Saturday, November 6, 2010

The Massachusetts experiment

Yes, we can do it. That was John Auerbach's message during today's Summit on Health Reform. Commissioner of Public Health for Massachusetts, Auerbach detailed the challenges and successes involved in his state's health reform experience, which began four years ago.

After three years of implementing the reform measures, Massachusetts' uninsured rate is now less than 3 percent — which means the state is nearing its goal of near-universal coverage, Auerbach said. But beyond having access to insurance, how did the state's reform efforts help improve people's health?

In the first year of reform, there was a 7 percent increase in residents receiving flu shots (many of which happened in a doctor's office), colonoscopy rates went up 8 percent, and smoking rates declined sharply, with more than 10 percent of adults enrolled in Medicaid taking advantage of nicotine replacement therapy, Auerbach said.

"We have to show how (reform is) having a short-term impact in terms of improving people's health," he said. "Public health people are good at that."

He also shared his three big lessons from the Massachusetts experience: Public health can help health reform succeed, health reform is not a substitute for public health, and public health must adapt to health reform.

1. Public health can help health reform succeed: Behind the scenes of implementation, public health input was crucial, Auerbach said. When stakeholders gathered to design the new insurance packages, public health folks were they only ones who brought up prevention, tobacco cessation, counseling newly diagnosed patients about chronic disease management, the importance of community health workers, substance abuse and mental health treatment. Public health workers were also the strongest advocates for making sure co-pays and deductibles didn't obstruct residents' access to care. Plus, public health workers are critical in reaching residents who may fall through the cracks.

2. Health reform is not a substitute for public health: Fixing the broken health care system is an expensive endeavor, so policy-makers are always looking for ways to save money — sometimes deciding to cut into public health services. For example, Auerbach said, Massachusetts legislators decided to cut funding for public health family planning services, as they thought the new reform measures would fill in the gap. But public health had the data showing that, among other concerns, many teens didn't want to talk to their parents about their sexual health needs — they wanted to access such services on their own. The data was compelling and the funding was eventually restored.

3. Public health must adapt to health reform: Public health should be at the discussion table and must be able to demonstrate that prevention works to save money. A lot of decisions will be made based on us being able to show cost savings, Auerbach said, and not over a lifetime, but in the short-term.

At the end of the day, Auerbach said, health reform is neither nirvana nor hell (he really did say that). To this blogger, it seemed the lesson was that reform is a give-and-take — almost a trial of errors — but that it is imperative to tackle if we're to keep moving forward.

— K.K.

Above, Massachusetts Commissioner of Public Health John Auerbach speaks to attendees at APHA's Summit on Health Reform. Photo courtesy Jim Ezell/EZ Event Photography

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