For years, Massachusetts has sat at the front lines of health reform. Before we had the Affordable Care Act, there was “Romneycare.”

Now, as the Obama Administration looks to better control healthcare spending, the nation once again turns to the Bay State.

How do you spend less on healthcare? One way is to get doctors to stop doing stuff that they get paid to do right now, like order tests, and send patients to the hospital. In Massachusetts, they’re stopping thanks to an agreement between Blue Cross Blue Shield and medical providers, says Harvard’s Michael Chernew.

“It looks like a meaningful reduction in spending, roughly upwards 10 percent of spending,” he says.

The state’s largest insurer effectively gives doctors a budget and a choice: go under and share some of the savings, or go over and face a penalty. Chernew’s work suggest this could be a national model.

The challenge is making sure those incentives don’t make docs stint on care, says primary care Dr. Tim Ferris.

“That could work to undermine the trust between a patient and a doctor. Is the doctor doing everything they can to help the patient,” he says.

Still Ferris, a payment reform cheerleader, says not only can change lower spending, it can also make care more convenient for patients.