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www.wbjournal.com • Worcester Business Journal 81 CENTRAL MASS. 2025: HEALTH CARE The excitement about uncertainty BY EMILY MICUCCI Worcester Business Journal Staff Writer Muldoon's optimism might seem curious, given the medical center's financial situation. Operating losses over the first half of its just-completed fiscal year has resulted in hundreds of layoffs and significant cuts to services at the hospital. (Early third-quarter numbers for parent organization UMass Memorial Health Care revealed an operating sur- plus that made a substantial dent in those losses.) But along with UMass Memorial Health Care (UMMHC), the region's dominant health care system, the medi- cal center has an opportunity to lead the way as a pioneer in a new system that emphasizes population health manage- ment instead of the fee-for-service sys- tem that's still largely in effect. Dr. Eric Dickson, CEO of UMMHC, said that model, in which insurance pay- ers reimburse providers for each service, is one that benefits providers when patients are sicker, at least where reve- nue is concerned. A global payment system, on the other hand, is one that pays providers a fixed amount to care for a certain number of patients. "We are embracing (state and federal health care reform) and really want to move toward becoming a true health care system," Dickson said. Technology as an enabler Because of UMMHC's reach, with five hospitals and 1,700 physicians, the sys- tem is able to apply this concept with relative ease. Leveraging technology that allows UMass doctors to monitor patients remotely, Dickson said UMMHC is able to move patient care to lower-cost settings, such as community hospitals, thereby saving money. Given the drive to move care to lower- cost settings, new opportunities will continue to open up for other types of providers, such as skilled nursing facili- ties and home health agencies. Medical care that once was provided in the hos- pital is being shifted to such facilities and patients' homes, and demand for those services will also increase as baby boomers continue to age. According to the U.S. Bureau of Labor Statistics, the number of people employed as home health aides is expected to increase 48 percent by 2020, making it one of the fastest-growing occupations in the U.S. The importance of other types of health care providers is also increasing. A shortage of primary care doctors has confounded Massachusetts physician groups for the last eight years, according to the Massachusetts Medical Society, which issues a report on the subject annually. To address that problem, many health care providers are piloting new programs that use mid-level pro- viders, such as physician assistants and nurse practitioners, in concert with doc- tors, said Dr. George Abraham, a pri- mary care physician and the Massachusetts governor for the American College of Physicians. This relieves primary care doctors' workloads while increasing access for patients, Abraham said. Primary care roles, anyone? Meanwhile, health care leaders are trying to boost enthusiasm for careers in primary care, according to Abraham. He said an advisory council under the Centers for Medicare and Medicaid (CMS) meets annually to set federal reimbursements, and the committee has been upping payments for primary care services while reducing payments slight- ly for specialist services. The hope is that private payers will follow suit, ultimately boosting salaries for primary care physi- cians. "Hopefully, that will turn the tide and … incentivize doctors going into pri- mary care," Abraham said. Regarding the transition to a global payment system, Abraham said physi- cians have been ambivalent about embracing the change because they're not in control of hospital pricing, and cannot order patients to go to one hospi- tal over another, so it will be difficult to manage costs for a population the way a large system might. In fact, Abraham is unconvinced that global payments will replace fee-for- service payments, at least in the world of primary care. "I think we will reach some sort of a hybrid model," Abraham said. n I f there's one thing health care leaders can agree on, it's that the future is anything but certain. Federal health care reform is changing the way providers are reimbursed and how health care is delivered, and state reform is putting constant pressure on providers to cut costs. But Patrick Muldoon, CEO of UMass Memorial Medical Center in Worcester, said he's looking on the bright side. "It really is a terrific time to be a health care leader because we're really working real time the communities we serve, rede- fining health care delivery of the future," Muldoon said.