When he eyes the three-legged stool that is the Massachusetts health care system, Andrew Dreyfus says two of those legs — access and quality of care — are plenty strong.
But it's the wobbly third leg representing affordability that has the system in what many describe as critical condition.
As head of the state's dominant health insurance provider — Blue Cross Blue Shield of Massachusetts — Dreyfus knows better than most the fiscal pressures facing doctors and hospitals on the one hand, and businesses and consumers on the other. Fortunately, he has some ideas about how to fix things, and his solutions have a lot in common with those put forward by Gov. Deval Patrick in his reform legislation, which will be the subject of a hearing before the Legislature's Joint Committee on Health Care Financing on Monday at Salem State University.
The focus these days of Dreyfus' company, the governor and advocacy groups like Health Care For All (see column by the latter's executive director elsewhere on this page) is to substitute a global payment model for the old fee-for-service system that plainly doesn't work.
"We need a new business model for health care," Dreyfus told members of the North Shore Chamber of Commerce at its monthly breakfast meeting at Salem's Hawthorne Hotel yesterday.
And it's one, he added, that will reward doctors and hospitals for the overall value of the care they provide rather than where they are located, the number of tests they order, or the complexity of the procedures they perform.
Toward that end, Blue Cross Blue Shield is seeking to persuade providers to sign "alternative quality contracts" in which they agree to provide care for a fixed cost per patient per year, with adjustments for the health status of individual patients at the time they are enrolled and "quality bonuses" for exceptional treatment.
That will change the focus, he noted, from treating illness to preventing it via early detection of disease and wellness programs.
Of course, Dreyfus pointed out, consumers also have a role to play in reducing costs.
Eastern Massachusetts has some of the finest teaching hospitals in the world, but partly as a result of people wanting to use those very expensive facilities for even routine procedures, it has the highest per-capita health care costs in the country.
Indeed, Dreyfus says half the reason insurance costs go up so much every year is that people insist on seeking treatment in higher-cost settings — a hospital emergency room, for example, instead of a doctor's office; or one of the big Boston hospitals instead of a community hospital.
Which is why both government and private insurers are trying to encourage consumers through the use of copays, deductibles and enrollment in comprehensive care networks to make choices that will save them money without sacrificing the quality of care they receive.
All of this make for an ambitious task that will require doctors and hospitals to make public the fees they charge and the results of the treatments they provide to facilitate comparison shopping, and for consumers to sacrifice some of the choice they have enjoyed when it comes to seeking treatment.
But to do nothing, as Gov. Patrick pointed out recently at another business forum, means settling for those double-digit premium increases that have been and continue to be a major drag on the state's recovery from the Great Recession.
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