Steve Walsh raises concerns about urgent care clinics

The president and CEO of the Massachusetts Health & Hospitals Association downplayed the recent outpatient expansion proposal of Partners HealthCare and said the real concern is the rapid growth of urgent care facilities across the state.

On a Health or Consequences episode of the CommonWealth Codcast, Steve Walsh said the Partners outpatient expansion will receive a rigorous regulatory review. But he said a bigger concern is the growth of unaffiliated urgent care providers like the CVS Minute Clinics.

“There has long been a question as to are the unaffiliated urgent care ambulatory surgery centers helping to fund CHIA, the Center for Health Information and Analysis; the Health Policy Commission; and community benefits? Do they accept Medicaid? Are they treating our poorest and most vulnerable residents? Are they doing the same kind of programs for the opioid epidemic as our traditional hospitals are? So the real problem isn’t necessarily the expansion by one member into other communities. It’s all of the other expansion that’s happened over the last decade and what that has done to not create a level playing field for our members and for the community residents they serve.”

Paul Hattis of Tufts University School of Medicine and John McDonough of the Harvard Chan School of Public Health peppered Walsh with questions about a series of current health policy issues. He said he tries to respond to issues based not on how they affect his association’s 70 member hospitals, but on how they affect the patients those institutions treat.

“The issues really apply to everyone, whether they’re large or small,” he said. “We don’t say, well, how big is this member so we’ll look at this issue differently. We look at the patient.”

On the proposed merger of Harvard Pilgrim Health Care and Tufts Health Plan, Walsh said he needed more data before reaching a conclusion. He took much the same approach on recent data from the Health Policy Commission suggesting that the shift to outpatient care doesn’t always save money because more and more patients are shifting to Partners outpatient facilities, which tend to charge more for outpatient surgeries than other hospitals bill for in-hospital procedures.

On the legislative front, the former state lawmaker backed efforts to create more transparency around pharmaceutical pricing and hailed Gov. Charlie Baker’s proposal to shift health care spending more in the direction of behavioral health and primary care as “an incredible move in the right direction.”

As the drafter of the law that created the Health Policy Commission, he said he wished he had put pharma under its purview (“at the time we weren’t sure we were able to”) and included provider and payer stakeholder voices on the commission.

He gave a measured response to the state’s push in to managed care — a shift from compensating health providers based on the services they supply to paying them based on the overall quality of care they provide to a patient.

“I for one am aspirational about this,” he said. “I believe that a move to value-based care is critically important. I believe treating the whole person and doing it in a different way is the future of health care. I don’t think there’s any other way we can go.”

But Walsh said the value-based compensation is still largely based on a fee-for-service system. “I share a frustration that 10 years on we’re not further along,” he said.

He also said the shift by MassHealth, the state’s Medicaid program, into value-based care with 17 accountable care organizations is moving in the right direction but he insisted it’s not a panacea. Health care remains very expensive, he said.

“It is still a little early to tell, but it’s clearly something everyone is committed to. The administration, [Health and Human Services] Secretary Marylou Sudders, Gov. Baker, [Assistant Secretary] Dan Tsai, are really doing an incredible job of trying to make it work because this is the future.”

He declined to give the effort a grade.  “We’re above average but there’s always room for improvement,” he said.


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