For more than 200 years, Boston has revolutionized the way healthcare services are delivered and paid for in the U.S., and that pioneering spirit shows no sign of retreat over the next 200.
Paul Revere and Sam Adams founded the first permanent medical center in New England in Boston in 1796 – then called the Boston Dispensary and today known as Tufts Medical Center. Massachusetts General Hospital followed, opening its doors in 1811.
“I tell people across the country that I’m from Massachusetts, and I’ve seen the future.”
In 2006, Boston made healthcare history when then-Gov. Mitt Romney took the stage at Faneuil Hall and signed landmark state healthcare legislation that extended health insurance coverage to virtually all state residents. That state effort became the roadmap for the federal Patient Protection and Affordable Care Act that became law in 2010.
Today, Boston offers a blend of storied academic medicine, cutting-edge biomedical research and a barometer on universal access and affordability. Three out of four of the state’s medical schools are in Boston. Harvard, Tufts and Boston universities train thousands of tomorrow’s physicians in the city. Many of the top biomedical companies are based in Boston to gain access to the top medical talent trained there. And sparked by Romney’s healthcare reform law, Boston is a test bed for new models of care delivery and financing.
“Boston is a mecca for healthcare,” says Sarah Hoit, CEO of ConnectedLiving, a Boston-based healthcare organization that uses mobile technology to improve the health status of seniors. “It’s a mecca for education, and it’s a mecca for technology. You couldn’t be in a better place to revolutionize what’s happening.”
Look no further than Boston to see what’s next in healthcare, agrees Tuft Medical Center’s CEO Emeritus Ellen Zane, who built Tuft’s innovative Distributed Academic Medical Center model to deliver high-quality academic medicine to surrounding communities at suburban-care prices.
“I tell people across the country that I’m from Massachusetts, and I’ve seen the future,” Zane says. “And the fact is, there is no turning back the clock when people get used to the fact that they have health coverage.”
Problem-Solving Healthcare’s Head-Scratchers
Boston—and greater Massachusetts—faces challenges that go along with near-universal coverage (97% of the state’s population now carries health insurance). Cost, access and quality are all areas that Boston must conquer in order to successfully cope with a well-insured populous. With a high concentration of providers, there is room for improvement in terms of coordinating care for patients and fostering a more collaborative environment, residents say.
“Because we do so much academic medicine here, because we do so much research and because Boston is a higher cost of living environment, cost is something that remains an issue,” Zane says. “We have not yet truly gotten our arms around how are we going to provide great care—not just say it’s great, but prove that it’s great—and do it in a cost-effective manner.”
Numerous studies have shown that pricing competition remains an obstacle to controlling healthcare costs in Boston and greater Massachusetts. In response, health plans have rolled out innovative payment reform and contract pricing programs that have shown promise in controlling costs while maintaining or improving care quality.
Most notable is Blue Cross and Blue Shield of Massachusetts’ Alternative Quality Contract program. Launched in 2009, it offers fixed payments for a patient’s care during a specified period. Participating hospitals include Boston Medical Center, Boston Children’s Hospital, Steward Health Care, Partners Healthcare and Beth Israel Deaconess Medical Center. Participation over two years led to a savings of 3.3% while improving care quality.
Too, accountable care organizations, or ACOs, hold promise to improve care quality and coordination while lowering costs. Five Boston-area systems—who care for 40% of the state’s Medicare beneficiaries—are working within the Centers for Medicare and Medicaid Services’ Pioneer ACO model.
Massachusetts also is leading the way on healthcare price transparency. It was just one of two states that received an “A” grade from the Catalyst for Payment Reform and the Health Care Improvements Institute for existing transparency laws. Since October 2013, Massachusetts insurers have been required to give price quotes for tests, procedures and office visits. As of January 2014, providers must give patients price estimates at the point of care.;
Preventive care has been a clear winner in Massachusetts, with more people getting colonoscopies, mammograms and other preventive screenings than prior to implementation of the universal healthcare law. In addition, more than 33,000 adults covered by the state’s Medicaid program, MassHealth, have quit smoking because of coverage for treatment and counseling for tobacco cessation. Other states are keen to replicate these numbers.
Boston is clearly on the path towards greater innovation in healthcare spending, quality and access. Healthcare is front-and-center in the state – and not just because Donald Berwick, M.D., former administrator for the Centers for Medicare and Medicaid, is running for governor.
“Boston is filled with incredibly passionate people who love to solve problems,” says Mike Coyne, CEO of QuantiaMD, the nation’s largest social networking and educational platform for physicians, also based in Boston. “Healthcare is a big problem, and we have a lot of people here working in healthcare and looking to make healthcare better.”