By: Stewart Landers, JD, MCP, John Snow, Inc.

While Massachusetts is examined, justifiably, as a model of how health care reform can move forward, it is rare that the role of public health in health reform takes center stage in that discussion. It is well known that health insurance coverage now extends to over 97 percent of residents, ranking Massachusetts first in the country in percentage of population insured. However, less is known about the role of public health in Massachusetts’ health care reform efforts and the lessons that may be applicable to the nation as a whole as it considers health reform at the federal level.

The legislation that propelled these high rates of insurance coverage also included the creation of a Quality and Cost Council and a Disparities Council. A year later, a second piece of legislation, dubbed Health Care Reform - Part 2, supported efforts to document serious reportable events, require electronic medical records and establish a gift ban. Part 2 also established an academic detailing program with respect to prescription drugs and a health care work force center.

In the executive branch, Gov. Deval Patrick's administration has pursued additional efforts improve public health. A “Healthy Massachusetts Compact” was organized across Secretariats to address health issues. A chronic disease blueprint was pursued by the secretary of Health and Human Services. The commissioner of public health spearheaded (with the governor in the lead) an anti-obesity campaign called “Mass In Motion” to promote healthy eating and physical activity (see www.mass.gov/massinmotion ). Finally, Massachusetts was selected as one of four states by the Centers for Disease Control and Prevention to test and document efforts to integrate chronic disease prevention and control.

As chronic disease accounts for a large and growing amount of health care costs, addressing chronic disease is critical for helping to address high health care costs as well as to improve the health of the public. Various measures, some collected annually through BRFSS, provide evidence of the effectiveness of health care reform including improved screening for cancers (e.g. increased colonoscopy rates) and reduced smoking rates, as more people have primary care providers to encourage and support their tobacco cessation efforts.

Still, many barriers to full access to care exist, and there are ongoing challenges that demand public health solutions such as teaching newly insured individuals how to maintain and use insurance, how to prevent co-pays and deductibles from negatively impacting public health programs and how geographic distribution of primary care providers may limit access. Cultural issues at the provider level can also be a barrier to access to services.

Please come to my presentation on Monday, Nov. 9, 2009 at 8:30 a.m. and be part of a discussion about how we move forward with innovative and integrated public health approaches that are a critical link to health care reform. It is session 3033.0, Presentation 1: Putting Public Health into Health Care Reform: Massachusetts’ Chronic Disease Integration Pilot Project.