The estimates vary, but most studies put the cost of administrative complexities in the national healthcare system at between $10 billion and $20 billion annually. The thinking goes that if you can cut down on duplicative forms, streamline the claims process, and erase the small, unnecessary roadblocks that delay and complicate care and the payment for care, you can reduce overall costs by dramatic amounts.

Now the Mass Collaborative – a group of 35 payers, providers, and trade associations dedicated to reducing complex and cumbersome healthcare administrative processes in Massachusetts – has created a website (www.masscollaborative.org) to publicize its administrative simplification work.

“By voluntarily coming together to find innovative ways to reduce and simplify the administrative burden that’s inherent in healthcare, the Collaborative has begun to take both cost and complexity out of the system and improve the overall end-to-end experience for healthcare providers, payers and patients,” said MHA President & CEO Lynn Nicholas, FACHE.

“The Mass Collaborative is leading the charge to bring about greater administrative standardization and simplification to increase efficiency and enable physicians to dedicate more time to caring for our members,” said Deborah Devaux, Senior V.P. of Blue Cross Blue Shield of Massachusetts.

Among its initiatives to date, the Mass Collaborative has:

• Created a universal “Provider Request for Claim Review Form,” which is used to submit a claim to a health plan or MassHealth for additional review. Previously, numerous forms from individual health plans added complexity to the system.
• Development of a streamlined process for health plan credentialing (www.hcasma.org).
• Created an e-mail distribution list to improve how health plans communicate with credentialed providers.

In the future, the Collaborative hopes to, among other items:

• Standardize prior authorization forms for medical, lab and prescription services.
• Address a new Massachusetts law (Chapter 111 Section 228) requiring physicians and hospitals to provide cost information for procedures and services to patients.
• Create a standardized patient information form that health plans and physician practices can use to determine cost estimates for patients.

The Mass Collaborative was developed by MHA, Blue Cross Blue Shield of Massachusetts, Massachusetts Association of Health Plans, MassHealth, Massachusetts Health Data Consortium, and the Massachusetts Medical Society. 

Massachusetts has a comparably better record in dealing with Veterans’ healthcare than many other states, including having veterans’ coordinators in many towns and cities to help vets navigate through the system. And the three hospitals in the VA Boston Healthcare System have been rated among the country’s best in terms of quality ratings and patient satisfaction scores.

Last Wednesday, the leaders of the Veterans Administration facilities in Massachusetts – the VA Boston Healthcare System, the Edith Nourse Rogers Memorial Veterans Hospital, and VA Central Western Massachusetts Healthcare System – met with the MHA Board of Trustees to discuss how Massachusetts hospitals and their federal counterparts can collaborate more closely to care for veterans.  All VA hospitals are MHA members.

The hospitals, their clinics and outpatient facilities, are situated so that a Massachusetts Veteran is never more than 30 miles or 30 minutes from one, Vincent W. Ng, the Director of the VA Boston Healthcare System, said last Wednesday. Ng was joined by his colleagues, Christine Croteau from Edith Nourse and John Collins, FACHE, from VA Central Western Mass.

While the state has its innovative Massachusetts Health Information Highway (The HIway) up and running to share medical records across the commonwealth, the VA has its own very advanced system, allowing a Veteran to have his or her records transmitted to any other VA facility throughout the entire nation. The MHA board discussed what steps need to be taken to better share records between the two parties.

The VA also has a tremendous database on the patients it serves, on veterans’ behavioral health issues, on their special needs, and best practices for treatment. Croteau told the board that her wish is that every patient entering a hospital ED be asked the simple question – “Are you a veteran?” – so that care for this special population could be coordinated better among all providers based on the information that the VA system has to share.

On January 1, CMS began paying primary care physicians a monthly fee to coordinate care for Medicare beneficiaries with multiple chronic conditions, even if there is no face-to-face exam. The policy was finalized in the CY 2014 Medicare Physician Fee Schedule Final Rule, to take effect in 2015.  This is a significant policy shift from Medicare’s historical position, which is that it pays a fee for services provided to a beneficiary in a doctor’s office or hospital.  Currently, about two-thirds of Medicare beneficiaries have multiple chronic conditions, such as diabetes and high cholesterol, but their care oftentimes is fragmented, and they end up seeing a different specialist for each condition.  To earn the monthly fee, which is about $40 per patient, a physician must develop a plan of care for a qualified patient and spend time each month on activities such as coordinating care with the beneficiary’s other healthcare providers, monitoring medicines, and taking after-hour calls.  A patient must agree to care coordination, because the fee is subject to Medicare’s standard deductible and co-insurance.  The care coordination fee is one of CMS’s efforts to help practitioners better manage their patient’s conditions, and the agency is considering expanding the program so that it is available to all Medicare beneficiaries, not just those who already have multiple chronic conditions. 

MHA President & CEO Lynn Nicholas, FACHE, was in D.C. on Thursday speaking before the AHA’s State Issues Forum that was focusing on “Provider Opportunities and Challenges on the Way to Healthcare Transformation.” She was part of a panel that looked at what’s working, and what isn’t, in states’ health reform landscapes. Nicholas has spoken around the U.S. in recent years about the Massachusetts experience and especially how the healthcare system here – providers, insurers, employers, and government – is moving as quickly as possible away from fee-for-service payments.  “Reform that leads to care delivery redesign is in the patient’s best interest,” Nicholas has said of the various alternative payment systems underway in the Bay State.

The PatientCareLink website has publicly posted the latest available nursing-sensitive care measures endorsed by the National Quality Forum (NQF) for 78 Bay State hospitals. Reported measures include pressure ulcer prevalence, patient falls, and patient falls with injury. To view the updated reports, visit www.patientcarelink.org and click on “Hospital Data” and then “Individual Hospital Performance Measures.”  The reports now incorporate the nursing-sensitive measure data reported for the period October 2013 – September 2014. In addition to individual hospitals’ results, PatientCareLink also includes statistical appendices, narrative comments if any were provided, and peer group comparison rates based on hospital size. PatientCareLink is the timely, transparent website maintained by MHA, the Organization of Nurse Leaders, MA-RI, and the Home Care Alliance of Massachusetts.  

MHA and Geneia on Wednesday announced a multi-year partnership to assist Massachusetts hospitals achieve the Triple Aim of improving the quality of care, increasing patient satisfaction, and reducing overall healthcare cost.  The Geneia Institute will deliver hands-on motivational interviewing courses for patient care teams, which will give team members needed skills and extensive run-through drills to affect behavior change in populations.

Motivational interviewing is a goal-oriented, patient-centered counseling style to elicit behavior change in patients. The technique was initially used to encourage patients to modify abusive drinking behaviors but has also been used successfully to help patients change a range of behaviors that put their health at risk or exacerbate a chronic condition.

MHA was awarded a Health Care Workforce Transformation Fund by the Commonwealth Corporation that will support the delivery of five motivational interviewing courses at Massachusetts hospitals in 2015 and 2016.  MHA members are invited to apply to hold one of the courses for their employees.  The first course will begin in April 2015.

MHA President & CEO Lynn Nicholas, FACHE, was in D.C. on Thursday speaking before the AHA’s State Issues Forum that was focusing on “Provider Opportunities and Challenges on the Way to Healthcare Transformation.” She was part of a panel that looked at what’s working, and what isn’t, in states’ health reform landscapes. Nicholas has spoken around the U.S. in recent years about the Massachusetts experience and especially how the healthcare system here – providers, insurers, employers, and government – is moving as quickly as possible away from fee-for-service payments.  “Reform that leads to care delivery redesign is in the patient’s best interest,” Nicholas has said of the various alternative payment systems underway in the Bay State.

Ten years ago, oncologists didn’t realize they were going to become genomics counselors. Five years ago, nurse practitioners didn’t realize they would be using artificial intelligence tools to help patients. One year ago, few realized the effect that wearables will have on the well-being of the elderly, and on healthcare at large. Healthcare is going through a “black swan”* period of change, when innovation and technology are transforming the roles of healthcare providers so quickly it’s hard to keep up.

The purpose of this program is to inform and ground participants regarding seven disruptive technologies that will transform healthcare delivery and distribution over the next 10 years. Learn more and register by visiting here.

*A “black swan” event is one that appears out of nowhere and changes everything, such as the invention of transistors or the Internet. The purpose of this program is to make sure that upcoming healthcare technologies are not a black swan event to you.