mms state of the state: judyann bigby- overview of the state of the state's healthcare

Commonwealth of MassachusettsExecutive Office of Health and Human Services

Overview of the State of the State’s Healthcare

Secretary JudyAnn BigbyMassachusetts Medical Society

October 2008

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Overview of the State of the State’s Healthcare

AccessCostsFinancial PerformanceLong term CarePhysician WorkforceQualityDisparitiesSummary

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Insurance

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Health Insurance

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Health Insurance

6

Health Insurance

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Health Insurance

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Access

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Access to Providers

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36%

30%

0%

10%

20%

30%

40%

Unmet Need for Health Care

Fall 2006

Fall 2007

Impact on Access to Care

Source: On the Road to Universal Coverage: Early Impacts of Health Reform in Massachusetts (Sharon Long, Urban Institute June 2008)

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80% 83%

65%70%

49%

59%

0%

20%

40%

60%

80%

100%

Usual source of care Doctor visit forpreventive care

Dental visit

Fall 2006

Fall 2007

Impact on Access to Care


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27%

17%

0%

10%

20%

30%

40%

Any unmet need due to costs

Fall 2006

Fall 2007

Impact on Affordability of Care


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48%

37%33%

24%

12%8%

0%

10%

20%

30%

40%

50%

60%

$500 or more $1000 or more $3000 or more

Fall 2006

Fall 2007

Impact on Affordability of Care: Out-of-Pocket HC Costs


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32%

24%27%

23%

0%

10%

20%

30%

40%

50%

Problems payingmedical bills

Paying medical bills offover time

Fall 2006

Fall 2007

Problems paying bills and medical debt for low-income adults


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Health Care Costs

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Health Care Costs

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Financial Performance

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Nursing Facility Industry ProfileAll Payers

Number of Facilities: 433• Urban Facilities: 113

Number of Licensed Beds (1/1/08 Census): 47,946• Average Occupancy (1/1/08 Census): 91%

Licensed beds in Urban Areas (1/1/08 Census): 10,902• Average Urban Occupancy (1/1/08 Census): 91%

Percentage For-Profit: 73%

Total Industry Revenue 2007 - $3.7B

Payer Mix• MassHealth 66.9% • Medicare 14.5%• Private/Other 17.4%

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MassHealth Nursing Facility Utilization & Spending FY 03-08

Expenditures and Units (Bed Days)

$1,558$1,564

$1,614

$1,586

$1,548

$1,448

$1,350

$1,400

$1,450

$1,500

$1,550

$1,600

$1,650

FY 03 FY 04 FY 05 FY 06 FY 07 FY 08

Fiscal Year

Expenditure

s (

in m

illions)

8,500,000

9,000,000

9,500,000

10,000,000

10,500,000

11,000,000

11,500,000

12,000,000

Bed D

ays

Expenditures

Units

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MassHealth Long-term Care Spending: FY03 - 08

$-

$500.00

$1,000.00

$1,500.00

$2,000.00

$2,500.00

$3,000.00

FY2003 FY2004 FY2005 FY2006 FY2007 FY2008

Fiscal Year

Expe

nditu

res

(in m

illio

ns)

CommunityLTC

NursingHomes

29%

71%

29%

71%

31%33% 38%

69% 67% 62%

42%

58%

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Physician Workforce

393.7

249.7236.6

125.6

88.1 87.6

0

50

100

150

200

250

300

350

400

450

Mass US Average State Median

Per 1

00,0

00 P

opul

atio

n

All Primary Care MMS Workforce Study 2008 Critical or Severe Shortages Dermatology Emergency Medicine Family Medicine General Surgery Internal Medicine Neurology Oncology Orthopedics Psychiatry Urology Vascular Surgery

*Residents, fellows, semi-retired, retired, temporarily not in practice, not active physicians excluded

2007 State Physician Workforce Data Book, Association of American Medical Colleges

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Quality of Care

Generally Massachusetts ranks very highly among nationally applied indicators• Mass ranks as well as or better

than national average on 23 of 24 ARHQ indicators

Opportunity for focus and alignment of:

• Measures• Focus

Chronic disease Care transitions and

coordination• Attention to clinical care in

arenas other than hospitals• As a means to control costs

Lots of Activity HCQCC MAHP and individual health plans Mass Health Quality Partners Mass E-Health Collaborative MassPro Mass Coalition for Prevention of Medical Errors State Quality Improvement InstituteMass Health Data Consortium

Medicare Bridges to Excellence National Quality Forum IHI Leapfrog

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Disparities

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19.5

8.28

6

18.4

7.9

10.3

6.4

12

6.9

0

2

4

6

8

10

12

14

16

18

20

Perc

en

t U

nin

su

red

<300% FPL >300% FPL Hispanic NW, NH White

impact of Health Reform on Uninsurance

Fall 2006

Fall 2007

Disparities

From: Long S. Who Gained the Most Under Health Reform in Massachusetts? Massachusetts Health Reform Policy Brief October 2008

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Disparities

Racial and Ethnic Health Disparities by EOHHS Regions inMassachusetts – November 2007 Summarizes disparities in health status, risk factors, mortality by region

in MassachusettsThere are wide spread racial and ethnic disparities in all regions of the

Commonwealth

http://www.mass.gov/Eeohhs2/docs/dph/research_epi/disparity_report.pdf

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Summary

Access to care is improving for many segments of the population• The number of uninsured is decreasing at a significant rate• There is a significant decline in uninsured among low-income, among part

time workers, among Hispanics• Financial barriers to access have decreased• The percentage of Mass residents who report having a regular provider

increased for the first time in yearsIn 2007 the financial performance of hospitals, health centers, health

plans was positive• Performance in early FY08 looked positive but economic downturn has

already had a significant impactThe balance of LTC for elderly and disabled is shifting to community

settingsPhysician workforce shortage is of concern but drivers need to be

examinedMassachusetts has a great opportunity to assess impact of closing gap

in disparities in access on disparities in health outcomes

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What’s Coming Up?

Payment reform• Expansion of P4P• Commission on Payment Reform • Patient Centered Medical Homes demonstrations

Health Information Technology• Mandated CPOE and EMR• E-Health Institute• Data from E-Health Collaborative

Transparency • Quality and Costs on consumer friendly website• Posting of medical errors and infections

mms state of the state: judyann bigby- overview of the state of the state's healthcare

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