Expanding health insurance coverage is unsustainable without cost controls, and moderating health spending is difficult, according to an assessment of Massachusetts' health reform by the Blue Cross and Blue Shield of Massachusetts Foundation (PDF).

In a new report, the foundation outlines lessons learned from the state's universal healthcare program, enacted in 2006.

Close coordination between Medicaid and other public insurance programs is crucial to capture new enrollees and also reduce administrative costs, for instance. And connecting the uninsured to coverage and care requires a cohesive and intense effort among stakeholders, according to the 24-page report.

Getting to a 100% covered population isn't realistic so maintaining a strong safety-net system is important, the report concludes.

The state is now turning its attention to moderating healthcare costs. Last month, Gov. Deval Patrick filed legislation to expand the use of alternate provider payments, such as global and bundled payments, and expand accountable care organizations and other integrated models.