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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

February 28, 2018

Starting tomorrow, MassHealth is enrolling most members into new health plan options, including Accountable Care Organizations. The change will impact up to 1.2 million MassHealth members.

What are MassHealth Accountable Care Organizations (ACOs)?

ACOs are provider-led organizations that coordinate care and are accountable for the quality and total cost of care of its members. Primary Care Providers (PCPs) work together with members and their team of network providers to coordinate care and connect members with available services and supports. MassHealth ACOs are a new kind of managed care option.

Who is eligible to enroll in an ACO?

People who are required to enroll in some kind of MassHealth managed care plan are eligible to enroll in an ACO. This only affects people who have MassHealth as their only health insurance coverage.

Who is not eligible to enroll in an ACO?

  • People who are enrolled in MassHealth and other health insurance coverage (for example Medicare or employer-sponsored health insurance).
  • People who are eligible for or enrolled in One Care, Senior Care Options (SCO), or PACE.
  • Seniors who are eligible for MassHealth based on their age.
  • People who are only eligible for or enrolled in MassHealth Limited.

Will an ACO be my only option for coverage through MassHealth?

In most areas of Massachusetts, MassHealth members required to enroll in managed care will have the following health plan options:

  • One or more ACO
  • Two Managed Care Organizations (MCOs) – Tufts Health Together and BMC HealthNet
  • Primary Care Clinician (PCC) Plan with the Massachusetts Behavioral Health Partnership

When do new plan options go into effect?

New MassHealth plan options, including ACOs, go into effect March 1, 2018. If you received a green-stripe letter, these new options apply to you. You may have already been assigned to a new ACO.

Can I keep all my current doctors?

MassHealth assigned members to plans that their primary care provider (PCP) participates in. You should check your doctors and/or your health plan to make sure your other providers, including specialists, are included in the new plan’s network. If they are not, you can work with you provider and plan to see if they can join the network, or you may consider switching plans.

What happens to prior authorizations or upcoming medical care?

Even if your current providers are not in your new plan or your new plan has not authorized your services, you will be able to keep scheduled appointments with your current providers and use previously authorized services through at least March 30th. You should work with you plan and providers to figure out your options after March 30th.

Will I be able to switch my ACO or health plan?

MassHealth members have until May 31, 2018 to switch plans. After that, MassHealth members can only switch plans for certain reasons, until March 1, 2019. People who become eligible for MassHealth after March 1, 2018 will have 90 days from the start of their MassHealth coverage to switch plans.

Where can I get more information about my enrollment options?

-Suzanne Curry

February 21, 2018

Last week, The Greater Boston Food Bank (GBFB) and Children’s HealthWatch released the first study of the health-related costs of hunger and food insecurity in Massachusetts. With one out of every 10 people in Massachusetts unable to afford enough food to lead an active, healthy life, An Avoidable $2.4 Billion Cost reveals exactly what its title says: the costs of debilitating health issues that are attributable to food insecurity are high…and avoidable.

The study breaks down the correlation between hunger and debilitating health issues that are attributable to food insecurity and presents the conditions – and their costs—in seven main categories:

  • Poor General Health: $635.4 million
  • Pulmonary Diseases: $572.6 million
  • Special Education: $520.3 million
  • Type 2 Diabetes: $251.1 million
  • Mental Health Conditions: $223.3 million
  • Obesity: $132.7 million
  • Rheumatology Diseases: $76.9 million

Hunger and food insecurity have particular and long-lasting ramifications for children—with negative effects that often persist through the lifespan. GBFB president and CEO Catherine D’Amato tells The Boston Globe: “If a child misses the right nutrition early on in their life…it can limit their potential to be an active citizen in their community. That damage is done.”

GBFB and Children’s HealthWatch encourage leaders in the health care community to join forces with policymakers at both the state and federal levels to reduce food insecurity, improve the health of food-insecure Massachusetts residents and reduce healthcare costs for individuals, families and the Commonwealth. Specific policy recommendations include:

  • Healthcare providers should screen patients routinely for food insecurity.
  • Congress should maintain the current funding levels and structure of the Supplemental Nutrition Assistance Program (SNAP).
  • Funding of the Massachusetts Emergency Food Assistance Program, which helps the state’s food banks serve the 700,000 food-insecure people in our state, should be increased to $20 million in FY19
  • Massachusetts should implement a common application for MassHealth and SNAP.
  • Massachusetts high-poverty schools should institute breakfast after the bell programs.

 As a consumer advocacy organization, Health Care For All (HCFA) knows that social determinants of health—factors such as lack of affordable housing, food insecurity, transportation barriers, limited access to well-paying jobs, and exposure to violence—contribute to poor health outcomes, drive up health care costs, and create health inequities across race and income. HCFA believes that addressing the social determinants of health (SDOH)—including hunger and food insecurity—is a critical component of our mission to create a health care system that provides comprehensive, affordable, accessible, and culturally competent care to everyone in Massachusetts—especially the most vulnerable among us.

The new MassHealth Accountable Care Organization (ACO) program provides an opportunity to begin to address some of the SDOH needs of MassHealth members. HCFA will be monitoring how these new ACOs use “flexible funds” to address social service needs, and we hope to learn more about the SDOH needs of the ACO member populations and the impacts of these interventions over time as the ACO program rolls out.

-Natalie Litton

February 8, 2018

With the end of Open Enrollment approaching, Health Care For All (HCFA) decided to host one last enrollment session in the city of Framingham on Saturday, January 20th 2018 to help those residents who still needed assistance applying for health insurance. HCFA coordinated an event alongside Rede ABR Radio Brasileira, the Joint Committee for Children’s Health Care in Everett, and the Edward M. Kennedy Community Health Center to serve the community.

A group picture featuring all of our dedicated volunteers following a successful enrollment session

Upon arriving in Framingham, the team quickly realized that many people were in need of help. While the enrollment session was not scheduled to begin until 10 AM, the line was already snaking around the outside of the building at 7 AM. Temperatures started in the 20’s and didn’t climb much during the day so we knew that something had to be done to help those standing in line in the cold. Along with cold hands and noses, many of these residents had small children with them as well. Some residents were moved to a backroom opened by ABR Radio Brasileira, our host, where kids had activities to play with and adults could sit and wait with refreshments - and heat! We also collected phone numbers so that people who lived close by could wait at home and come back once their turn was approaching.

Thumbs up for health care! Who can disagree with that?

It can be difficult to estimate how many people will show up to a session of this nature and it is hard to plan accordingly but we had amazing volunteers and partners who adapted quickly and committed to help as many attendees as possible.

The outreach strategies used with our partner organizations were very successful. We implemented an advertising campaign in Spanish and Portuguese on both radio and TV to reach out to diverse communities in the area. Ilma Paixao, who leads ABR Radio, and her team were very effective not just at broadcasting the information about the enrollment session but also connecting with the communities to make them feel welcome and safe, including offering their space to host the event itself. This successful ethnic media campaign was made possible thanks to Blue Cross Blue Shield of MA and the Community Charitable Donation by Sanofi Genzyme. These outreach strategies resulted in many individuals attending who preferred to use Portuguese or Spanish as their primary language. This was not a problem for our team as we had 14 volunteers who were fluent in Portuguese and English with the remaining 5 volunteers being a mix of Spanish speakers and English speakers. 

Health care volunteers hard at work!

Some of the attendees came with questions that could be answered in 10 minutes. Other residents needed to fill out entire applications that can take an hour to complete. We were able to serve most of the people standing in line on the same day, but we knew that four hours would not suffice to meet the needs of all the community members who showed up. We had to do something to help as many as possible. We decided to call the remaining residents on the list and screen them over-the-phone to see if they needed help applying for health insurance before the end of Open Enrollment under the Health Connector. Those who qualified for Connector coverage were asked to call the HelpLine before the end of Tuesday to fill out an application. We also shared magnets with the HelpLine number with people who had questions about other kinds of coverage and asked them to connect to our enrollment experts after the 23rd to make sure that we could help those who needed to take action before the deadline. 

A busy room with a flurry of health care enrollments!

At the latest count, 581 people were served as a result of the Framingham enrollment session. In fact, that number continues to grow as more and more people keep calling into our office regarding coverage questions because they heard about HCFA through the outreach campaign for this session. Word of the event spread so far that we assisted residents from as far away as Lowell, Peabody, and even Cape Cod. This is one of our most successful events as a Navigator organization working with the Massachusetts Health Connector and with the support of the MetroWest Health Foundation. 

All smiles after enrolling in health care coverage

January 26, 2018

The high cost of prescription drugs is a familiar story to consumers across America who struggle to pay for the medication on which they depend in order to get and stay well. The state's Health Polcy Commission found that prescription drug costs continue to be the fast rising cause of our state health care cost growth:

As consumers across the country rang in 2018, many prescription drug companies announced that the new year would see price increases for dozens of drugs. Effective January 1st, pharmaceutical companies Allergan, Teva, Collectis, Insys, Sysnergy and Supernus all raised prices on drugs that treat a wide range of conditions including hypertension, dry eye, irritable bowel syndrome and Alzheimer’s disease.

While this news may seem par for the course, consider the details. In 2016, a number of pharmaceutical executives pledged to keep price increases below 10%. Allergan chief executive Brent Saunders, for example, made this promise as part of his company’s “social contract” with patients. These companies touted a promise to limit price increases to "single digits."

This makes the rate of 2018 price increases particularly interesting:

  • Allergan is increasing the price on at least 18 medications—including its dry eye drug Restasis, irritable bowel syndrome medication Linzess, hypertension treatment Bystolic, and Alzheimer’s treatment Namenda XR—all by 9.5%.
  • Amgen is increasing the price on its top-selling rheumatoid arthritis and psoriasis treatment Enbrel by 9.7%.
  • Biogen is increasing the prices of its multiple sclerosis medications Tecfidera and Avonex/Plegridy by 8% each.
  • Horizon Pharma is increasing the prices of four medications – all by 9.9%.
  • Teva is raising prices on seven medications at rates ranging from 2.3% to 9.4%.

A pattern quickly emerges: drug company price increases continue to squeeze consumers, but by staying below 10%, their executives are adhering to their self-imposed limits … just barely.

We're not fooled. HCFA continues to call on the legislature to enact strong drug pricing transparency and other laws to control unconscionable drug prices. The state Senate included a provision forcing drug companies to transparently justify exorbitant prices as part of its health care reform package. That bill is now pending before the House, and is expected to come up in the next few months. We urge the House to follow suit, and do something about high drug prices.

                                                                                                                                            -Natalie Litton


January 3, 2018

CHIA 2017 Health Insurance Survey Highlights

The recently released 2017 Massachusetts Health Insurance Survey from the Center for Health Information and Analysis (CHIA) found that at only 3.7 percent, the uninsurance rate in the Commonwealth remains well below the rest of the nation. Nevertheless, insurance coverage does not automatically translate into health care access, and with nearly one in ten Massachusetts residents underinsured, it is clear there is more to the story of Bay Staters’ ability to get the care they need when they need it.

CHIA considers survey respondents “underinsured” if they had health insurance coverage all year but spent 10 percent or more of their family income on family out-of-pocket health care expenses in the past twelve months. More than 12 percent of respondents over age 65 fell were considered underinsured, compared to 8.2 percent of non-elderly adults and 8 percent of children up to age 18. CHIA reports that the statewide underinsurance rate was 8.8 percent.

High co-pays and deductibles along with services that simply aren’t covered by their insurance cause Massachusetts’ underinsured to delay and avoid receiving the care they need. Over a quarter of respondents reported an unmet need for medical or dental care in the past 12 months due to cost. Proving the point that coverage does not ensure access, CHIA reports that 65.2 percent of these respondents had health insurance at the time. Furthermore, 78 percent of respondents with medical debt had incurred all medical bills while they and their family were insured.

While we can be proud of the progress made since passage of the Commonwealth’s universal health coverage law in 2006, it is clear that even with health insurance coverage, cost remains a barrier to the health care that makes and keeps us well.

                                                                                                                                                                                                                 -Natalie Litton

December 8, 2017

Governor Baker, along with the governors of Oregon, Montana, and Nevada, today published an op-ed in the New York Times urging Congress to reauthorize funding the Children’s Health Insurance Program (CHIP), the program that provides health coverage to almost nine million children of low-income families across the country. The op-ed emphasized the benefits to kids’ health that CHIP has brought about since its creation in 1997 and the disastrous consequences of allowing the program to expire.

“Since the program went into effect, the percentage of children who are uninsured has dropped from 15 percent to 5.3 percent. Children who would otherwise be uninsured can now visit doctors for the regular checkups all kids should have and get the treatment they need when they’re sick or hurt, whether they’re suffering from a sore throat, a broken bone or a life-threatening illness. CHIP doesn’t just provide insurance coverage for children — it indirectly provides financial stability for many working families who depend on the program to cover their children’s health care. Many of them would otherwise be financially devastated by their kids’ hospital bills.”

Funding for CHIP expired at the end of September, and states will soon run out of the reserve funds they have been using to continue the program. In Massachusetts, CHIP provides coverage for 172,000 children. The Commonwealth will lose $295 million in federal funding if CHIP is not reauthorized. Coverage for many would be at risk, and losing federal funding for the program will be a major blow to the state’s budget. 

Governor Baker has taken a leading role in advocating for the reauthorization of the Children’s Health Insurance Program and for community health centers. Federal funding for community health centers also expired at the end of September. In Massachusetts, community health centers provide primary care to about one million residents, or about one seventh of the state’s population.    

Governor Baker and Oregon’s Governor Brown sent a letter to Congress at the end of November asking for reauthorization of CHIP, funding for community health centers, and funding for a federal home visiting program. The letter explained how, even if CHIP funding is ultimately reauthorized, the delay in funding is already causing harm.

“Absent congressional action, states will be forced to take steps including the notification of thousands of families of the loss of CHIP health care coverage. Taking steps to avoid those worst-case outcomes places a tremendous administrative and financial burden on states and sows confusion among vulnerable populations.”

Health Care For All thanks Governor Baker for his consistent advocacy on behalf of these vital programs.

November 20, 2017

Funding for the Children’s Health Insurance Program (CHIP) expired on September 30. CHIP provides health insurance for children and pregnant mothers who are low-income but are not eligible for Medicaid. States have a limited amount of funds left to maintain the program, but without federal reauthorization, these funds will soon run out. CHIP has been responsible for a massive decrease in the number of uninsured children throughout the country. When CHIP became law in 1997, 14 percent of people below the age of 18 were uninsured. By 2015, this number had decreased to less than 5 percent. In Massachusetts, CHIP covers about 160,000 children, including 7,000 expecting mothers. CHIP has helped the Commonwealth reach the incredible rate of 99 percent insurance coverage for children, which is the highest in the nation. According to updated estimates provided by MassHealth, without Congressional action, Massachusetts will exhaust its federal CHIP funding in mid-January.

Federal funding for community health centers expired on the same day. Community health centers are a vital part of the health care system, and a lack of federal funding will throw these health centers into a finical crisis, affecting a massive portion of the population. Many community health centers, uncertain when funding may reauthorized, are already experiencing considerable financial stress, which is hampering their ability to function effectively. In Massachusetts, community health centers provide primary care to one in seven state residents, or about 1 million people. Community health centers tend to serve large amounts of patients without private insurance, including those covered through Medicaid and those who are uninsured. The most vulnerable members of our society will be disproportionately affected if community health centers are forced to cut services due to a lack of federal funding.

Senator Elizabeth Warren recently posted a video calling for the reauthorization of funds for both CHIP and community health centers. Health Care For All commends Senator Warren for her commitment in fighting for these vital programs. HCFA calls on Congress to work together to forge a clean bipartisan agreement on funding of both CHIP and community health centers, two essential components of our health care system. 

November 17, 2017

Last week, the state Senate considered over 150 amendments proposed to their comprehensive health care cost control package, titled the HEALTH Act, for Health Empowerment and Affordability while Leveraging Transformative Health care (see our initial thoughts on the bill here). After spending two full days discussing and voting on amendments, the Senate approved the bill right at midnight on November 9. The final Senate bill, incorporating all the amendments, is expected to be numbered S. 2211, and so should be available online here.

The wide-ranging final bill includes over 150 sections, concerning many aspects of the state’s health care system. The bill now goes to the House. House leaders have said they will be reviewing the bill and preparing their version sometime in the new year.

HCFA was active during the amendment process, working on a number of proposed improvements to the bill. As you can see from the brief summaries below, among the many provisions are a number of long-standing HCFA priorities. Below is an outline of some of the key issues included in the bill; we apologize for the length, but this is a very large bill.

MassHealth reforms: We are thankful to the Senate for not including a package of proposed reforms to MassHealth that reduces eligibility for non-disabled adults which would limit benefits and impose barriers to keeping coverage and continuity of care. Most of these proposals also need federal approval; the Centers for Medicare and Medicaid Services is currently reviewing the 1115 waiver amendment Massachusetts submitted in September.

Oral Health: The bill allows dental therapists to practice in Massachusetts. Allowing dental therapists to work in Massachusetts would expand access to oral health. Low income children and families, older adults, people with disabilities and communities of color face the substantial barriers to accessing needed dental care. Dental therapists are licensed midlevel dental providers, working under a dentist’s supervision. As community-based providers who understand the history, culture, and language of their patients, they enable the dental team to deliver culturally competent, patient-centered care, mobilizing the strengths of underserved communities. Dental therapists could bring much needed care to underserved people and address oral health disparities.

Academic detailing: The Senate bill requires the Health Policy Commission to implement Academic Detailing, which is an evidence-based prescriber education program that focuses on the therapeutic and cost-effective utilization of prescription drugs. Academic Detailing supports prescribers to make informed decisions based on balanced research data rather than biased promotional information from drug companies. The Senate considered an amendment supported by HCFA that would have included an assessment on pharmaceutical companies to fund the program, but this amendment was not adopted.

Prevention: The Senate bill renews authorization for the Prevention and Wellness Trust Fund (PWTF) , which expired in June. PWTF is an innovative approach to address social determinants of health. It was set up as a pilot program in 2012, with the goal of reducing health costs by increasing access to community-based prevention. The pilot phase focused on hypertension, childhood asthma, elderly falls and tobacco use reduction, and operated in nine communities. PWTF is unique in addressing community factors that lead to poor health. HCFA worked with other public health advocates to add a funding mechanism to the provision, which originally had no source of funds. An amendment to the bill increases the tax on flavored cigars to fund the program.

Medicare Savings Programs: The Senate considered an amendment filed by Senator L’Italien that would leverage federal and existing state funds to expand eligibility to Medicare Savings Programs (MSPs), which help lower costs for Medicare beneficiaries with limited incomes. In the end, the Senate approved a redrafted amendment that directs the Executive Office of Elder Affairs and the Executive Office of Health and Human Services to develop plans to utilize Prescription Advantage program funding and expand MSPs, respectively, by September 2018.

Prescription Drug Price Transparency: The Senate bill includes a number of provisions to increase transparency of prescription drug pricing. The bill requires the Center for Health Information and Analysis to collect pricing information from pharmaceutical manufacturers and pharmacy benefit managers, including research and development costs, marketing and advertising costs and annual profits. The bill also requires these entities to take part in the Health Policy Commission’s annual health cost trends hearings where the Commission can solicit sworn testimony from the industry on factors driving drug price increases. An amendment supported by HCFA strengthened the reporting requirements and allows the Attorney General to compel pricing information from industry officials, subject to a financial penalty and other legal action for noncompliance.

November 16, 2017

The Massachusetts legislature recently passed legislation, called the Contraceptive ACCESS bill, to ensure access to birth control in Massachusetts. The bill now needs the signature of the Governor to become law.

The Affordable Care Act mandates coverage of birth control without copayments. However, the Trump administration recently moved to roll back this requirement by allowing employers to request exemptions from this requirement based on religious or moral beliefs. This could result in some employers choosing to no longer cover birth control in the insurance plans they offer to workers.

The ACCESS bill ensures that, even with this action on the federal level, employers in Massachusetts will continue to provide employees with coverage for birth control without copayments.

This bill also increases access to birth control in several other ways. It allows women to receive a 12- month supply of oral contraceptives at once, instead of requiring women to repeatedly return to the pharmacy to renew their prescription throughout the year.

This legislation further allows for women to access emergency contraception without a copayment or new prescription, which is vital to ensure timely access. Before this legislation, a woman would need to get a prescription to receive emergency contraception without a copayment. Emergency contraception is meant to be taken immediately, so being forced to wait for a prescription could undermine the effectiveness of the medication.

Access to contraception is critical to the health and wellbeing of women and their families. Health Care For All believes birth control should be available to all who need it, regardless of economic status. HCFA supports this legislation as a measure to increase access to birth control in Massachusetts and to protect against attacks on access to affordable birth control from the federal level.  

(Image courtesy of NARAL Pro-Choice Massachusetts

November 14, 2017

Despite being completely preventable, dental disease is a major cause of illness in the US. Millions suffer from painful untreated dental issues due to an inability to access dental care, which impacts their ability to eat, talk, gain or retain employment and maintain good overall health. Low income children and families, older adults, people with disabilities and communities of color face the greatest barriers to accessing care.

Dental access is a severe problem in Massachusetts. A 2016 Massachusetts Health Policy Commission study highlighted the severe access problem for low-income people. It found that only 56% of low-income adults saw a dentist in the past year, compared to 82% of high-income adults.

The lack of access to dental care is also evidenced by the large number of ER visits for preventable dental issues. In Massachusetts, for example, ER use by children covered by Medicaid for preventable oral health conditions was 3.4 times that for kids with commercial coverage. For non-elderly adults, the rate of ER visits by Medicaid members was a stunning 16.6 times that of those with commercial coverage.

These disparities affect many – adults of color, people with disabilities and older adult communities face significant social, structural, cultural, economic and geographic barriers in accessing care and have high rates of oral health problems.  The current dental delivery system is not overcoming these barriers. This is why health care advocates across the country keep pushing to add dental therapists, licensed midlevel dental providers to the dental team. Dental therapists could immediately bring care to millions of underserved people nationwide and address oral health disparities.  In Massachusetts, the Senate’s recently passed health care bill includes authorization for dental therapists.

Dental therapists work with the dental team similar to the way physician assistants work on the medical team—they are early intervention and prevention dental professionals who are trained to provide a limited scope of services under the supervision of a dentist. They have been working worldwide since the 1920s and have been part of the US dental team for over a decade. Specifically designed to work in underserved areas, dental therapists are practicing safely, effectively and increasing access to care in Alaska, Minnesota, and the Swinomish Indian Tribal Community in Washington, and were also recently authorized in Vermont and Maine.

Several dental therapy programs are recruiting providers directly from the communities where oral health needs are the greatest. Utilizing community-based providers who understand the history, culture, and language of their patients enables the dental team to deliver culturally competent, patient-centered care and mobilizes the strengths of underserved communities.

In addition to delivering patient centered care, dental therapists are proving to relieve the financial burden on dental practices who have limited resources for oral health services for vulnerable and underserved populations. Since dental therapists are less expensive to hire, dental practices are able to provide care for more Medicaid patients, even with lower reimbursement rates, and still be profitable. These are critical components to being able to remove some of the systemic barriers that prevent underserved communities from accessing dental services, and building the community’s health care delivery capacity to improve oral health outcomes.

Access to dental services and good oral health should not be treated as novelties reserved for those lucky enough to live near a dentist, have dental insurance and afford to receive treatment. These are critical components to overall good health, and it is imperative that we address the structural barriers that cause oral health disparities. Dental therapists can address these disparities by expanding and bolstering the current dental delivery system to serve these underserved communities. Dental therapy is an evidenced-based solution that has increased access to care in Alaska and Minnesota, especially for hard-to-reach populations, and can do the same in Massachusetts.

                                                                                                                                       -- Kristen McGlaston, Community Catalyst