The health care legislation under consideration in the State House has ambitious goals — to cap spending and change the way providers are paid. The bills encourage health insurance plans to move to a variety of payment methods that share the same focus: they would require providers to be held financially responsible for the health outcomes of their patients; they promote coordination of care; and they discourage redundant care. It’s easy to see the logic behind the concept of managing the cost of care through these methods, and why they have been embraced by policy makers and health care experts for some time. The problem, and what the legislation doesn’t recognize, is that fewer — not more — employers are offering these types of insurance plans.
I believe that physicians and hospitals should be rewarded for providing high-quality and efficient care rather than just more care, so I have supported these types of plans. Tufts Medical Center and the 1,500 physicians in our physicians network were among the first providers in the state to sign on to an Alternative Quality Contract (AQC), Blue Cross and Blue Shield of Massachusetts’ version of budgeting the cost of health care. AQC and similar plans by other insurers give providers a stake in maintaining patient health, rather than being paid for each procedure or service, and provide significant incentive payments for meeting quality goals. Those plans also provide infrastructure investments to support the information systems and analytic capabilities providers must have to take financial responsibility for overseeing their patients’ overall health, not just treating them when they’re ill.