1. EU Connected Health Conference Keynote address
May 7, 2009 Noon
Belfast, Ireland
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Thank You. Good Afternoon.
It is a great opportunity to be here in Belfast and speak with you about how health care
technology and connected health are going to change the face of how people receive their
health care.
While comprehensive health care is the rule in Europe, it is the exception in the United
States.
Only my state of Massachusetts has comprehensive mandated health care coverage for
residents.
And, even though the United States as a whole is not quite there, Congress, lead by Senator
Ted Kennedy, is working on a plan -- and Massachusetts is the blueprint.
In 2006, Massachusetts embarked on bold enterprise of providing affordable access to
health insurance for all of our citizens.
While this may not seem very bold compared to many of the European health systems, for
the United States, this is a landmark effort for a state to undertake alone.
At that time, I was the Chair of the Senate Committee on Ways and Means, and was one of
the six negotiators that hammered out the legislation. It was not an easy task.
There were hurdles and pitfalls throughout the process – businesses concerned there would
be an impossible burden placed on them…
Individuals not convinced there would be affordable options…
Providers who were concerned about the cost of health care…
And, insurers who were reluctant to change the status quo.
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2. We brought them all to the table, and found a compromise where the burden of health care
was balanced on the shoulders of government, insurers, providers and individuals.
At the time we passed our health care reform law, the estimated number of uninsured in
Massachusetts ranged from 500,000 to 600,000 people.
The reform law, which provided government subsidized health insurance to certain low-
income populations-- among many other reforms-- was aimed at reducing that number,
over many years, to as close to zero as possible.
Three years have passed since this law was implemented, and the success of the reforms
has more than surpassed our expectations.
The number of people enrolled in private or subsidized health insurance plans has increased
by 439,000 in Massachusetts.
We now have the highest rate of insured of any state in the United States at 97.4 percent.
The uninsured rate was 2.6 percent or only 167,000 individuals statewide.
To give you some perspective, the nationwide average in the United States is 15 percent
uninsured.
We were the first state to attempt such a comprehensive reform, and no other state has
since.
In many respects, Massachusetts is an experiment for the rest of our nation.
So far, it has been an outstanding success in expanding access to affordable health care
insurance.
Successful reforms, however, also bring with them new challenges to face and solve. Our
Health Care Reform law was no exception.
One of the issues that I have focused on since becoming the President of the Massachusetts
Senate is reducing the cost of health care while, at the same time, improving health care
quality.
I view progress on this issue as not only critical to our state’s success in providing health
care to all of our citizens, but also to Massachusetts’ economic future as an international
leader in health care technology and innovation.
Cost is an obstacle we continue to struggle with, especially in a time of even more limited
resources.
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3. Even before the current fiscal crisis, leaders in Massachusetts recognized that reigning in the
growth in health care costs would be essential to creating a sustainable path for access
reform, as well as for cities and towns, businesses, and families for their own health care
costs.
Without progress in controlling the ever rising cost of health care, the weight of our
successes could sink the whole effort.
While I would argue that we have the best health care network in the United States,
Massachusetts also has the highest per capita health care costs of any state in our nation.
And the United States has the highest per capita health care costs of any industrialized
nation in the world.
This is serious challenge for Massachusetts.
Addressing the growth in health care costs is in many ways even more difficult than
addressing the access problem.
Whereas our original effort was aimed at expanding access to affordable health insurance
for approximately 550,000 uninsured residents in Massachusetts, addressing health care
costs involves reforming health care delivery for over 6 million residents.
As you all know, rising health care costs are an international problem. The ability of one
state to buck these trends is debatable, but we knew we needed to act.
Last year I, along with my colleagues in the Massachusetts Senate, promoted a second
phase of Health Care Reform aimed at reducing the skyrocketing costs.
We identified 4 main principles to achieve this goal:
Improve access to primary care services;
Enhance transparency of health care costs and quality;
Promote payment reform and efficiency in the health care system;
Encourage adoption of interconnected health information technology.
This last principle, the adoption of interconnected health information technology and role of
modern systems to transform health care delivery, is integral to the other three.
When you look at improved access to primary care, these connected health systems can
allow for immediate and improved access to basic primary care services, including the
management of chronic illness.
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4. The remote monitoring of high cost diseases and consumer engagement by general
practitioners can be greatly expanded through the use of connected health technologies.
I know that remote monitoring has been very successful here, and I hope further encourage
that practice in Massachusetts as well.
Technology also allows enhanced transparency.
With electronic medical records, connected through interoperable exchanges, we will allow
for new insights and transparency into health care costs trends.
They also have the ability to track, in ways not currently possible, quality outcomes in order
to encourage and incentivize best medical practices.
An interconnected health system also improves patient care and efficiency by reducing
unnecessary duplication of services and medical errors.
It also has the potential to streamline administrative functions, including billing and coding.
The central role of health information technology in all of these cost and quality principles is
not a new idea.
Yet, in the United States, the adoption of basic technologies, like electronic medical records,
has been slow and fragmented.
Massachusetts is poised to lead our nation on this issue.
The legislation we passed last year established the goal of state-wide implementation of
electronic health records as part of an interoperable health information exchange by the end
of 2014.
The state provided $15 million in initial funding and established a quasi-independent
organization, the eHealth Institute to oversee the implementation of this program.
Our efforts will allow us to tap into federal funding since the United State’s domestic
stimulus package has significant provisions pertaining to health information technology.
The bill establishes as a goal the use of certified electronic health records (EHRs) for every
person in the United States by 2014 and creates reimbursement incentives through
Medicare and Medicaid for providers to adopt this technology.
The stimulus provides for $2 billion (US) in funding for implementation support for grants
and loans for health information technology purposes, as well as funding for academic
medical centers, interoperability testing, demonstration projects and further research and
analysis.
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5. It also provides an estimated $17 billion for Medicaid and Medicare incentive
reimbursements staring in 2011 for providers and hospitals use EHRs.
This translates into potentially over $500 million for our Massachusetts health care
providers.
A 5 to 1 federal match on state spending contained in the stimulus will turn our $15 million
state investment into $90 million for the e-Health Institute.
Other states, in the midst of their own budget shortfalls, will be hard-pressed to make any
state investment that will be eligible for this match.
Massachusetts already set aside these funds and will now reap benefits from our foresight.
Nationwide in the United States, only 17 percent of doctors have even basic electronic
health records.
The work we do now on this effort will dramatically transform our health care system into
one that reduces duplication, provides higher quality care, and empowers physicians and
consumers with more accessible health information.
But it also comes with its share of dangers.
We must move quickly and thoughtfully to maximize the potential benefits.
With most of the funds flowing directly to physicians and hospitals to reimburse them for
the costs of these systems, our government needs be proactive in ensuring that providers
are making informed purchasing decisions.
Already, vendors and salesmen are aggressively reaching out to doctors about purchasing
particular software systems.
We know that some of these products do not deliver on all of their promises, and in the
absence of impartial assistance and guidance from the state, doctors may act alone and be
persuaded to purchase systems that will not meet future standards.
Government needs to be equally aggressive in pushing high-quality systems that can be
linked together in true health information exchanges.
Electronic records alone do not provide the system-wide savings and quality improvements
that are possible – the records must all be of a high standard, with strong privacy
protections, and be able to exchange information in real time between the practitioner’s
office, the community site, and the hospital setting.
Government must also provide implementation assistance and training. Having electronic
medical records is not enough – care processes must also transform to take advantage of
these systems.
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6. Transitioning to a paper-less doctor’s office is a multi-year effort for any practice that
requires dramatic redesigns of the way care is delivered.
In order to reap all of the benefits of these systems, the electronic medical record must
work with and support the physician and staff.
If physicians feel that the systems are working against them and hindering care, then it will
be a waste of money.
At the same time that we are moving forward with developing interoperable health records
systems in the United States, we must not neglect the potential of other connected health
technologies.
Connected health systems have the ability to greatly expand the reach, the efficiency, and
the quality of health care delivery and health maintenance.
In the United States, 32 percent of large home health agencies are already using remote
monitoring.
This is great, but we need to better.
Evidence is being compiled that shows the ability of targeted systems to produce real
savings by reducing hospital admission rates.
Of those home health care agencies that are already using telehealth, 76 percent report a
reduction in unplanned hospital admissions, and 77 percent report a reduction in emergency
room visits.
Hospitalizations represent a $3.5 billion annual expense in Massachusetts, and we estimate
that up to 15 percent of all hospitalizations are for conditions that could be prevented.
Furthermore, preventing readmission rates, up to which 75 percent could be prevented,
represents significant potential for savings.
Companies in Massachusetts are on the forefront of developing connected health
technologies and implementing the care programs necessary to maximize their benefit.
Partners Healthcare, based in Massachusetts, is an international leader in Connected Health,
and is currently collaborating with Northern Ireland and the European Centre for Connected
Health.
Partners established in 1995 a Center for Connected Health aimed at creating effective, new
solutions to deliver quality patient care outside of the traditional medical setting.
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7. One example of this is the Connected Cardiac Care program at Massachusetts General
Hospital.
This program aims to avoid unnecessary costs by improving patients understanding of their
condition, and provide on-going nursing support and review of key health measures while
the patient is at home.
Data from this pilot suggests that telemonitored patients have a lower re-hospitalization
rate than those who do not.
Another Massachusetts company, Dovetail Health based out of Needham, MA, has created
an enhanced connected health model that identifies the 10 percent of the patients at the
greatest risk of readmission and provides transition support for 30 days.
By supporting the highest risk patients, every $1 million invested Dovetail claims they can
deliver a savings of $5 million through reduced readmissions and admission.
The benefit can also be seen as we work to implement connected health technologies in
rural areas.
As you are aware, more often, rural residents have less access to quality health care.
According to the United States Agency for Healthcare Research and Quality, while 20
percent of American’s live in rural areas, only 9 percent of our physicians practice there.
That means that rural residents are much less likely to have regular medical appointments
or keep up on chronic conditions.
This lack of access drives up the cost of service, and leads to later diagnosis. It is these
residents who will benefit the most from this technology, because if we are able to give the
tools to rural residents to help manage chronic conditions, we will see a decrease in cost of
services in those areas and an increase in overall health.
In addition to the health benefits that will clearly be gained by an increase in health care
technology, there is an economic development opportunity for new industries to thrive in
Massachusetts.
My state is an internationally renowned center of health care research and treatment, and
the health care industry is a crucial driver of the state’s knowledge-based economy,
employing approximately 400,000 people, or more than 13 percent of the state’s workforce.
As a knowledge-based economy in Massachusetts, our strengths: health care, academia, IT,
and life sciences- could be leveraged to support a new health information technology
industry.
This industry has the potential not only to grow in Massachusetts, but to produce the tools,
products and services both nationally and internationally.
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8. At an intersection between our health care policy goals and our economic development
goals, this industry could produce compounded benefits to Massachusetts and our trade
partners.
With due respect to our fellow states, Massachusetts is where the new generation of health
care is emerging, and we are ready and willing to partner with European companies to move
this important agenda forward.
Already we can see the potential for a shared economic future with the work that Partners
Healthcare has done here in Northern Ireland with connected health. If we are all
committed to the development of this technology, we must be willing to work together, to
build off of each other’s advancements, and to invest in an exchange of ideas.
Massachusetts, along with the rest of the world, is facing significant budgetary and
economic crises.
These shortfalls will result in painful cuts, loss of jobs and services to many of our citizens.
As we grapple with the daunting and immediate recession, it is important to always keep an
eye on the long-term.
We will recover from the global economic recession and some of the decisions we make now
will set the foundation for our future recovery.
I think this economic emergency has the potential to bring us closer together, to allow
economic growth across borders based on the shared values and goals of innovation and
technological advances.
Talk, however, must be followed by action, and the “connection” of people, in forums such
as this, to share lessons and establish relationships are essential for future successes.
It is the work that we do together that will have a global effect on health care.
Thank you.
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