Opening statement by Senator Richard T. Moore in support of Senate Bill No. 2145 - An Act to Establish a Caring Commonwealth

February 11, 2004

In recent years, as the cost of health care has risen dramatically, as access to health care has become an increasing concern among employers, working families, and the public at large, and as questions about adequate levels of patient safety and quality of care have multiplied, state policy makers and health care leaders have been making major decisions about budget cuts and allocation of resources without any comprehensive plan to guide those critical choices. As a state, we’ve been lurching from crisis to crisis in health care, making serious, often shortsighted cuts that harm the state’s core mission in health care without any vision of what kind of health care we want and can afford.

After two years of review in 2001-2002 by a “blue ribbon task force,” the previous administration’s response to this crisis was called “watchful waiting.” With the arrival on Beacon Hill last year of a new, reform-minded administration, some of us were optimistic that health care would be among the reforms proposed.

It is, however, more than a little surprising, with health care access, affordability, and quality so high on the list of concerns among our people, that Governor Romney offered only a fleeting mention of the word “health” in his “State of the State” Address earlier this month and his budget recommendations suggest that his Administration’s vision of health care reform is to eliminate programs and cut funding without any evidence that such cuts are based on reason and common sense, let alone scientific research results. If the Governor truly wants “to put people first,” as he claimed in his address, there is no more important area of public policy than health care. There can be no “legacy of learning” for our children if many of them are not physically and mentally healthy and ready to learn. If the Governor really wants some kind of “reform” to tackle, there’s no better place than our health care system – so urgently in need of real reform.

To be fair the Romney Administration, with considerable help from the Legislature, especially Senator Susan Tucker, has reorganized the Executive Office of Health and Human Services, but our health system needs real reform that brings results, not simply a reshuffling of boxes on an organizational chart that, given the crisis in health care, might be seen as akin to shuffling the deck chairs on the Titanic! We need to focus our time and energies more on whether the desired health outcomes of health and human service programs are being achieved than on where to locate the program within the state’s administration.

Until now, we’ve had no vision of where we want our health care system to go or how to get there, but a lot of very thoughtful people have shared their ideas with the Committee on Health Care over the past several months. We’ve combined all of that good input to offer the citizens of Massachusetts a bold agenda for real reform and dramatic change in their health care system. It’s called, “Massachusetts – A Caring Commonwealth, the State Health Care Policy.

Dr. Donald Berwick, one of the true national leaders in health care reform, wrote to the Committee that: “The proposed health care policy is superb, and it is path-finding, I think, since I have seen nothing of this level of ambition and clarity in any other state yet. It could catapult Massachusetts into the lead in realizing a good part of the vision of care articulated by the Institute of Medicine’s report, “Crossing the Quality Chasm.”

The “Caring Commonwealth” policy is set forth in what is currently a 43-page document that recommends progress in health care in Massachusetts through achieving ten basic goals with more than 150 objectives that are either “Immediate” – in the next year; “Short Term” – between 2005 and 2010; or “Long Term” – between 2011-2015. The phased schedule is based on the apparent degree of difficulty in coordination, cost, and education or technology needed to attain each objective.

The strategic goal of the health care system is to reduce the burden of physical and mental illness, injury, and disability, and to improve the overall health status and function of all Massachusetts residents including an emphasis on closing the gaps in health status by addressing the unique needs of vulnerable populations.

The Commonwealth needs a health care system with a strategic planning capacity that accurately identifies the health care needs of the Commonwealth’s citizens, that produces a long-term plan that is reviewed and updated on a bi-annual basis, including service capacity requirements, workforce development needs, preferred service delivery systems, clinical methodologies, patient volumes and budget projections. Senate Bill No. 2145 would establish a mechanism for this strategic planning activity to occur.

Senate Bill No. 2145 calls for creation of a “Massachusetts Health Policy Coordinating Council,” comprised of representatives from government and many of the major health advocacy organizations. The Council will annually review progress toward achieving policy objectives, update specific objectives and their priority as the health needs of the population change, and form action teams of stakeholders to lead efforts to achieve the various objectives.

The details of what’s in the current version plan, for those who want to learn more, and perhaps to suggest further improvements, can be found on a web site, www.caringcommonwealth.com. Today, we’re very grateful that a number of expert witnesses who have been invited, have joined us to speak to the plan in general, and to specific goals of the plan.

However, before proceeding to that portion of the hearing, let offer a few highlights of the proposed policy that Senate Bill No. 2145 is designed to guide through to implementation in order to set the stage for those who will speak about specific portions of the plan.

The “Caring Commonwealth” has ten specific goals, each with a number of objectives that, if fulfilled, would move Massachusetts measurably toward achievement of the goals.

GOAL 1 Focus on Patient-Centered Care. To Improve the Patient Experience with Health Care by encouraging physicians and all health care professional to incorporate the six values of patient care in their practices, and recognize the importance of physicians, dentists, and health care organization leaders in supporting and implementing goals that value the needs, concerns, and respect of patients. There are six aims for improving the patient experience. They are: Safety – striving to make patients and all health professionals safe from harm resulting from medical error. Effectiveness – matching care to science; eliminating overuse, underuse, and misuse in the delivery of health care. Patient-centeredness – honoring the individual and respecting choice. Timeliness – reducing unnecessary delays in the delivery of care. Efficiency – reducing waste and promoting the best quality care at a reasonable cost. Equity – closing racial, ethnic, regional and economic gaps in quality and accessibility of health care.

GOAL 2 Focus on Prevention and Care Management. To strengthen prevention and care management with a focus on altering our citizens’ health diminishing behaviors as the primary objectives of all aspects of health care in the Commonwealth.
GOAL 3 Focus on Health Care for All. To develop universal access to care for every resident of the Commonwealth for both physical and mental health needs and that a financing mechanism exists which is fair, and equitable to all stakeholders, so that optimum health is achieved for all citizens that is affordable and in a manner which is fiscally responsible. We especially need to provide for a system that eliminates racial, gender, and ethnic health disparities regardless of individual wealth.
GOAL 4 Focus on Strengthening the Public Health System. To strengthen the public health system in the Commonwealth and its communities to implement the objectives of Healthy Communities 2010 and to effectively respond to the threat of bio-terrorism or natural disasters through an “all hazards approach.”
GOAL 5 Focus on Preparedness for Health Emergencies. To strengthen the emergency medical system in the Commonwealth, and increase the ability of individuals and communities to respond to medical emergencies and mental health episodes.
GOAL 6 Focus on Resource Stability. To establish a funding mechanism to support the physical and mental health needs of the Commonwealth during cyclical economic downturns.
GOAL 7 Focus on Supporting Caregivers. To develop a system to ensure an adequate supply of highly competent, empathic and diverse health care professionals to meet the workforce needs of the Commonwealth supported by the latest, most effective medical technology and health management and information systems.
GOAL 8 Focus on the Vital Role of Health Care in the Massachusetts Economy. To encourage the economic success of the health care system in its role as a major component of the Commonwealth’s economic prosperity so that Massachusetts is a national leader in medical and bio-medical technology.
GOAL 9 Focus on Aging with Dignity. To develop a system to provide care with dignity in the least restrictive environment appropriate to the needs of each individual and their family so that every resident of the Commonwealth shall receive end of life care when needed.
GOAL 10 Focus on Compassionate End of Life. To achieve a system of compassionate end of life care for all Massachusetts residents whenever needed.

As we continue to refine the goals and objectives of “Caring Commonwealth,” and more importantly, as we work to implement them, the active involvement and support of all stakeholders are both needed and welcome. I look forward to working with my colleagues on the Health Care Committee and in the Legislature as a whole and with the experts who have joined us today to focus on various aspects of health policy, and any others who have constructive suggestions to offer as we collectively work to improve our health care system and its ability to serve all of our fellow citizens now, and in the future.