This article first appeared in the August/September 2008 issue of the newsletter "States in Action."

Realizing that coverage expansion, the focus of the state's 2006 health reform legislation, is not enough to improve overall health system performance, Massachusetts is undertaking what some policymakers are calling "Health Care Reform 2.0," with a focus on improving health care quality. Massachusetts aims to implement the chronic care model in medical homes statewide, with the help of the State Quality Improvement Institute.

The Massachusetts SQII team, led by JudyAnn Bigby, M.D., the state's Secretary of Health and Human Services, and including public and private health care leaders, plans to promote coordinated, integrated care using a team-based approach. Its action plan is guided by the following principles:[1]

• Pursue a multifaceted approach: Clinical (care of the individual); Public Health (care of populations/communities); and Health Policy (payment for, organization of, and delivery of services);
• Seek a critical mass. No single actor has enough dominance to change provider behavior. Public and private partnerships/collaboratives are necessary to effect change.
• There are multiple and complex determinants of health and health care. Non-traditional health actors (housing, parks, transportation, urban planning) should be included "at the table."
• Coverage is not enough. An accountable health care system should focus on the patient by optimizing services and payment to maximize health outcomes.
• Think broadly—act incrementally.
• Collaborative participation and shared commitment by non-SQII team members (e.g., Department of Public Health, Healthy Massachusetts Compact, Massachusetts Medical Society, and other external stakeholders) are essential in order to align priorities and actions.

One of the state's key strategies for achieving its goals is payment reform. "Aligning quality measurement across payers and reforming payments to primary care physicians are essential to redesigning medical practices and implementing the medical home model," says Bigby. For example, practitioners could receive additional care management payments over the typical service reimbursements. The team hopes that, by the spring of 2009, they will have a statewide, multi-payer coalition to sponsor and test this approach.

The team also plans to work with the state's Medicaid agency, the Group Insurance Commission (the state employee and retiree health plan), and the Connector (the state's health insurance exchange) to explore opportunities to promote self-management of chronic conditions.

Additional planned interventions include educating primary care providers about evidence-based diabetes care standards, creating a diabetes patient registry, and working with the Department of Health to launch a consumer education campaign.