Whose Healthcare Plan Controls Costs Better, MA or RI?

Whose Healthcare Plan Controls Costs Better, MA or RI?

Both Rhode Island and Massachusetts are taking significant steps to contain rising healthcare costs. How do the states’ approaches stack up?

ACOs Take Hold in MA

In early August, Massachusetts Governor Duval Patrick signed into law a bill he believes will provide a model to guard against spiraling healthcare costs. Specifically, the bill is intended to save the state up to $200 billion in healthcare costs over the next 15 years by encouraging the creation of “Accountable Care Organizations” (ACOs), a key piece of federal healthcare reform. 

ACOs are groups of doctors who come together under one organization and are paid based on improving a members overall health versus being reimbursed for each test or procedure, offering a more coordinated approach to medicine.

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Other MA Improvements

Patrick’s bill contains several other provisions designed to control costs.

• Expands the role of physician assistants and nurse practitioners by enabling them to act as primary care providers.

• Creates a new wellness tax credit for businesses that adopt programs to combat preventable chronic diseases

• Provides $135 million in grants to help small community hospitals adopt electronic medical records.

• Attempts to reduce malpractice costs by including a 182-day “cooling off period” to help both sides negotiate a settlement.

• Bans mandatory overtime for hospital nurses except in emergency situations.

PCMHs Increase in RI

Rhode Island is focused on its own version of the ACO: the Patient-Center Medical Home (PCMH). In 2006, the Office of the Health Insurance Commissioner convened a community-wide collaborative – comprised of payers, providers, employers, state agencies and others – known as the Rhode Island Chronic Care Sustainability Initiative (CSI-RI) to develop a sustainable model that improves the care of patients with chronic disease.

The CSI-RI project emphasizes PCMHs, which use advanced health information technology to coordinate care among a patient-centered team. Key features of a PCMH include:

• Patients have a point person (often a nurse) who they can call to help navigate the healthcare system.

• The care team develops individualized holistic healthcare plans to meet patient needs.

• The practice uses health information technology to ensure that the patient gets the right care, at the right place, and at the right time.

 

CSI-RI launched its first five pilot sites in 2008, expanded in 2010 and recently added three additional sites. Today, the state’s all-payer chronic-care medical home initiative encompasses more than 50,000 patients with diabetes, coronary artery disease and depression. The goal of the program is to increase patient compliance and reduce risk levels – all to lower costs.

A Push for Electronic Medical Records in RI

Rhode Island is also driving providers to adopt electronic medical records. The Rhode Island Health Information Exchange (HIE) initiative, known as currentcare, is a public–private effort to allow providers, with their patients' permission, to electronically access important health information from a variety of sources.

By providing providers access to all patient health information in one place, currentcare, a joint effort of the Rhode Island Department of Health and the non-profit Rhode Island Quality Institute (RIQI), patients can avoid costly duplication of tests and dangerous drug interactions.

Both States Pioneers in Health Exchanges

While Massachusetts established its version of a health benefits Exchange a couple of years ago, Rhode Island is one of the first states to set up a health benefits Exchange under the provisions of federal healthcare reform. Rhode Island’s Exchange, which will provide a health purchasing marketplace for individuals, Medicaid recipients and small businesses, is expected to be up and running by January 1, 2014, in line with PPACA requirements and ahead of many other states.  Whether the state Exchanges will help control costs, however, remains to be seen. 

While the two states are taking slightly different approaches to stem healthcare costs, both seem committed to impacting care delivery in meaningful ways for the consumer.

Amy Gallagher has over 19 years of healthcare industry experience. As Vice President at Cornerstone Group, she advises large employers on long-term cost-containment strategies, consumer-driven solutions and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, is a member of local organizations like the Rhode Island Business Group on Health, HRM-RI, SHRM, WELCOA, and the Rhode Island Business Healthcare Advisory Council, and participates in the Lieutenant Governor’s Health Benefits Exchange work group of the Health Care Reform Commission.

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