A few months ago, Health Affairs published Robert Mechanic and colleagues’ The New Era Of Payment Reform, Spending Targets, And Cost Containment In Massachusetts: Early Lessons For The Nation. The article describes the cost containment bill that was signed into law in Massachusetts last August and discusses the growing pressure on policymakers to control health care spending as we expand health care to near universal coverage.
For those working in population health, the interesting story about the Massachusetts legislation is that a small group of bright and dedicated public health advocates from the Massachusetts Public Health Association (MPHA) brought together a broad coalition of partners across the state to call for a sizable and sustainable investment in community-level population health strategies. According to Maddie Ribble, Director of Policy and Communications at MPHA, “civic leaders and organizations coalesced around this proposal, including unusual allies such as mayors, town managers, religious leaders, and business leaders. In addition, more than one hundred legislators actively supported the effort.” This monumental achievement can best be characterized as eighteen months of intensive political organizing, during which time prevention and public health were a significant part of the public debate. With widespread support, a sixty million dollar Prevention and Wellness Trust Fund was included in the cost containment legislation, to be used for community-based prevention strategies over four years.
The Trust will be administered by the Massachusetts Department of Public Health with most of the money awarded through competitive grants for community-level, evidence-based prevention strategies for the following purposes:
- Reduce rates of the state’s most costly preventable health conditions
- Reduce health disparities
- Increase healthy behaviors
- Increase the adoption of workplace-based wellness programs
- Develop a stronger evidence-base of effective prevention programs
An evaluation of the impact of these investments was built into the legislation. According to Val Bassett, the former Executive Director of MPHA who helped advance the legislation, “advocates expect that promising results will be a basis for continuing (the investments) past four years.”
The Trust, the first of its kind in the nation, makes two important contributions to population health. First, through their unified voice and strategic efforts, these public health advocates influenced legislation by making a clear and compelling case that in order to control health care spending, we must invest upstream in community-level population health strategies. Second, in our ongoing efforts to find sustainable financing mechanisms for population health, one idea is to capture a portion of the savings that are generated in a high-performance health care delivery system. In other words, as we bend the health care cost curve, a portion of the savings can be used for prevention, public health, and population-based strategies. Massachusetts goes one step further: the $60 million in the Trust is captured upfront from the health care delivery system. Health plans and large hospital systems proactively invest upstream to improve health outcomes as an integral part of their cost containment strategy. According to Bassett, beyond the obvious benefits to individuals and communities that enjoy greater health and well-being, the “upfront investors are the biggest beneficiaries of the fiscal impact of the Trust.”
As the Health Affairs article says, we can look to Massachusetts for early lessons for the nation. With their innovative trust, Massachusetts is on the road to having the necessary resources to improve population health. If they succeed in reducing health care costs through population-based strategies, they will complete the virtuous cycle of better care, better health, and lower costs.