Health or Consequences

[Originally published Dec 5, 2020]

Jim Hunt, who is preparing to stop down as president and CEO of the Massachusetts League of Community Health Centers, talks with Paul Hattis and John McDonough about the origins of the community health center movement and the current challenges.

[Originally published Oct 11, 2020]

We talk to David Seltz, the executive director of the state’s Health Policy Commission, about how the coronavirus is changing health care.

[Originally published Aug 28, 2020]

The federal government allows states to recoup Medicaid costs after the deaths of patients who use the program. Estate recovery allows homes to be seized and sold to pay off expended Medicaid dollars, a move advocates decry as penalizing low-income families, and making Medicaid into a loan program.

Some states take the federal rules a step further. “MassHealth has some of the strongest and most draconian state recovery rules in the country,” Somerville Rep. Christine Barber said on a new “Health or Consequences” episode of The Codcast with John McDonough of the Harvard Chan School of Public Health and Dr. Paul Hattis, who recently retired from Tufts University School of Medicine.

[Originally published Jul 2, 2020]

[Originally published May 15, 2020]

[Originally published Mar 14, 2020]

[Originally published Feb 7, 2020]

[Originally published Dec 27, 2019]

[Originally published Dec 6, 2019]

There’s a back to the future feel to some of the changes taking place in US health care, and Atrius Health, which provides care to some 740,000 patients, is a leading player in that effort in Massachusetts.

After years of soaring health care costs, there is growing interest in moving away from the fee-for-service model that has long dominated care, where providers are paid for each patient interaction or procedure. The trend now is toward giving health providers a set budget to care for patients over the course of a year. The idea is that it creates an incentive for providers to do all they can to maintain patient health, even if it means more spending on preventive services to prevent costlier outcomes down the road.

It harkens to the early days of managed care, when such a system was touted as a way to achieve the double-win of better health outcomes at lower cost. By the 1990s, however, HMOs were in retreat, faced with a public pounding as many big for-profit companies seemed more interested in managing costs by denying various services than promoting good health outcomes. The idea behind managed care, however, is enjoying a revival as the US health care system struggles to find ways to better coordinate care and control cost growth.

At Atrius, one of the state’s largest health networks, with more than 700 physicians and 400 non-physician providers, more than 80 percent of all revenue now comes from some sort of global payment structure that moves away from the traditional fee-for-service model.

“Which means we are directly aligned with our patients’ interests,” said Dr. Steven Strongwater, the CEO of Atrius, on this week’s episode of The Codcast. “We want to keep patients healthy and well and out of ERs and hospitals to lower their out-of-pocket costs, and to improve their outcomes, their patient experience, and safety.”

[Originally published Nov 1, 2019]

Monica Bharel, the state’s public health commissioner, is definitely a glass-half-full type of person.

On the Health or Consequences edition of the Codcast with Paul Hattis of Tufts University Medical School and John McDonough of Harvard’s T.H. Chan School of Public Health, Bharel went through a series of major challenges facing her agency and in each instance ended her discussion on an optimistic note.