Massachusetts has achieved high quality healthcare but still has gaps, especially in preventable hospitalizations. The document analyzes 3 policy options - the state innovation plan, building on successful innovation grants, and expanding the medical home model. It recommends expanding medical homes to address gaps like asthma/diabetes hospitalizations and improve prevention recommendations, as medical homes have shown initial success in Massachusetts and are a cost-effective approach.

1. To: The Honorable Charlie Baker, Governor of Massachusetts
From: Priyanka Surio, Health Policy Advisor
Subject: Bringing Massachusetts into the 21st
Century: An Assessment of Healthcare Innovations
Date: June 5, 2015
EXECUTIVE SUMMARY
Problem Statement
While Massachusetts is a leader in healthcare coverage, access, and innovative solutions, there are still gaps in
the health delivery system that remain that prevent the state from becoming the healthiest state in the nation.
There are a number of innovations to consider to bring and keep Massachusetts in the 21st
century of healthcare
delivery.
Background
Currently, Massachusetts performs high on quality measures, achieving or outperforming 98 out of 207
measures. Massachusetts still performs weak on benchmark measures related to preventable hospitalizations,
specifically asthma, hypertension, diabetes, and COPD. Governor Patrick introduced “An Act improving the
quality of healthcare and reducing costs through increased transparency, efficiency and innovation” in 2011 and
the legislation was passed in 2012 in an effort to propose a comprehensive approach to reducing healthcare costs
while improving quality.
Policy Options
Three policy options that have recently occurred or are currently underway can be considered for the state of
Massachusetts. The Massachusetts Department of Health released their State Healthcare Innovation Plan which
outlines several programs, efforts, and collaborative partnerships to improve delivery of healthcare. As part of
the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services has also awarded the state of
Massachusetts and New England region with 11 healthcare innovation awards specifically for Medicare,
Medicaid, dual-eligible and CHIP populations. Finally, the medical home model, which is largely promoted in
the ACA, is a cost effective method to address some salient gaps in healthcare quality such as increasing
recommendations for prevention and wellness measures for all populations, improving access to care, and
reducing preventable hospitalizations.

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Recommendation
Of all three policy options, expanding on the medical home model is the most appropriate to address
Massachusetts gaps in care as they relate to preventable hospitalizations for asthma, hypertension, diabetes, and
COPD and to improve on physician-patient communication about prevention measures that are culturally
competent for a diverse audience.
PROBLEM STATEMENT
1. What are some of the biggest challenges that face the Massachusetts in light of its gains towards improving
quality of the health delivery system?
2. What healthcare innovation could have the biggest impact in improving the quality of Massachusetts’ health
delivery system?
Current Status of Healthcare Quality
Massachusetts has a strong rating for healthcare quality measures meaning that most of its metrics for
delivery of care are above the national average. Areas where Massachusetts is doing particularly well include
preventive care, safety and chronic care. Acute care measures perform at the upper echelon of average data
standards; and can be due to the number of hospitalizations for conditions that could have either been prevented
or better managed by the population. Regarding access to care, Massachusetts performs highly with patient
utilization of various resources and delivery systems. Massachusetts also performs well in structural access and
patient centered care. Care is performed best in an ambulatory setting and only average in a hospital setting.
When considering all quality measures compared to achievable benchmarks derived from top performing states,
Massachusetts performs pretty well. Benchmarks were available for 207 measures of which 32 were far from the
benchmark, 77 were close to it and 98 achieved the benchmark or better. The National Healthcare Quality
Report examines measures that were performed better including those achieved over the benchmark, such as
adolescent female immunization health, adolescent immunization against meningitis, hospital admission rates
for short term complications of diabetes, and computerized systems that allowed for easy clinical
documentation.
Gaps/Challenges to Healthcare Quality
While Massachusetts performs well in utilizing innovation, preventive care and one where access is

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highly available, there are still many gaps in the quality delivered at the hospital system of care. Quality of care
can vary greatly between different socioeconomic groups and ethnicities. Lower income populations receive
lower quality of healthcare delivery in addition to Hispanics and Asian Pacific Islander populations. When
considering various benchmarks, Hispanics and Black populations had more measures that were farther away
from their benchmark goal.
According to the 2014 National Healthcare Quality Report, many of the measures where Massachusetts
performed more than 100% from the benchmark include avoidable hospital admissions for COPD and asthma,
hospitalization for immunization preventable influenza, admissions for hypertension, hospitalization for
uncontrollable diabetes, hospitalization for asthma age 18-29 and even worse for ages 2-17, and new AIDS
cases. Measures where Massachusetts performed between 60-75% away from the benchmark include potentially
avoidable hospitalizations for acute and chronic conditions, the number of patients who visited a doctor or clinic
and were not able to fully understand what their provider explained to them, and the number of patients who did
not feel that their opinions and comments were regarded by the healthcare provider.
When considering different disease conditions, Massachusetts performs weak in cancer and average in
cardiovascular and respiratory diseases. Gaps in quality for respiratory diseases can be attributed to the fact that
there is a high prevalence of asthma hospitalizations. Asthma prevalence in Massachusetts is high with 10.4% of
adults reporting they have asthma compared with the 9% national average. Children have lifetime prevalence
rates that are higher than the national average by several percentage points. When looking at asthma
hospitalization rates, they are higher in Massachusetts with 155/100,000 compared with the US rate of
144/100,000.
BACKGROUND
MA as the 5th healthiest state has been able to achieve a lower prevalence of obesity and has a good
supply of primary care physicians. In addition, Massachusetts is considered a national leader in health coverage
and innovation where 98% of their residents and virtually all children have health insurance. Massachusetts’
next phase of health reform is ensuring that care is of the highest quality; therefore, in 2009 the Massachusetts
Health Care Quality and Cost Council (QCC) developed a Roadmap to Cost Containment to identify strategies
that would reduce healthcare costs and cost growth. In 2011, the Governor’s predecessor, Mr. Patrick,

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introduced legislation that proposed a balanced comprehensive approach to healthcare cost containment. The
legislation “An Act improving the quality of healthcare and reducing costs through increased transparency,
efficiency and innovation”, was passed in 2012 and included payment reform, health resource planning, set an
annual target for growth of health care spending, promoted integrated delivery systems, promoted wellness and
prevention, reformed malpractice policies, and supported health IT development. In Fall 2012, the
Massachusetts Department of Health released a state healthcare innovation plan that strategically planned next
steps for the implementation of the cost containment legislation and built on active stakeholder engagement and
partnership.
POLICY OPTIONS
1. Implementation of the Massachusetts State Healthcare Innovation Plan
Outlined in the State Healthcare Innovation Plan, Massachusetts has been working on various multi-payer
efforts to improve the quality of the healthcare delivery system. These include the Patient Centered Medical
Home Initiative, All Payer Claims Database, the state Health Information Exchange, the Statewide Quality
Advisory Committee, and involvement in alternative payment methodologies including ACO’s.
2. Build off Successful Innovations
Per Section 3201 of the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) developed
the Health Care Innovation Awards to award up to $1 billion in funding awards to organizations implementing
compelling new ideas to delivering improved quality care and lowering costs to Medicare, Medicaid and CHIP
populations, especially medically needy populations. CMS has already awarded several innovation grants that
address some of Massachusetts’ salient gaps including:
• Preventing avoidable re-hospitalizations: Post-Acute Care Transition Program (PACT) at Beth Israel
Deaconess Medical
• New England asthma innovations collaborative
• Transitions clinic network: linking high-risk Medicaid patients from prison to community primary care
• Care management of mental and physical co-morbidities: a Triple Aim bulls-eye
• Patient-centric electronic environment for improving acute care performance
• Community health workers and HCH: a partnership to promote primary care

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• Engaging patients through shared decision making: using patient & family activators to meet triple aims
• Community-based health homes for individuals with serious mental illness
3. Continue to Fortify the Medical Home Model
The Affordable Care Act has a number of provisions that not only increase health coverage, but also promote
medical homes. Berenson et al. with the Commonwealth Fund, defines the medical home as one that expands
access to and delivers high quality primary care. Medical homes:
• Provide patients with timely and enhanced access to care
• Partner with patients
• Manage existing health conditions
• Coordinate care across various providers (including hospitals, physician offices, long term care)
• Prioritize quality improvement
Patients who are linked to medical homes have better access to care, are more likely to receive recommendations
for prevention and wellness measures, and better manage their chronic conditions as compared to patients
without medical homes. Medical homes also contain costs through reducing preventable hospitalizations,
decreasing emergency department use and other acute care services.
RECOMMENDATION
In Summation, Massachusetts is the leader in healthcare innovation and health coverage, and the 5th
healthiest state in the nation. Nonetheless, gaps are still persistent that threaten Massachusetts’ ability to provide
quality care, especially to low income and minority populations. Gaps such as preventable hospitalizations and
recommendations from providers on prevention/wellness measures are costing the Massachusetts healthcare
system millions of dollars. The Medical Home Model is an effort currently underway that should continue to be
strengthened upon and invested in to keep the state as a leader in 21st
century healthcare innovations and bring it
up from 5th
healthiest to 1st
healthiest state. It is recommended that Governor Baker and his esteemed Cabinet
Secretary of Health, Mary Lou Studders consider expanding on the medical home model which has
demonstrated initial success in Massachusetts’ weak areas and is politically feasible given its cost savings in
reducing unnecessary emergency department and hospital utilization.

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REFERENCES
MassHealth. Copyright 2015 of the Commonwealth of Massachusetts. Retrieved May 2015 from
http://www.mass.gov/eohhs/gov/departments/masshealth/
Immigrants And Health Care: Sources Of Vulnerability. Kathryn Pitkin Derose, José J. Escarce and Nicole
Lurie. Health Affairs. September 2007 vol. 26 no. 5 1258-1268.
U.S. Census Bureau: State and County QuickFacts. Data derived from Population Estimates, American
Community Survey, Census of Population and Housing, State and County Housing Unit Estimates, County
Business Patterns, Nonemployer Statistics, Economic Census, Survey of Business Owners, Building Permits.
Retrieved May 2015: http://quickfacts.census.gov/qfd/index.html
Massachusetts Health Reform: A Five-year Progress Report. November 2011. Blue Cross Blue Shield
Foundation. http://bluecrossfoundation.org/healthreform/~/media/0ff9bf33e14e4e089335ad12e8deb77e.pdf.
State Snapshots. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved June
2015: http://www.ahrq.gov/research/data/state-snapshots/index.html.
Health Care Innovation Awards. 2012. Centers for Medicare and Medicaid Services. Baltimore, MD. Retrieved
May 2015: http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/Massachusetts.html.
U.S. Census Bureau. State & County Quick Facts: Massachusetts. Retrieved June 2015:
http://quickfacts.census.gov/qfd/states/25000.html.
U.S. Census Bureau. Projections of the Population, by Age and Sex, of States: 1995 to 2025. Retrieved June
2015: http://www.census.gov/population/projections/state/stpjage.txt.
Achieving Better Quality of Care for Low-Income Populations: The Roles of Health Insurance and the Medical
Home in Reducing Health Inequities. Julia Berenson, Michelle M. Doty, Melinda K. Abrams, andAnthony Shih.
The Commonwealth Fund. May 2012. Vol 11, Pub 1600.

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Appendix:
Source: State Snapshots. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/research/data/state-snapshots/index.html
Source: State Snapshots. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/research/data/state-snapshots/index.html

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Source: Health Care Innovation Awards. 2012. Centers for Medicare and Medicaid Services. Baltimore, MD.
Retrieved May 2015: http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/Massachusetts.html.