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Universally Accessible & Affordable
Affordable quality care for all Tame budget-busting costs Preserve healthcare jobs
A. planned strategic change Avoid “July surprise” when overdue budget hits unexpectedly (and often retroactively) during summer lull .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.T. teams to develop implementation specifics Not more disconnected “Blue Ribbon Committee” window-dressing Long-term.
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 Commonwealth’s 1997 implementation of federal Medicaid ** Prescription Advantage is a state drug program for the elderly and 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 . disabled.AFFORDABLE QUALITY CARE FOR ALL SOLUTIONS (continued) Publish annual consumer health guide Promote basic health literacy Essential information for primary caregivers of children.
2002 .4 billion MassHealth* (Medicaid) $4.7% of US. 13. prisoners.TAME BUDGET-BUSTING COSTS PROBLEMS Healthcare. is crowding out other needs $6.2% in Mass) More effective and farther reaching treatments Heavy usage: 33% more hospital outpatient visits per capita than U. veterans.S.2 billion including state workers & retirees. nearly half of entire $23b state budget. 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. and public health services Runaway growth: four times inflation Aging population (12.
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. especially for poor administrative practices that waste money . unified plan Use state’s 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.
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 .
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) .RESTRUCTURE THE BUREAUCRACY SOLUTIONS (continued) PUBLIC HEALTH Veterans Services Soldier’s 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.
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 .
70% > 70% 77% *Federal Medical Assistance Percentage .59% 60% .MEDICAID PLAYING FIELD (FMAP*) 50% < 51% 51% .
3 billion Federal share would increase by over $1.WHAT LEVEL MEDICAID MEANS TO MASSACHUSETTS TAXPAYERS 77% instead of 50% federal share $6.4 billion Medicaid budget Federal share now about $3.7 billion annually .
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 PROBLEMS Healthcare is our largest employer and vital to our future economic growth 360.
PRESERVE HEALTHCARE JOBS SOLUTIONS End the need for defensive medicine Guidelines for fair malpractice judgments based on true economic loss. and security standards (HIPAA*) now Push low-cost electronic data exchange (NEHEN**) and internet-based automatic processing for state (MassHealth. privacy. GIC. not “punishment” Limited liability (safe harbor) linked to corrective medical error reporting Eliminate expensive manual paperwork Implement uniform transaction. PA) Recapture drug rebate float with EFT*** * Health Insurance Portability and Accountability Act of 1996 ** New England Healthcare EDI Network *** Banking system’s electronic funds transfer .
and quality consulting services to pharmacies nationwide . operational. economic.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.
lower errors.5b savings in state budget (not including federal changes) . more involved patients 20% lower cost AND higher quality Up to $2. faster treatments.OUR COLLABORATIVE APPROACH More affordable care for all Broader reach.
Strong Medicine Universally Accessible & Affordable .