Better Care Campaign Visits Brockton

How does state Representative Christine Canavan measure success in health care reform? “Knowing there are fewer people going to bed in pain is real progress,” she says.

Canavan, who is also a nurse, talked about the progress the state has made in health care reform at a public forum at the Brockton Neighborhood Health Center August 11. The forum was sponsored by Health Care For All and the Massachusetts Campaign for Better Care.

After ticking off a list of accomplishments, including the recent passage of the small business health care cost containment bill, Canavan talked about the need for payment reform and keeping costs down for consumers. And one key thing policymakers need to keep in mind, she says, when calculating the affordability of various plans are the “copays, deductibles, and prescription costs” that are passed along to individuals by health insurers — as well as the costs of treatments and tools that contribute to a sick individual’s quality of life, but aren’t necessarily seen as medically necessary.

As an example, Canavan recounted the story of a patient of hers who was being treated for cancer of the bowels. As her illness — and intensive treatment — progressed, the woman gradually became weaker and more uncomfortable. She could not sit down without significant pain. A nurse ordered her a pillow made especially for people in her condition, and she was finally able to sit. But the pillow — which cost $347 — was not covered by her health insurer. The woman could not afford the pillow — and it was returned. “I’ve never forgotten the cost of that pillow,” says Canavan.

Canavan was joined by Brockton state Representative Michael Brady, who said that lawmakers were “fighting every day to keep health care costs down.” More transparency in the costs of care was necessary, he said, as well as more educating for the public around health care costs.

Gia Limanek of the Commonwealth Care Alliance also spoke at the forum and explained how the Alliance keeps costs down by budgeting an annual cost per patient as opposed to a fee-for-service model. The Alliance is paid by MassHealth and Medicare to care for some of the Commonwealth’s most vulnerable residents — frail elders living at or below the poverty line. Measures of patient satisfaction find that patients of the Alliance are happy with their care, they have fewer hospital visits and are healthier than their peers who are not in the Alliance’s care.

“The Commonwealth Care Alliance shows that by improving the quality of care, we can lower the costs of care,” said Health Care For All’s Research Director Brian Rosman.

There are three prerequisites for global payments to work today, Rosman explained, to avoid the issues that plagued capitation in the 1990s. The first is that there are much more sophisticated and robust methods of collecting feedback from patients and doctors and measuring results today than existed 15 years ago. The second is that today’s global payment method are adjusted for risk — annual payments are higher for patients who are sicker. And, last, there must be more transparency in the system. “Everything a health system does must be open for inspection,” Rosman said, noting that as part of its agreement with the state, if the Alliance comes under budget, the non-profit returns money to the state. A few years ago, he noted, the Alliance returned savings to the state.

As a point of discussion, Rosman asked Limanek how the Alliance would have handled the pillow that Canavan’s patient needed.

“Oh, we would have paid for that,” Limanek replied.

The Better Care Campaign for Massachusetts works with policymakers and stakeholders to address patient concerns for better quality and more affordable healthcare. It is an affiliate of the national Campaign for Better Care, which is building a strong and lasting consumer voice for coordinated, comprehensive health care by mobilizing consumer advocates, older adults, and their families. The Better Care campaign will hold forums throughout the state over the next six to eight months collecting consumer stories of their experiences within the health care system. Watch this space for more details.

The event was covered by Brockton press, including radio station 95.9 WATD-FM and the Brockton Beat Blog.
-Susan Ryan Vollmar