By Ann Batdorf-Barnes, DO, MPH
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.
Health Affairs, The
New Era of Payment Reform, Spending Targets, And Cost Containment In
Massachusetts: Early Lessons For The Nation (October 2012)
Improving Population Health Blog : Health
in All Policies & Payment Reform
Massachusetts
Public Health Association
Prevention
and Wellness Trust
Ann Batdorf-Barnes, DO , MPH is a consultant to the Kresge Foundation. The opinions expressed are those of the author and do not necessarily reflect the official opinion of the Foundation.