Strong Medicine

Universally Accessible & Affordable

OUR OBJECTIVES

Affordable quality care for all Tame budget-busting costs Preserve healthcare jobs

OUR APPROACH

Collaborative decision-making instead of

Beacon Hill lump-it-or-leave mandates

Latest example: pharmacy pullout due to Medicaid reduction below wholesale drug cost

High level S.W.A.T. teams to develop

implementation specifics

Not more disconnected Blue Ribbon Committee window-dressing

Long-term, planned strategic change

Avoid July surprise when overdue budget hits unexpectedly (and often retroactively) during summer lull

AFFORDABLE QUALITY CARE FOR ALL PROBLEMS

Families just above Medicaid limits receive

no support and often must play healthcare roulette

Seniors, unable to find adequate home care

services, are unnecessarily institutionalized

High prescription costs squeeze out other needs

Families seeking help face a bewildering

alphabet soup of agencies and may not receive needed care

AFFORDABLE QUALITY CARE FOR ALL SOLUTIONS

Apply sliding fee scale to MassHealth*

rather than all-or-nothing limits

Proactive care management for all

MassHealth* recipients

Disease-specific prevention for at-risk groups

Revamp policies to emphasize home-based

care instead of institutionalization

Extend federal most-favored Rx pricing to

all Prescription Advantage** participants

* MassHealth is the Commonwealths 1997 implementation of federal Medicaid ** Prescription Advantage is a state drug program for the elderly and disabled

AFFORDABLE QUALITY CARE FOR ALL SOLUTIONS (continued)

Publish annual consumer health guide

Promote basic health literacy Essential information for primary caregivers of children, disabled, and the elderly Useful cost and quality comparisons

Give HHS* a user-friendly face

One-stop portal for all service needs with dedicated case consultant for each client Health Hotline to shorten response time and avoid unnecessary office visits

* Health and Human Services (HHS) is the executive branch area responsible for the majority of financial assistance and care delivery

TAME BUDGET-BUSTING COSTS PROBLEMS

Healthcare, nearly half of entire $23b state

budget, is crowding out other needs

$6.4 billion MassHealth* (Medicaid) $4.2 billion including state workers & retirees, prisoners, veterans, and public health services

Runaway growth: four times inflation

Aging population (12.7% of US, 13.2% in Mass) More effective and farther reaching treatments Heavy usage: 33% more hospital outpatient visits per capita than U.S. average 13% Medicaid increase in FY02**
* MassHealth currently provides healthcare benefits to one million low- and moderate-income Massachusetts residents ** Commonwealth Official Statement March 25, 2002

TAME BUDGET-BUSTING COSTS PROBLEMS (continued)

HHS* is a 1960s bureaucracy fumbling a

21st century crisis

15 independently funded agencies complicate span of control and coordination Isolated agency missions inefficiently deliver services with rigid, out-dated rules

Federal policies place Massachusetts at a

competitive disadvantage

Lack of Medicare drug coverage hits our high proportion of elderly Massive regulation dampens our innovative spirit We receive the lowest Medicaid federal match of any state
* Health & Human Services

TAME BUDGET-BUSTING COSTS SOLUTIONS

Cover all state and municipal employees in a single, unified plan

Use states purchasing power to lower cost Local aid incentives to aggregate plans

Remove unnecessary red tape and focus on enforcement

Target fraud and abuse Penalties for passive non-compliance, especially for poor administrative practices that waste money

THE RED TAPE JUNGLE

TAME BUDGET-BUSTING COSTS SOLUTIONS (continued)

Restructure HHS & other related programs into three coherent groups
1. 2. 3.

Public health Social and rehabilitation services Financial assistance

Give HHS Secretary necessary resources to implement structural change

Centralize all direct purchasing at secretariat level and reduce number of vendors Award new contracts based on measured results

RESTRUCTURE THE BUREAUCRACY SOLUTIONS (continued)

PUBLIC HEALTH
Veterans Services Soldiers Homes Group Insurance Comm Dept Mental Health Dept Public Health Division Medical Assistance Dept Corrections (healthcare only) Board of Registration in Medicine Division of Insurance (health only) Division Professional Licensure (health) Elder Affairs (health related) Low Level Rad. Waste Div Health Care Finance & Policy

SOCIAL & REHABILITATION

Dept Mental Retardation Dept Social Services Dept Youth Services Mass Commission for the Blind Mass Commission for the Deaf Mass Rehabilitation Commission Office for Child Care Services Mass Office on Disability Elder Affairs (social & rehab related)

FINANCIAL ASSISTANCE
Dept Transitional Assistance Office for Refugees and Immigrants Elder Affairs (financial related)

TAME BUDGET-BUSTING COSTS SOLUTIONS (continued)

Lobby hard for a Medicare drug benefit Use federal waivers to bypass medicine-

by-manual regulation

Make Medicaid a level playing field for all

states

MEDICAID PLAYING FIELD (FMAP*)

50%
< 51% 51% - 59% 60% - 70% > 70%

77%

*Federal Medical Assistance Percentage

WHAT LEVEL MEDICAID MEANS TO MASSACHUSETTS TAXPAYERS

77% instead of 50% federal share $6.4 billion Medicaid budget

Federal share now about $3.3 billion

Federal share would increase by over

$1.7 billion annually

PRESERVE HEALTHCARE JOBS PROBLEMS

Healthcare is our largest employer and vital

to our future economic growth

360,000 workers earning over $15b in wages $2.5 billion flows in for research & non-resident care

BUT, at an alarming rate

Malpractice insurance rates are skyrocketing MDs and other health professionals are leaving the Commonwealth Hospitals are closing Once bedrock institutions face uncertain futures

PRESERVE HEALTHCARE JOBS SOLUTIONS

End the need for defensive medicine

Guidelines for fair malpractice judgments based on true economic loss, not punishment Limited liability (safe harbor) linked to corrective medical error reporting

Eliminate expensive manual paperwork

Implement uniform transaction, privacy, and security standards (HIPAA*) now Push low-cost electronic data exchange (NEHEN**) and internet-based automatic processing for state (MassHealth, GIC, PA) Recapture drug rebate float with EFT***
* Health Insurance Portability and Accountability Act of 1996 ** New England Healthcare EDI Network *** Banking systems electronic funds transfer

PRESERVE HEALTHCARE JOBS SOLUTIONS (continued)

Optimize communication between physician and pharmacist to reduce expensive adverse drug interactions

Owen* pharmacy management model Cost-effective analysis of generics

Streamline administrative processes and standardize IT solutions

Insist on proper business practices, including timely billing and co-pay collection

* Owen Health provides clinical, operational, economic, and quality consulting services to pharmacies nationwide

OUR COLLABORATIVE APPROACH

More affordable care for all Broader reach, lower errors, faster

treatments, more involved patients

20% lower cost AND higher quality Up to $2.5b savings in state budget (not including federal changes)

Strong Medicine
Universally Accessible & Affordable