Worcester Business Journal

Worcester Business Journal www.wbjournal.com 2016 Economic Forecast 27 We are looking for Business Leaders of the Year in the following categories: • Large Business • Entrepreneur/Small Business • Nonprofit • Corporate Citizen of the Year Our Corporate Citizen award is given to a company, not an individual, that actively services the community. For detailed information and to submit a nomination visit: www.wbjournal.com/businessleaders CALL FOR NOMINATIONS! 2016 Business Leaders of the Year and Corporate Citizen of the Year Nominations are now open! Nomination deadline: Friday, January 8, 2016 QUESTIONS ABOUT NOMINATIONS? Contact Brad Kane at bkane@wbjournal.com The 2016 honorees will be profiled in Worcester Business Journal's February 15, 2016 edition and honored at a special reception in early March. 2016 Presenting sponsor H e a l t h C a re Health Care, Morales explained that while Steward and other health care sys- tems that serve large numbers of low- income patients, known as "dispropor- tionate share" providers, do well in man- aging the health care of patients covered by risk-based contracts with commercial insurers and the federal Medicare pro- gram for seniors, MassHealth has yet to embrace that model. That means there's considerable waste within the system, which operates on a fee-for-service basis and therefore doesn't encourage population health management the way an accountable care organization system does, according to Morales. Accountable care organizations assume risk for a certain patient popula- tion, and their payment is determined in part by the quality of care received. Under the traditional fee-for-service system, which still dominates the U.S. healthcare system even as public and private payers are inking more risk- based contracts, providers are paid by the service, regardless of the outcome for the patient. Health care providers across the state like Steward and other groups, such as unions representing health care work- ers, have been working to change that over the last two years. They seem to be gaining traction, with Gov. Charlie Baker favorable to the idea, according to Morales. The UMass Memorial Health Care system, Central Massachusetts' largest and, like Steward, a "disproportionate share" provider, favors the ACO model for MassHealth, according to CEO Eric Dickson. But he said a more targeted approach is needed. Dickson said healthcare systems should focus on the patients that require the most health care; about 5 percent of the population generates 50 percent of the health care services rendered, Dickson said. It's that population that UMass Memorial has asked Baker and state lawmakers —"anyone who will lis- ten," according to Dickson — to zero in on as they draft healthcare policy. "We think that it really has to be about taking risk and managing risk for that five percent of the population," said Dickson, who said that evidence shows that risk-based contracts for the young, healthy population don't seem to gener- ate significant savings. An emergency room physician, Dickson said he's seen patients who have visited the ER as many as 200 times a year. Those patients are getting lost in a fee-for-service system that does not consider the big picture when address- ing their healthcare needs, according to Dickson. Often, these patients are low income and have behavioral health and substance abuse problems that need to be addressed, he said. "What can you offer somebody on their 175th ER visit?" Dickson said. H ealthcare workers spoke out in favor of a proposed bill, which proponents say will reduce health care spending while boosting community hospitals, during a legisla- tive hearing before the Joint Committee on Health Care Financing. Titled "An Act Relative to Equitable Health Care Pricing," the bill was filed in April by Sen. Benjamin Downing, D-Pittsfield, with heavy support from the healthcare workers union 1199SEIU United Healthcare Workers East. The union and other bill supporters say the current hospital payment system gives an advantage to large providers, which have an edge in negotiating pric- ing with insurance companies because of their size. If passed, the bill would require pri- vate insurers to negotiate new contracts with high-price providers, which sup- porters say would level the playing field. Prices could be no more than 20 percent higher than the average amount paid to other providers for the same services. Meanwhile, a pricing floor would be set so that safety-net hospitals that care for a large number of low-income patients would be paid no more than 10 percent lower than the average prices for the same services. Gov. Charlie Baker is opposed. Baker spoke at a hearing, saying that regula- tion is not the answer to reducing healthcare spending, according to the State House News Service. But he did push for making pricing information publicly available. Currently, prices negotiated between hospitals and pri- vate insurers are confidential. n Workers push health care pricing bill at hearing, Baker opposed Blue Cross Blue Shield .....................48% Harvard Pilgrim Health Care ............26% Tufts Health Plan ..............................40% UnitedHealthcare ................................0% WellPoint ..................................... no data Cigna ...................................................0% Aetna ...................................................0% Fallon Health .....................................21% Health New England .........................64% Unicare ................................................0% Neighborhood Health Plan ...............13% Risk-based contracting Insurers' business customers covered by global payments, or risk-based contracts, in 2013 in Massachusetts: Source: Blue Cross Blue Shield of Massachusetts, 2015 report Customers with Insurer risk-based contracts

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