Payment Reform

The basics of Chapter 224

In August 2012, the Massachusetts Legilature passed Chapter 224 of the Acts of 2012, “An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation.” The law aims to control health care cost growth through a number of mechanisms, including the creation of new commissions and agencies to monitor and enforce the health care cost growth benchmark, wide adoption of alternative payment methodologies, increased price transparency, investments in wellness and prevention, an expanded primary care workforce, a focus on health resource planning, and further support for health information technology, among others. 

Focus on Behavioral health

  1. Patient-Centered Care: Payment reform legislation should align incentives so that patients are at the center of our health care system. The payment system should support teams that can deliver culturally-competent, coordinated preventive and primary care that focuses on the patient's physical and behavioral health. The system should encourage development of a robust primary care workforce.
  2.  Family and Consumer Voice: Individual health care consumers are the heart of the care system, and must have a strong voice in the design and governance of the payment reform structures. Consumers should be represented on any state implementation board, as well as in the governance of Accountable Care Organizations (ACOs) and/or other payment intermediaries.

  3. Patient Activation and Empowerment: Patient activation and patient empowerment methods result in better health outcomes, reduced costs, reduced disparities, and better satisfaction with one’s health care. Practitioners, Department of Public Health, patients and community agencies all have a role in developing a system that gives patients confidence and tools to navigate a new system.

  4. Patient Choice and Accessibility: The payment system should preserve patients’ provider choice. Patients must have access to caregivers with linguistic and cultural capacity to provide effective care within their geographic area. Payment systems should promote patients’ continuity of care with their providers. Patients should have access to clinical trials and medically necessary out-of- network care, including out-of-state providers.

  5. Consumer Protections: Current protections provided by the Office of Patient Protection and other managed care regulations must be maintained and extended to encompass ACOs, patientcentered primary care homes, and other payment reform entities.

  6. Transparency: Measures of care and incentives built into the payment system must be transparent, accessible, and understandable by patients. All legislation should provide for an open process that provides full disclosure and explanation of all payment methods.

  7. Evaluation and Monitoring: Payment reform should include independent, meaningful and frequent monitoring and evaluation of the payment system transition, focusing on quality of care and improvement impact on health outcomes, including patient satisfaction, and quality of life. The evaluation should be public. The transition strategy should permit adjustments to be made as implementation proceeds.

  8. Development and Support for Robust Behavioral Health Workforce: The Behavioral Health System of Care must be stable and have sufficient capacity to serve children with behavioral health needs.