Could Mass. health trust have national impact?

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December 19, 2013

The 2006 Mass­a­chu­setts health­care reform law requiring res­i­dents to have health insur­ance is widely rec­og­nized for laying the ground­work for Pres­i­dent Obama’s Afford­able Care Act. Now, a North­eastern Uni­ver­sity report offers a com­pre­hen­sive exam­i­na­tion of another state health ini­tia­tive focused on cost pre­ven­tion that could again become a model repli­cated across the U.S.

The white paper, pre­pared by Northeastern’s Insti­tute on Urban Health Research and Prac­tice, exam­ines a Mass­a­chu­setts ini­tia­tive that takes an alter­na­tive approach to sup­porting public health pro­grams: the Mass­a­chu­setts Pre­ven­tion and Well­ness Trust, a four-​​year, $60 mil­lion project designed to sup­port pre­ven­tion and health pro­mo­tion activ­i­ties and gather evi­dence on the cost sav­ings achieved by these activities.

The report’s pri­mary author is John Auer­bach, the institute’s director and a Dis­tin­guished Pro­fessor of the Prac­tice in Northeastern’s Bouvé Col­lege of Health Sci­ences. The paper was funded and released by the Robert Wood Johnson Foun­da­tion, a phil­an­thropic orga­ni­za­tion focusing on issues crit­ical to health and health­care in the United States.

John Auer­bach, director of the Insti­tute on Urban Health Research and Prac­tice and Dis­tin­guished Pro­fessor of the Prac­tice in the Bouvé Col­lege of Health Sci­ences, is the report pri­mary author. Photo by Brooks Canaday.

Estab­lished in July 2012 by the state leg­is­la­ture, the Mass­a­chu­setts Pre­ven­tion and Well­ness Trust stems from a cost con­tain­ment bill that fol­lowed the commonwealth’s land­mark 2006 leg­is­la­tion. The trust will fund between six and 12 community-​​based part­ner­ships that pro­vide research-​​based inter­ven­tions that can reduce rates of the most preva­lent and pre­ventable health con­di­tions; increase healthy behav­iors; address health dis­par­i­ties; and increase the adop­tion of workplace-​​based well­ness or health man­age­ment programs.

The white paper notes that tra­di­tional approaches to sup­porting public health activities—namely with gov­ern­ment funds for disease-​​specific programs—are strug­gling because of funding cuts and are unlikely to improve in the near future. It cites the trust as one of sev­eral novel exper­i­ments underway across the country seeking to iden­tify inno­v­a­tive methods that sup­port public health activities.

“People in Wash­ington are now looking to whether this latest Mass­a­chu­setts ini­tia­tive is some­thing that can be repli­cated nation­ally or in other states,” said Auer­bach, who is the Mass­a­chu­setts’ former health commissioner.

The trust was funded through a one-​​time assess­ment on Mass­a­chu­setts’ largest insurers and hos­pi­tals, and, according to the report, the money will be “dis­trib­uted to inno­v­a­tive col­lab­o­ra­tive teams who want to improve health out­comes through com­mu­nity change and linking clin­ical providers with com­mu­nity partners.”

The exten­sive report com­prises a review of six years worth of health­care and pay­ment reform leg­is­la­tion. It includes an overview of the trust; the ground­work laid for its pas­sage and the issues raised by the leg­is­la­tion during that time; feed­back from the key indi­vid­uals and groups who secured its pas­sage; pre­lim­i­nary lessons other states can learn from Mass­a­chu­setts’ approach; and sev­eral case studies.

The authors noted that by under­standing the funding, struc­ture, and pri­or­i­ties of the trust, other states could iden­tify places in their own bud­gets and health­care infra­struc­ture that will allow them to form sim­ilar ini­tia­tives. The impli­ca­tions of these find­ings, they wrote, go far beyond reduced health­care costs; they could also pro­vide a frame­work for mar­shaling a state’s mul­ti­tude of resources—including hos­pi­tals, health prac­ti­tioners, com­mu­nity health cen­ters, uni­ver­si­ties, and food assis­tance organizations—to improve the long-​​term health of the entire population.

The report, as Auer­bach put it, ana­lyzed the trust’s poten­tial value to achieve the “triple aim of better health out­comes, better quality of care, and lower costs.”