Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Massachusetts: Connecting Health Coverage to Public Health

With its 2006 landmark health reform resulting in more than 400,000 newly insured residents, Massachusetts is building public health into numerous efforts to contain costs and improve quality in the health care system. These efforts include multi-agency collaborations, public reporting, "core" public health activities, and the promotion of patient-centered medical homes.

"During early discussions about health care reform, there was interest by some legislators and activists to ensure a strong connection between health insurance and public health," said John Auerbach, the state's commissioner of public health. "As coverage expansion was implemented, the focus on cost and quality intensified, and their link to prevention and wellness was clear. A new governor demonstrated his commitment by appointing a Secretary of Health and Human Services with significant public health expertise."

HealthyMass Initiative
Through a "HealthyMass" compact launched in December 2007, nine state agencies committed to collaborating with each other and other stakeholders to make the state a healthier place to live and work. The agencies agreed to align policies and practices to: ensure access to care, advance health care quality, contain health care costs, promote individual wellness, and promote healthy communities. Massachusetts Secretary of Health and Human Services JudyAnn Bigby described this initiative as working "toward a more comprehensive approach to health that recognizes the inextricable links between cost, quality, access, and prevention and wellness."1

HealthyMass activities related to public health include:

  • a Chronic Disease Management and Wellness Task Force that designed a statewide action plan for preventing and managing diabetes; and
  • a blueprint for a statewide system of care to prevent and control chronic disease, including early diagnosis, ensuring effective treatment, and considering non-clinical issues. A draft is expected to be released later this summer.

Quality and Cost Council
A Quality and Cost Council, created by the 2006 reform bill and including governmental and private sector representatives, is developing public reporting initiatives to reach goals set by Secretary Bigby. One achievement is the launch of a Web site with information on the costs and quality of care provided at state hospitals. Most of the current indicators are related to costs, but the Department of Public Health (DPH) is helping to develop additional quality measures.

The Council also established a requirement that hospitals report to DPH hospital-acquired infections and medical errors, information that it plans to make available to the public on its Web site. DPH is working with hospitals to develop effective approaches to prevent medical errors, providing tool kits and technical assistance, and facilitating communication among hospitals about successful strategies. Under a new law that prohibits hospitals from billing for reportable events (serious and largely preventable conditions), the legislature directed DPH, as a neutral organization, to craft regulations and guidelines on how to determine whether an event was preventable.

"We expect that public reporting and non-payment for preventable events will result in significant savings as well as improvement in quality of care," said Auerbach. "The hope is that when providers are not paid for medical errors, they will find ways to prevent them."

Core Public Health Activities: Reducing Smoking and Obesity
Numerous core public health activities are directly related to the health care reform initiative's emphasis on prevention and wellness. Anti-smoking initiatives include a statewide smoking cessation hotline. Also, DPH offered veterans and their families—a population with high smoking rates—one free month of nicotine replacement therapy (NRT) and special counseling. About 3,800 people—more than twice the number expected—enrolled. After the state raised taxes on tobacco products by one dollar, a similar program was offered to the general population. About 9,500 people received two weeks' supply of free NRT and phone counseling. Follow-up calls after seven months indicated that approximately 20 percent of them had quit smoking.

Another set of initiatives promotes diet and exercise. The state partnered with television and radio stations to implement a high-profile public information campaign on healthy eating, and to promote "Mass in Motion," a Web site offering tool kits, information, and an interactive blog. Further, state regulations were adopted in the past six months requiring fast food restaurants to post calories on menus and mandating all public schools to calculate students' body mass index and relate the information along with explanatory materials to their parents.

The state joined five foundations to fund grants totaling $1.5 million over two years to mayors to develop wellness programs that may include such changes as zoning to expand farmers' markets that offer fresh, healthy foods. "The goal is to make healthy behavior the easiest behavior, so it doesn't require extraordinary effort," said Auerbach.

Patient-Centered Medical Homes
Last summer, the Massachusetts legislature appropriated $5 million for a medical home demonstration, with a goal to transform all primary care practices to patient-centered medical homes (PCMHs) by 2015. A PCMH coordinating council invited payers, medical societies, and other stakeholders to come together to help design the initiative—by setting priorities, developing and recognizing standards for a medical home, and creating a payment mechanism—and to encourage participation.

These efforts will be jump-started by a $500,000 grant from The Commonwealth Fund and four local foundations to the state to participate in the Safety Net Medical Home Initiative, with technical support from Qualis Health and the MacColl Institute for Healthcare Innovation.2 This fall, 14 community health centers across Massachusetts will be selected to participate in efforts to become patient-centered medical homes. The four-year grant will support a practice coach for the health centers, technical assistance by Qualis Health, and an evaluation.3

Under the PCMH model, teams of primary care providers coordinate patients' health care needs, including managing chronic conditions, coordinating specialist appointments and hospital admissions, engaging patients in their care, and reminding patients about tests and routine check-ups. Clinical decision support tools assist the practices. Accompanying payment reforms—not yet developed—will reimburse the practices for the extra services provided.

The goal is to begin PCMH payment reform for Medicaid reimbursement at 50 to 100 high-volume Medicaid practices by early 2010, according to Joel Weissman, Ph.D., senior health policy advisor to the secretary, Executive Office of Health and Human Services.

For more information

Contact: Kristin Golden, Director, Policy and Planning, MA Department of Public Health, [email protected]
About HealthyMass Initiative, see: Office of Health and Human Services Web site
About Mass in Motion, see: Office of Health and Human Services Web site
About Safety Net Medical Home Initiative, see: Qualis Health Web site

2. Massachusetts was one of five states selected through a competitive process to participate in the Safety Net Medical Home Initiative. The Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS) in cooperation with the Massachusetts League of Community Health Centers (The League) will serve as the Regional Coordinating Center (RCC) for the initiative.
3. For more information about Qualis Health, see:

Publication Details