The Massachusetts Well being Coverage Fee on Tuesday unanimously permitted Mass Normal Brigham’s 18-month plan to curb extreme spending.
In January, the fee ordered Mass Normal to give you a efficiency enchancment plan after it exceeded the fee’s spending progress benchmark by $293 million from 2014 to 2019. The fee mentioned Mass Normal’s actions may jeopardize the state and its care supply system.
That is the primary time the fee went via the approval course of for a efficiency enchancment plan.
Boston-based Mass Normal revised its annual financial savings goal to $127.8 million, a rise from the $70 million it proposed in Might.
The plan will probably be carried out from Oct. 1 to March 31, 2024.
The biggest portion of financial savings, $90 million a 12 months, would come from modifications in industrial pricing methods, akin to shifting pricing at outpatient facility MG West to a neighborhood hospital fee schedule. Mass Normal has diminished charges charged to the Mass Normal Brigham Well being Plan for ConnectorCare members.
“I do know there’s been a number of forwards and backwards between the events,” Fee Vice Chair Martin Cohen mentioned at Tuesday’s assembly. “This PIP received’t change the worth disparities that exist in our state, but it surely does acknowledge that worth issues to making sure that healthcare is accessible and reasonably priced for residents of the Commonwealth.”
Mass Normal plans to avoid wasting one other $32.4 million a 12 months by decreasing pointless hospitalizations, emergency division visits and different bills. To do this, the well being system will broaden its built-in care administration program, a high-risk care program, by greater than 4,000 sufferers, primarily these lined by industrial payers and Medicaid. There are roughly 15,000 sufferers in this system.
Mass Normal may also work to scale back post-acute admissions and pointless outpatient imaging.
The well being system will proceed to put money into its at-home hospital mannequin, for which it has negotiated industrial payer charges lower than these for in-hospital companies. It additionally plans to proceed digital care, akin to telehealth, and to shift care to neighborhood hospitals and ambulatory facilities.
One other key a part of the revised plan was guaranteeing Mass Normal will make the plan sustainable and proceed the cost-cutting methods after the implementation interval. Fee members acknowledged the well being system’s efforts to implement the modifications amid a financially difficult interval for the business.
Mass Normal will report any progress to its personal management every quarter and to the fee at the very least each six months beginning in April.