensive health coverage law in 2006. In the Supreme Court ruling that preserved tax subsidies for insurance purchased through Federal Exchanges, Chief Justice John Roberts cited the Massachusetts law as a blueprint for the ACA. “The Affordable Care Act adopts a version of the three key reforms that made the Massachusetts system successful,” he wrote. A combination of insurance market regulation, an individual coverage mandate, and subsidies to help low- and moderate income people buy insurance “enabled Massachusetts to drastically reduce its uninsured rate.”
Two years after the Massachusetts law took effect, the state had an insurance system in place that offered residents access to coverage regardless of their medical history, employment status, age or income. The rate of uninsured residents fell to less than four percent, by far the lowest in the nation. But supporters of reform realized that the state could never sustain broad health coverage if costs were rising too rapidly or if quality of care was uneven or unreliable. So, once the major issues related to coverage were settled, our political and civic leaders turned their attention to quality and affordability.
Not surprisingly, our state’s push to control health care costs surfaced traditional debates about whether private market forces or government oversight would be most effective. (Yes, we have those debates in Massachusetts!) In the end, we reached a compromise: a new state law created a framework for cost containment oversight, but its success depends largely on private sector initiatives that are changing how we pay for care and how health care is organized and delivered. Instead of continuing to rely on our traditional, inflationary fee-for-service payment system, we are moving to one that rewards physicians and hospitals for higher quality, better outcomes, and lower costs. And it’s working. The approach that Blue Cross Blue Shield of Massachusetts launched six years ago, which we call the Alternative Quality Contract (AQC), has been rigorously evaluated by Harvard Medical School experts. Their study, published in the New England Journal of Medicine, found that the AQC improved the quality of patient care and lowered costs – in excess of national and regional trends.
Innovations in other parts of the country, many still in their early stages, are starting to produce similar results. Most encouraging of all, the Obama administration has announced its intention to accelerate the development of payment models that reward caregivers based on quality, rather than the quantity of care they give patients. Since Medicare pays for more than a third of the health care delivered in the U.S., the administration’s commitment is an important signal that major changes are underway.
Unlike coverage reform, the changes needed to improve outcomes and make health care more affordable do not trigger deep partisan divisions. Yes, we need to have serious debates about how best to measure and reward quality of care for physicians. And we need to offer corresponding incentives to patients that do not simply shift costs but actively engage them in their own care. But these are not partisan issues that will generate long and historic court battles.
I’ve found that Republicans and Democrats are equally interested in how we promote quality and affordability, and both agree that our health care system is fragmented and inefficient. In Massachusetts, our Republican governor is a long-time champion for making cost and quality information more transparent to consumers, and our Democratic legislature passed legislation to reform health care payment and delivery. Right there, we’ve got two key ingredients for a health care system that provides better care for patients and better value for those who pay the bills.
I realize that the national political waters will never be nearly as calm as they have been in Massachusetts, where elected officials, along with business groups, consumer advocates and health care leaders have focused on making health reform work. And I know that health care is at once profoundly personal and a major, growing component of our nation’s economy. It will always drive passionate debate. Still, national political and health care leaders would do well to follow Massachusetts’ lead and turn the focus to cost and quality through innovative payment reform. Together, we can build a far better health care system for the American people – one where high quality care is both accessible and affordable.
Andrew Dreyfus is President and Chief Executive Officer at Blue Cross Blue Shield of Massachusetts.