Achieving accountable care in Massachusetts: payment reform to drive delivery system change.

On November 30, 2010, the Massachusetts Health Policy Forum will convene a forum to examine models of accountable health care delivery. The forum will showcase organizations from Massachusetts and other states that have taken significant steps toward improving the efficiency and quality of health care delivery through vertically and virtually integrated systems. Local stakeholders representing government, payers, providers and consumers will discuss challenges and opportunities for the Commonwealth in promoting accountable care. This paper outlines the challenge of rising health care costs in Massachusetts and provides a brief summary of actions and reports by state officials to address quality and cost concerns. It then discusses the concept of accountable care delivery and related models of coordinated health care. Next, it provides a short overview of the five organizations invited to describe their delivery models. Finally, it identifies unresolved issues that may be addressed at the forum.

Health care reform in Massachusetts: implementation of coverage expansions and a health insurance mandate.

CONTEXT: Much can be learned from Massachusetts's experience implementing health insurance coverage expansions and an individual health insurance mandate. While achieving political consensus on reform is difficult, implementation can be equally or even more challenging. METHODS: The data in this article are based on a case study of Massachusetts, including interviews with key stakeholders, state government, and Commonwealth Health Insurance Connector Authority officials during the first three years of the program and a detailed analysis of primary and secondary documents. FINDINGS: Coverage expansion and an individual mandate led Massachusetts to define affordability standards, establish a minimum level of insurance coverage, adopt insurance market reforms, and institute incentives and penalties to encourage coverage. Implementation entailed trade-offs between the comprehensiveness of benefits and premium costs, the subsidy levels and affordability, and among the level of mandate penalties, public support, and coverage gains. CONCLUSIONS: National lessons from the Massachusetts experience come not only from the specific decisions made but also from the process of decision making, the need to keep stakeholders engaged, the relationship of decisions to existing programs and regulations, and the interactions among program components.