Yearlong effort aims to address rising costs, consumer protections

UPDATED, Nov. 11: The state Senate approved at the stroke of midnight Thursday, Nov. 9, a wide-ranging bill that seeks to control the rising costs of medical care and prescription drugs, including a controversial plan that would fine hospitals if spending rises too fast.

Sen. Cindy Friedman joined the majority in the 33-6 vote. The Arlington Democrat said she is pleased that the bill's final version included several of her amendments related to improving access to treatment for mental health and substance-use disorders.

What Sen Brownsberger thinks about the package

Globe, Nov. 11, 2017: Health bill momentum slows at State House

"This robust legislation takes necessary steps to contain health-care costs for everyone while continuing to deliver quality care and access to services," she said in a Nov. 10 news release. "Going forward, we have to continue to work together to level the playing field and look for ways to ensure that someone with an acute behavioral health condition has the same access to health-care coverage as an individual with medical and surgical needs."

The Boston Globe reported that legislation also would require pharmaceutical companies to submit to more scrutiny from state officials. The bill sailed through after two days of debate and much last-minute wrangling over technical language.

Senators approved several changes to their original bill, including to some sections that had drawn criticism from the health-care industry, but they said it remained the same at its core. The bill’s drafters said it will help curb costs for consumers and the state budget, while improving patient care.

The legislation is S. 2022, An Act Furthering Health Empowerment and Affordability by Leveraging Transformative Health Care. It focuses on both short- and long-term goals on how to fix our health-care system to lower costs, improve outcomes and maintain access. The legislation is the result of the Special Senate Committee on Health Care Cost Containment and Reform, which convened to analyze our health-care system by comparing it to the best practices in other states and engaging stakeholders in a series of meetings over the last year.

The bill now heads to the House of Representatives for consideration.   

"Massachusetts continues to lead on health care, and having a robust economy depends upon lowering costs for everyone without compromising quality or access. This bill will help working families, businesses and our state budget," said Senate President Stan Rosenberg, Democrat of Amherst, in the release. "I’m very proud of the work the Senate did to craft a comprehensive report and draft legislation that touches so many aspects of our health-care system and meets the needs of all engaged stakeholders.

Sought best practices

Health-care costs are continuing to strain the budgets of working families, businesses and municipal and state governments, Friedman's release said. The Senate has continued to push for reforms to the current system through diligent research, stakeholder engagement and legislation.

The Senate, with the logistical support of the Milbank Memorial Fund, spent the last year meeting with officials from seven states, health-care experts, and stakeholders to examine best practices while lowering costs and improving outcomes.

The bill aims to put into effect more effective care delivery, such as telemedicine and mobile integrated health, to reducing emergency room visits, to expanding provider versatility while also addressing price variation between larger hospitals and their smaller community hospital counterparts. 

A recent study by the University of California Davis Health system estimates that "by using telemedicine for clinical appointments and consultations, its patients avoided travel distances that totaled more than 5 million miles. Those patients also saved nearly nine years of travel time and about $3 million in travel costs."

Mobile approach, telemedicine

The bill aims to reduce hospital readmissions and emergency department use through mobile integrated health and telemedicine as well as expanding access to behavioral health. The Massachusetts Health Policy Commission has estimated that 42 percent of all emergency department visits are avoidable.

The bill aims to tackle provider price variation, the variation between providers for similar procedures, by setting a floor for providers while also adding a benchmark for hospital spending. If hospitals exceed the benchmark, the state will issue fines or penalties on those institutions.  
 
Postacute care in an institutional setting and long-term care and supports cost the state an estimated $4.7 billion in 2015, a major cost driver for MassHealth, the release says.

The bill increases transition planning for patients into community settings and strengthening coordination between providers.

Pharma costs

Pharmaceutical costs have been a driver of increased health-care costs for a number of years. The Center for Health Information and Analysis reported a 6.4-percent growth in pharmaceutical spending in 2016.

Drug costs are making families choose between filling prescriptions and paying for other essentials like housing and food. The bill aims to set greater oversight and transparency in drug costs and encourages Massachusetts to enter into bulk-purchasing arrangements, including a multistate drug-purchasing consortium, as occur in other states, to lower costs and protect consumers. 

The legislation encompasses the whole system from Medicaid to the commercials market, addresses price variation, increases price transparency for consumers, leverages better federal funding opportunities, and expands scope of practice for many practitioners including dental therapists, optometrists, podiatrists, and nurse anesthetists. 

This news announcement was published Friday, Nov. 10, 2017, and updated Nov. 11, to add links.