September 2009

September 30, 2009

Tomorrow, about 11,500 legal immigrants in the Greater Boston area who lost their Commonwealth Care coverage on August 31st will be transitioned into the new Commonwealth Care Bridge plan, offered by CeltiCare. Legal immigrants in this category north and south of Boston will be enrolled on November 1st; Central and Western Mass residents will transition on December 1st.

While people in these areas are waiting for their coverage to begin, they remain eligible for the Health Safety Net program (formerly free care) and some may be eligible for emergency care via MassHealth Limited. Community Partners has a good explanation of these options, here.

The enrollment materials will include an insurance card with a primary care physician (PCP) assigned to the member. The assignments will not carry over the member's current PCP, so unless someone gets their current PCP by chance, each member will be assigned a new primary care doctor. Members can call at any time, however, to switch their primary care physician if they want to. The doctor must be in the network, which in Boston will be based on the Caritas Christi network. Additional health centers are being added as the plan negotiates with centers.

The following documents contain details about the plan:

CeltiCare’s customer service numbers will also be up and running tomorrow, with a dedicated phone number for folks in active treatment to call. CeltiCare says they plan to look at each care transition case individually to determine whether clients will be able to stay with their current providers to continue treatment.

CeltiCare Website: celticarehealthplan.com

Member Services: 866-895-1786

Direct line into medical management dep't for care transition issues (for those in active treatment): 866-895-1786 ext. 65292

TDD/TTY line: 866-614-1949

If you or someone you know needs assistance the following resources are available:

  • HCFA HelpLine: (800) 272-4232 or click here for our online HelpLine service.
  • Community Partners: (413) 253-4283 / www.compartners.org
  • Mass Law Reform Institute: (617) 350-0700 x309 or 318
  • MIRA Coalition: (617) 350-5480

-Suzanne Curry
Health Reform Coalition Coordinator

September 30, 2009

The HCQCC met today to discuss the long-awaited Roadmap to Cost Containment (Roadmap). Prior to this part of the meeting, they had a few sub-committee updates. The anticipated sub-committee restructuring has been completed and there are now fewer committees with a sharper focus for each (check out our earlier post here). Jack Evjy, MD from the MMS presented a brief report on the Advisory Committee’s discussion about the Roadmap and promised a more detailed report at the next QCC meeting.

The Council also voted to amend their Data Intake Collection regulations. The changes allow for an administrative process for data collection and also establish a fee schedule for those who wish to use the QCC’s data. These regulations will the subject of a hearing in November, details to follow.

Last on the agenda was the discussion of the Roadmap. Secretary Bigby set the stage by reminding the Council of their previous goals around cost and quality and other state initiatives in this area. Beth Waldman and Michael Bailit, from Bailit Consulting, presented the Roadmap recommendations to the Council members. (see the slides here)

The recommendations are: adopt comprehensive payment reform, adopt and use health information technology, implement evidence-based coverage informed by comparative effectiveness information, develop health resource planning, support system redesign, implement health plan design innovation to promote use of high-value care, enact malpractice reform and peer review protections, implement administrative simplification, engage consumers, encourage healthy behaviors, and further promote transparency. (Check out the details on the proposals below the fold.)

Check out our blog here for more information on payment reform and the Special Commission’s recommendations. The discussion revolved around the specific recommendations of the Special Commission. Many questions remained unanswered as they were not addressed by the Special Commission, but rather left to the implementing oversight entity. Of special concern to the Council was the structure of the ACO- an undecided matter thus far. Based on the discussion, the final Roadmap may contain some further recommendations about the ACO structure and requirements for that structure.

Implement evidence-based coverage informed by comparative effectiveness information: The QCC would recommend creation of an entity (state or regional) to look at existing clinical research and synthesis of this research and make recommendations about services to insurers, employers, providers and consumers. The entity will focus initially on areas where there is overuse. The discussion around this topic also highlighted the need to look at areas where there is underuse as well. The potential for cost containment with this strategy is high based on the existing research and programs. The entity will also need to make sure there is an exception and appeal process for those individuals for whom the recommendation is clinically inappropriate.

Implement health plan design innovation to promote use of high-value care: increase employer offering and employee take-up of products that provide incentives for use of high value services and providers with the goal of improving health outcomes and reducing premiums costs. Of note, this strategy is not about cost-shifting from employers to consumers, but about getting better value within the system. The RAND Report modeled savings in a range of $1.1 billion increase over 10 years to a $1.2 billion savings over 10 years.

The QCC did not get to the rest of the strategies at this meeting and postponed the remainder of the discussion to the next meeting.

They did briefly discuss their role once this Roadmap is complete. The recommendation is that they should develop a scorecard of the Commonwealth’s progress in containing health care costs to be released annually. The QCC will look at the transition from a high-level to make sure things are working properly.

The next meeting will be October 21st at 1pm at One Ashburton Place on the 21st Floor.

Georgia J. Maheras, Esq.
Private Market Policy Manager

September 30, 2009


For the month of October, HCFA is asking you to Tweet for Health Reform! A Healthy Tweet is a campaign to spread the word about the importance of health reform while raising money for HCFA’s HelpLine. Click here for the full details or visit http://tinyurl.com/4reform.

Hundreds of people call HCFA’s HelpLine every week. These are people who need health care and don’t know how to access the system. Many callers have recently lost their jobs or work several jobs, but are not offered insurance or can’t afford it . The HelpLine enrolls callers in health coverage and ensures that callers can access the care they need.

We need your help! The HelpLine is busier than ever – legal immigrants are confused about the change in their coverage, more and more people are losing their jobs and the debate over national health reform has people in Massachusetts wondering what will happen to their own coverage. HCFA needs to raise $5,000 by October 31st in order to keep the HelpLine answering calls.

How can you help?

Thanks for helping HCFA fundraise through social media! We, and those we help through our HelpLine, appreciate any amount you can give.

September 30, 2009

EOHHS has released an updated notice for the October 8th and 9th FY 11 budget hearings. Click here to download the Notice of Public Hearings (.pdf).

UPDATE from EOHHS: “EOHHS has decided to reschedule their budget hearings scheduled for Thursday the 8th (Roxbury) and Friday the 9th (Holyoke). Given the most recent news about state revenues continuing to decline, they are rescheduling the hearings until after the extent of the revenue shortfall is fully understood.”

September 30, 2009

Yesterday’s Boston Globe includes a pair of stories on the Mass. pharma industry: one on the doctors who took speakers’ fees from Eli Lilly and the other announcing that Boston is hosting the biggest annual biotech convention. We find it poetic that these two stories are paired up and note that despite great fear of a chill, our gift ban and disclosure law have not brought on an ice age.

Story 1: As Channel 5 (and we) covered last week, as part of a court settlement, Eli Lilly is required to make public disclosure of payments made to physicians, including speakers’ fees paid to doctors who make marketing pitches on behalf of the drug firm. More than 60 Massachusetts doctors were paid some $588,000 for speaking in the first three months of 2009. Boston Medical Center, which restricts their doctors from participating in marketing activities, initially told the Globe that the speeches were OK, since the doctors created their own materials. When confronted with the reality that the industry controls the content (they're paying for it, after all), BMC reversed itself and ordered the doctors to stop the presentations.

In the article, Dr. Steven Nissen, head of cardiovascular medicine at the Cleveland Clinic Foundation, said doctors in speakers bureaus “are actually acting as an agent for the pharmaceutical company. That does create divided loyalties, and universities are realizing the challenges that presents.’’ This echoes our concern with this practice and like many academic medical centers believe that providers serve as a mouth-piece for industry. Lilly’s disclosure of more than 60 Bay State doctors who took speaker’s fees is remarkable and shows the importance of public disclosure of provider-industry interactions.

Story 2: Despite warnings that all was lost, the big Biotech convention is coming back to Boston in 2012. It seems that the Boston Convention Center has somehow overcome the dire circumstances predicted by Robert Coughlin a mere 6 months ago: “At the time, Robert Coughlin, president of the Massachusetts Biotechnology Council, warned that the new rules, which were considered to be the most stringent in the nation, would make event organizers think twice before coming back to Boston.” Instead, biotech jobs have been a major growth area for the Commonwealth.

From the beginning of this debate, we said that (1) the public would learn a lot from the disclosure of payments to physicians, and (2) that requiring disclosure would not unduly hurt pharma business in Massachusetts. Yesterday's Globe made both those points, beautifully.
-Georgia J. Maheras

UPDATE - The Oct. 1 Globe editorial makes the same points we would make. It concludes:

Massachusetts General Hospital, Brigham and Women’s Hospital, and McLean Hospital - all of which also employ doctors who have received money from Eli Lilly this year - will prohibit their doctors from receiving speakers’ fees from the pharmaceutical industry starting today. Other hospitals in Massachusetts and around the country should follow their lead immediately.

The state, which as of next summer will require drug companies to disclose their speakers and the amounts they are paid, should not stop with transparency. Neither should Congress when it considers a Senate bill that would require such disclosure nationwide. While transparency is a good first step that exposes doctors’ financial relationships to the broader medical community, it is unlikely to affect how patients view their doctors. More important, it will not address the subtle ways the payments influence and interfere with patient care.

Patients trust doctors as stewards of their health. They revere them as scientists who can exercise sound, independent judgment. Allowing doctors to promote drugs for pharmaceutical companies takes advantage of that trust and reverence. It also compromises doctors’ most important work: treating people who are ill.

September 29, 2009
Uninsurance Rates by County

Uninsurance Rates by County

Massachusetts has the lowest uninsurance rate in the country. New US Census data confirm the success of health reform in expanding coverage. The data also show significant variation in uninsurance rates among the different counties in Massachusetts. Click here to see an interactive map of Massachusetts that shows the uninsurance rates for adults age 18-64 for each county.

September 29, 2009

Help Your Kids Prepare for School Oral health is a critical part of overall health and significantly impacts a child's success in school! Join HCFA and UMass Memorial as we provide FREE screenings and fluoride varnish for children ages 0 - 21 years. The varnish is a protective coating that is painted onto a child's teeth to prevent cavaties. Click here to download flyer (.pdf). What: FREE oral health screenings Where: Auburn Mall Food Court 385 Soutbridge Street Auburn, MA 01501 When: Wednesday, September 30th, 4-6pm

September 29, 2009

The QCC is meeting September 30, 9:00-11:30am, at the Division of Health Care Finance and Policy, 2 Boylston Street, Boston, John Daley conference room, 5th floor. The agenda includes:

I. Committee reports (Quality and Safety Committee; Advisory Committee)

II. Update from Administrative Directors

III. Discussions Items:

  • Vote on Change to Data Intake Regulations
  • Discussion of Roadmap to Cost Containment
  • Performance Measurement Alignment Proposal

Deborah W. Wachenheim
Health Quality Manager

September 28, 2009

Thursday is an important day for oral health in the Commonwealth. On October 1, 2009 MassHealth dental benefits will be extended to cover children under the age of 19 who receive Family Assistance premium assistance, in order to comply with CHIPRA regulations. A copy of the announcement can be downloaded here (.pdf).

Regular readers know that oral health is an important part of overall health. Left untreated, dental disease can interfere with a child’s ability to eat, sleep, speak and learn. As we age, the implications of this disease become more severe. Decades of research have confirmed the associations between dental disease and serious lifelong ailments such as heart disease, stroke, and diabetes.

Under the newly expanded benefit, MassHealth will pay for dental services that are not already covered by the child’s private dental insurance. This includes essential services, such as comprehensive and periodic screenings and preventive care, as well as emergency care, oral surgery, and more. Access to these benefits will ensure better oral health and overall health for the children of Massachusetts.

If you have MassHealth coverage, you can find a list of services covered here (as well as a list of those that aren’t, here), courtesy of MassResources.org.

- Courtney Chelo
Oral Health Campaign Organizer

September 25, 2009

We have designed our health care system so that dentists take care of your mouth and physicians are responsible for the rest of your body. However, these two pieces interact in many important ways, and keeping them separate can cause significant complications. Yesterday's Kevin Cullen column in the Boston Globe demonstrates the dangers of separating the mouth from the rest of the body.

The mouth is the gateway to the body. Infections that start in the mouth can travel through the rest of the body, creating or encouraging serious long-term health problems. In this particular case, 4-year old Haylee “has Velocardiofacial syndrome, a rare genetic disorder that causes developmental delays. It also prevents her from producing enamel, something [her mom] found out when she brought Haylee to the dentist in November and was shocked to learn that half of her teeth had cavities.”

Although several doctors stated that the problems in Haylee’s mouth stemmed completely from her medical problem, her medical insurance would not cover the full costs of necessary surgery, claiming that some of it was considered “dental.” Even with dental coverage, Haylee’s mom was left with over $2,000 in fees for Haylee’s treatment.

Because we have left the mouth out of medical care, there are serious gaps left in coverage. If we want to build a truly comprehensive health care system so that kids like Haylee cannot fall through the cracks, we must ensure that oral health is included in overall health care.
-Christine Keeves

September 25, 2009

Now it all comes out. Pharma giant Eli Lilly, required by a court settlement to get ahead of state (and likely to be federal) statutes requiring the disclosure of payments to prescribers, has put their payment database online (see it here). And here comes Channel 5, combing through the hundreds of payments, and skunking out the big Massachusetts names.

And guess what -- right now it's the most read story on their site.

BOSTON -- Pharmaceutical companies are paying doctors in Massachusetts and across the country stunning amounts of money, Team 5 Investigates reported Thursday.

Drug manufacturer Eli Lilly recently released a list of doctors paid to do what's called advising and education. But critics told Team 5 these payments are for nothing more than a sales pitch, and they create a conflict of interest.

"They're salespeople with MDs after their names," said Dan Carlat, a Newburyport psychiatrist.

Dr. Brent P. Forester, a Belmont psychiatrist, took in $50,800, and Dr. Stephen C. Ellen, a Bedford psychiatrist, received $50,700 from Eli Lilly alone in just the first three months of this year.

Other top earners included Belmont psychiatrist Dr. Gopinath K. Mallya, who made $38,900, and Dr. Sumer D. Verma, a Lexington psychiatrist who made $36,100 in the first 3 months of 2009.

Channel 5 put the whole package together: the well-done video is here, along with the list of top 10 doctors who received the most payments, by amount, and the explanatory statements by the doctors (or their employers) named by the report and an interview with Lilly.

In the report, expert Dr. Daniel Carlat responded with his personal experience:

Carlat used to be on another drug company's payroll. "I called myself a drug whore," Carlat said. "That really is what it feels like when you're doing it."

One pharmaceutical company paid Carlat $30,000 for talking to doctors about depression and highlighting a drug made by that company. On his blog, he calls it the "dirty 30," but said it's nothing compared to what he said some doctors pocket.

"I personally know of some doctors in the business who have made upwards of one million dollars a year," Carlat said.

The report also highlights our partners at the Pew Prescription Project, which is working to get a federal disclosure law passed that builds on the Massachusetts law enacted last summer.

The disclosure will allow patients the opportunity to know if their doctor is on the payroll of one or more of the drug companies. We know that aggressive industry marketing of new drugs and devices to doctors through undisclosed gifts, consulting payments, speaking fees, classes, and meals can inappropriately influence medical decisions and create conflicts of interest. Thanks Channel 5 for spreading the sunshine.
-Brian Rosman

September 25, 2009

Massachusetts Administration and Finance Secretary Leslie Kirwan announced today that she was stepping down from her post. We're going to greatly miss her remarkable personal commitment to expanding affordable quality health care in Massachusetts.

The job of running ANF, as it's called in state lingo, is extraordinarily demanding. The state budget and financing world is difficult during good years; during the dramatic turn-down that we've experienced the past 2 years, it's been a never-ending headache. State law imposed on Secretary Kirwan the added responsibility of chairing the Connector Board and the Payment Reform Commission. She devoted enormous energy to these tasks which were peripheral to her core job. She not only worried about the fiscal impact of health policy, but the human impact. Time after time her leadership led to better health care for Massachusetts. She was always concerned about the impact on the most vulnerable. This included paying attention to the sustainability of government programs, and the creative use of government to leverage private efforts.

Her staff was responsive, talented and the most open ANF staff to advocates in generations, and we trust her successor will continue the strong collaboration with the health advocacy community.

The Connector Board will now have three new members - the Secretary of A and F, the Medicaid Director and the Commissioner of Insurance. We will work with the new members as they are appointed to bring them up to speed on the concerns of consumers.

We echo the Connector's statement, highlighting Secretary Kirwan's leadership of the board:

The fact that Massachusetts can boast of having the lowest uninsured rate in the country is due in no small measure to Leslie Kirwan’s leadership as chairperson of the Health Connector board of directors. Her unwavering commitment to reform was evidenced not only by how she navigated the board through a sea of difficult policy decisions, but also in her role as the state’s chief financial officer. She fought for the funding necessary to make reform as successful as it is in the face of the worst financial crisis to face us since the Great Depression. Her efforts have greatly improved the lives of hundreds of thousands previously uninsured Massachusetts residents. It’s been a distinct pleasure for both our board and staff to work so closely with her, and we wish her well.
Jon Kingsdale
Executive Director
Commonwealth Health Insurance Connector Authority

Thanks Leslie, on behalf of everyone who's been affected by your outstanding work.

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