Addressing health care at Jewish Family & Children's Service

Charlie Baker and I shared a podium today at the annual meeting of the Board of Advocates of the Jewish Family & Children's Service.  JFCS provides a multitude of services to the community, and does so very well, and we both felt honored to be invited.  We were led in a panel discussion by Sy Friedland, former CEO of JFCS, on the topic of "What's going to happen in health care, no matter what happens in Washington?"  (You see Sy and Charlie in this photo.)

Before attempting a run for Governor in 2010, Charlie was CEO of Harvard Pilgrim Health Care, a highly respected health insurance company in the state.  In previous lives, he served both as Secretary for Administration and Finance and as Secretary of Health and Human Service for the Commonwealth.  As you might expect, he has lots of thoughtful things to say about the health care system.

I remember, during the campaign, that Charlie explained the major items of his health care platform to be increasing payments to primary care doctors and other cognitive specialists, with the purpose of giving them the chance to spend more time with patients and thereby avoiding as many referrals to higher paid specialists; pursuing broad-based transparency of cost and quality to offset unsupported reputations of certain hospital and physician groups that were thereby able to exercise undue market power; and to create coordinated medical management programs for the 120,000 dual eligible people in the state.  These are folks who are "old enough for Medicare, but sick and poor enough for Medicaid."

As Charlie noted today, dual eligible people constitute 20% of Medicare subscribers, but account for 40% of Medicare spending.  Likewise, they account for 15% of Medicaid enrollees, by 30% of Medicaid costs.  Based on relatively small pilot programs in the state, covering about 15,000 to 20,000 people, coordinated management of these patients results in service delivery at 30% lower cost than the two uncoordinated programs.  (My keen readers will quickly note that these contracts are annual fixed fee payments based on patient risk characteristics -- the one clear example that capitation can work in selected environments.)

Charlie's remarks were timely during the gubernatorial campaign, and they were more so today, in the Governor Deval Patrick has announced that he wants to create just such a program.  Charlie graciously complimented the Governor on his intentions in this regard.

That still leaves his other two items to be implemented.  Both remain excellent ideas.