Massachusetts is a trailblazer in health care reform. The recent historic passage of the health care cost-control law attests to this, as does the astounding figure of 98 percent of our state’s residents being insured — the highest rate of coverage in the nation. The Massachusetts model of health care demonstrates the positive impact health care reform can have on the lives of everyday Americans. Reform is working. And while the progress in Massachusetts has been tremendous, our work is not yet done.
Mandatory health coverage and the passage of this historic law are just the first steps to improve health care quality and efficiency in health care spending. Soon, Massachusetts will embark on another initiative, to find more patient-centered and cost-efficient ways to treat health care consumers who qualify for both Medicare and Medicaid, sometimes referred to as the “dual eligible” population.
The proposed initiative for the dual eligible population will replace multiple and fragmented fee-for-service payments for individual services with combined Medicare-Medicaid global payments. It will provide coverage for both medical and behavioral health care, as well as community-based support services such as transportation assistance and person care attendants. The focus on behavioral health care is imperative as two-thirds of dual eligible members seek behavioral health services.
Network Health supports Massachusetts’ move towards an integrated, community-based care program for the dual eligible population, as we believe it has enormous potential to positively affect the health and well-being of state residents. Network Health already has a similar integrated care management program for our members. Since 2011, this program has effectively reduced unnecessary emergency room visits by 11 percent and kept 30-day readmissions flat at just 13 percent of total medical and surgical admissions.
We believe that engaging individuals with complex needs in a holistic, individualized way leads to better health outcomes and improved lives. We applaud Massachusetts for designing a patient-centered, cost-effective care program for the dual eligible population, which comprises some of our most vulnerable residents. In developing this new model of care, the Patrick administration solicited all stakeholders to ensure the program would be high-quality and economical, and most importantly, respectful and responsive to those it aims to serve: disabled individuals, their families, and their caregivers.
With the spotlight on the Commonwealth after passing this landmark legislation, we can once again lead the way for the entire nation. We can provide a roadmap for integrating services for dual eligible individuals that not only reduces unproductive spending, but also improves their health outcomes — ultimately leading our nation to true health care reform.