Massachusetts Gov. Charlie Baker in late 2019 unveiled a healthcare reform proposal that he said would improve access and quality and bring down costs. A big part of the initiative would require hospitals to boost spending on primary care and behavioral health by 30% over three years. Joseph White, chair of the Massachusetts Health and Hospital Association, said the governor is pointed in the right direction. The CEO of Lowell General Hospital and parent organization Circle Health, White said healthcare has to move more aggressively toward a value-based system. He spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: Gov. Baker has been pushing healthcare reforms. Overall, what are your impressions about his plan?
White: His title of it is very telling: Act to Improve Healthcare by Investing in Value. To that end, I believe he’s directionally correct. While the members of MHA may not all agree on each individual piece, the goal is to start a conversation and move an idea forward that healthcare needs to change. I applaud the governor. We at MHA want to get behind it and see if we can push to continue this conversation, especially in the areas where he’s calling out primary care and behavioral health, and surprise billing, which we’re very much interested in eliminating.
The investments in telemedicine he’s talking about are well received.
MH: The plan calls on hospitals to increase spending on behavioral health and primary care. How would that work across MHA’s membership?
White: It will be different across the commonwealth, whether it’s an academic medical center or a small critical-access hospital. The nice thing about the governor’s bill is that it’s directionally correct. I don’t think they call out (your baseline) specifically. But just think about the principles here, improving primary care means improving access. And if you take a look at the two or three things that healthcare has to change at any level, one of those is access and that gets right back to primary care, whether it’s empowering nurse practitioners and others to support primary-care physicians, or it’s looking for ways to build a practice that is more relevant with respect to getting in to see primary-care (clinicians) and then paying for it.
When you invest in primary care, it’s got to be under the banner of value, which means we’re getting paid to keep people healthy. And behavioral health is a great example. If we just continue to get paid when people are sick with behavioral health problems, we’re not getting upstream enough to fix the problem. So I am applauding the governor with his emphasis on spending more. I don’t think we have nailed down what that looks like, but that’s where I think MHA is going to help … frame that up and move forward.
MH: You referenced the governor’s attention to surprise billing. There’s action in Congress, too. Where do you land on the issue? Would you like to see benchmark rates? Arbitration?
White: MHA’s position is we like the arbitration model. But more importantly, we agree wholeheartedly that we should end surprise billing; patients should not be getting surprise bills, whether it’s locally because they traveled and are up against an emergency department visit that’s out of network. We can do much better than that. We are going to work hard with the secretary and with the governor, we support Congressman (Richard) Neal (chairman of the Ways and Means Committee, whose bill includes arbitration and his) efforts going forward in Washington.
MH: Massachusetts Attorney General Maura Healey has been pretty active at looking at the merger and acquisition front. Have you felt that the scrutiny’s been too much or do you feel like the pressure she’s put on some of the proposed mergers is about right?
White: She’s got a very steady hand and she does some really good work. In any consolidating marketplace like healthcare, it’s good to have a set of eyeballs on what’s happening. The (state’s) Health Policy Commission does a great job. I think that level of scrutiny is good, it’s healthy, and I think our success in Massachusetts will continue forward with the appropriate watch as health systems continue to consolidate. It’s just a logical path forward as healthcare has got to get more efficient and scale is going to matter. The days of the independent community hospital in smaller environments are going to be tougher and tougher, and consolidation is going to continue for all the right reasons, and it’s appropriate to have some oversight.
MH: What are the right reasons? There’s a healthy debate over whether consolidation is actually beneficial to the patient, especially in terms of cost.
White: There are three things that we’re going to have to do as an industry that are going to require some scale. First, healthcare is too expensive. We’ve got to drop the total cost of care. It’s hard to do when you’re small. Secondarily, we, as an industry, have to take more responsibility for improving overall quality. The Joint Commission is now advocating—and we’re supporting—a run toward high-reliability or zero harm. It’s hard to do that without having access to more patients in larger scale. And third, we’ve got to improve patient loyalty and access, and it’s very difficult to improve overall access and get into new ventures like admitting to home or changing service lines to improve the transition from inpatient to outpatient if you’re small and not working with others.
There are some very big, global topics that are categorically important for the industry to get at and they’ll be much easier to accomplish with some scale.
MH: Are there areas that Lowell and Circle Health are looking at to reshape care?
White: There’s still too much variability, too many hospitalizations, too many unnecessary tests and procedures. We’ll continue teaming up with our amazing doctors to keep care local through our partnership with Tufts Medical Center and really drive toward dropping the costs of care, improving the quality of our care and our outcomes.
We’ve had some really cool results across a bunch of clinical areas, but most importantly, we’re focusing with our doctors on going beyond the four walls of the hospital and looking for ways to provide care in less-expensive settings, including the home and getting our services out into the communities that we serve through large patient-access centers.