October 2009

October 31, 2009

Last week, the Blue Cross Blue Shield Foundation of Massachusetts released Accessing Children’s Mental Health Services in Massachusetts: Workforce Capacity Assessment (pdf).

It’s no secret that there is a workforce shortage among mental health practitioners treating children with mental health needs. In some geographic areas, up to 82% of prescriber practices are full and unable to take new patients. Currently, there are approximately 6,800 child and adolescent mental health providers in Massachusetts. In 2020, it is estimated that we will have 8,300. However, according to those same projections, it is thought that we will need 12,100 providers.

The Foundation found that things are likely to get worse, not better: of those who responded to a survey, 54% of child mental health practitioners plan to leave the field in the next five years.

What can we do?
The payment structure for child mental health clinicians conspires to discourage new providers from joining the ranks. For some reason, child clinicians are paid at a lower rate than their counterparts who work with adults. Additionally, to provide the best care possible for a child with mental health needs, a clinician often needs to talk to many people in that child’s life: parents, pediatricians, and teachers, to name a few. However, these so-called “collateral contacts” that are vital for effectively coordinated care are not billable through private insurance.

In the survey conducted by the Blue Cross Blue Shield Foundation, establishing financial support for collateral work was listed as the top priority to improve child provider work satisfaction and was the second most frequently given factor that would increase the likelihood that providers would work with children.

The Children’s Mental Health Campaign (www.childrensmentalhealthcampaign.org) is actively working to pass legislation that would provide for reimbursement to clinicians for collateral contacts. Last month, the bill was favorably reported out of the Mental Health and Substance Abuse Committee and is expected to be acted on by the Health Care Financing Committee soon.

Many thanks to the Blue Cross Blue Shield Foundation for their hard work in putting together the report. Because of their efforts, the Campaign is better able to articulate to legislators and other policy makers the need for the passage of Collateral Contacts legislation.
Matt Noyes

October 30, 2009

Health Care For All and the Oral Health Advocacy Task Force applauds the Governor’s continued support for health reform, including oral health. Although he faced many difficult decisions as he fought to balance the budget, and are grateful that he has preserved adult dental benefits in MassHealth.

Oral health is a critical part of overall health- poor oral health is associated with other chronic health problems such as heart disease, stroke, diabetes, low-birth weight, and premature infant births.

The Governor has helped approximately one in ten Massachusetts residents by safeguarding these benefits. These programs provide access to vital services including exams, preventive cleanings, fillings, and dentures that allow for adequate nutrition to almost 700,000 individuals. He showed great foresight in protecting these programs, which offer significant cost-savings in the long run by decreasing the severity of other chronic diseases and granting access to cost-effective preventive services.

This move also protects vulnerable populations. More than 120,000 low-income seniors and 180,000 disabled individuals receive dental coverage through MassHealth. In addition, eliminating these benefits for adults would have negatively impacted children and families. We know that parents and children go to the dentist as a family unit, so limiting insurance coverage for adults leads to lower participation among children. Additionally, eliminating dental benefits for adults would have decreased the number of providers who will accept MassHealth, limiting access for children.

This victory is the direct result of the effective integration of communications and advocacy. We generated countless phone calls to legislators and the administration, made several literature drops at the State House, had numerous meetings with policy makers, ran advertorials that raised the profile of oral health, sent press releases far and wide, and a leveraged a tremendous amount of teamwork and participation from each member of the Taskforce.

We would like come together again to thank Governor Patrick for supporting the kinds of programs and policies that promote public health and connect the mouth to the rest of the body. Please take a moment to call the Governor and thank him. You can reach his constituent services office at 617.725.4005. Tell them that you are a member of the Oral Health Advocacy Taskforce and that you are calling to thank the Governor for preserving MassHealth Adult Dental Benefits, and for recognizing oral health as an essentail part of overall health. Let him know that the Taskforce looks forward to working with him to identify new sources of revenue, such as closing the tax loophole on Other Tobacco Products.

We will continue our work to keep oral health safe- the state in general and MassHealth in particular still faces deficits and we must continue to be vigilant in our advocacy. Please stay tuned in the coming weeks as we continue to advocate for oral health in the Commonwealth!

-Christine Keeves

October 30, 2009

As the second phase of Commonwealth Care Bridge enrollment begins, here is some important information that may be useful to you:

November 1st Enrollment
Over 10,000 residents in the northern and southern parts of the state are expected to be automatically enrolled into Commonwealth Care Bridge on November 1st - Sunday. Here’s what to expect:

  • Saturday 10/31 - Monday 11/2: New members in the north & south regions receive confirmation letter from Connector. Click here for a sample letter.
  • Click here for a list of towns in each region.
  • Beginning Monday 11/2: New members can call CeltiCare customer service at 866-895-1786 to find out if their provider accepts CommCare Bridge; if not, customer service representatives should be able to help them find a new provider in their area.

Network Development
Meanwhile, CeltiCare continues to expand their network in Greater Boston, and other parts of the state.

  • Click here for an updated list (as of 10/23) of community health centers.
  • Click here for the most recent (as of 10/23) hospital network.

Please note that the addition of Partners HealthCare sites only applies to existing patients.

Additional Information

  • CeltiCare has reaffirmed their commitment to working with individuals in active treatment. Folks with care care transition cases can call 866-895-1786 ext. 65292 for assistance.
  • CommCare Bridge members will not have to pay co-pays for diabetes medications (insulin and diabetic supplies).
  • CeltiCare has committed to providing transportation for patients seeking family planning services under certain circumstances. They are also working with providers in the Boston area to provide van transportation.

If you or someone you know needs assistance you can direct them to the HCFA HelpLine at (800) 272-4232 or click here for our online HelpLine service. We will post more information on the blog as we receive it. If you have additional information to share, please let Suzanne know at scurry@hcfama.org.

Suzanne Curry
Health Reform Coalition Coordinator

October 29, 2009

Citing a new mantra - “Leadership Through Values” - Governor Patrick announced $352 million in cuts to the FY10 state budget this afternoon. He described how he balanced his constitutional duty with his moral values: “Those values include creating good jobs at good wages, offering a world-class education to our kids, delivering quality, affordable health care to our residents, protecting and supporting the most vulnerable – those are the values to which we as a Commonwealth are committed. So as I meet my statutory responsibility to bring the budget in line, I do so according to my moral responsibility to those values.”

The cuts announced today included a $3.5 million reduction in the MassHealth administrative line item; no cuts were made to eligibility or services. In this grim fiscal climate, we applaud the Governor for upholding his commitment to health reform by preserving MassHealth and Commonwealth Care eligibility and services. By preserving MassHealth adult dental benefits, for example, approximately one in ten Massachusetts residents will continue to have access to cost-effective preventive oral health care.

This is not to say that MassHealth is out of the woods for the remainder of FY10, because the agency is operating at a $300 million deficit. The possibility exists for further action in upcoming weeks and months to address the MassHealth shortfall.

In addition to the lack of MassHealth line item cuts, the accompanying legislation proposed a transfer of $30 million from the General Fund to the Medical Security Trust Fund, which pays for medical coverage under the Medical Security Program for unemployed workers. Currently, over 27,000 unemployed individuals and their families in Massachusetts depend on the MSP for affordable health coverage. This transfer will need to be matched with other funding, including adjusting the employer assessment, in order to enable the program to operate next year.

Despite this positive news, there were cuts to many important programs in the Department of Public Health, Department of Mental Health, and in the Executive Office of Elder Affairs. DPH took an $8 million hit and HCFA priorities including the Division of Health Care Quality and Improvement, the Pharmaceutical and Medical Device Marketing Regulation program, and Health Promotion and Disease Prevention were reduced. School-based health, teen pregnancy prevention, and smoking cessation programs were also cut while funding for the primary care workforce development program was eliminated entirely. DMH lost over $10 million in funding, mostly in adult mental health services.

Prescription Advantage was reduced by $5.6 million, likely signaling that premium assistance for low-income Prescription Advantage enrollees will be eliminated. This represents another 14% cut to their budget, after a 30% cut was imposed from FY09 to FY10. AARP noted that Prescription Advantage is a lifeline for thousands of seniors who are struggling to afford their medications. These cuts will surely lead to increases in other costs, as drugs keep seniors health and out of more expensive care.

Cuts will also deeply affect welfare and housing programs for low income people. Some 8,400 families with a disabled member will lose benefits, and 700 families' grants will be reduced. Homeless shelters will also face cuts. The Mass Budget and Policy Center quickly posted an overview of all the cuts.

Governor Patrick filed this adjusted budget with a request to the legislature to grant him authority to make cuts beyond his branch. Every state manager has been asked to take a 9-day furlough and agency heads have been told to make additional personnel cuts which accounts for $35 million. The Governor remained adamant about not cutting local aid because he feels that local towns and cities have been cut enough.
- Suzanne Curry and Jessica Hamilton

October 28, 2009

As the Governor called for last week, the Division of Insurance has announced an ambitious schedule of hearings to look into rising small business health insurance premium rates.

The DOI announcement explains that the hearings will be in two stages. The first stage will consist of 5 "introductory informational" public hearings, Monday through Friday of next week. The hearings will be held in Lowell, Springfield, Boston, Bridgewater and Worcester.

The purpose of the public hearings is to gather comments regarding questions DOI should consider in advance of the main event, dubbed the "Health Plan Hearings."

The second stage of the hearings start on November 9. According to the notice, "Massachusetts health plans will be asked to respond to questions posed by the Division regarding health premiums they charge to small businesses. It is anticipated that these Health Plan Hearings will take place three days per week for a period of at least six weeks." That's S - I - X weeks.

Also posted on the DOI website is an analysis of premium increases for both small and large group plans for each carrier between April 2008 and April 2009. The document begins to answer a key concern of small businesses - that they pay much more than large businesses for the same coverage. The link on the state site is incorrect (in our Firefox browser; it works fine in IE), however, but we figured out the typo and you can read the document here (pdf).

The comparisons show some real differences between the plans. One must look at the data to get the full understanding. For example, for Blue Cross, small group premiums in their less expensive plan increased 14%, while large group premiums for the same plan went up around 10%. This Blue Cross small business plan now costs 9% more than the large business equivalent. In contrast, the cheapest Harvard Pilgrim small group plan went up by 9.2%, while the equivalent large group plan increased 11.9%. For this Harvard Pilgrim plan, small groups pay just 2.9% more than large groups.

For some carriers, however, the comparisons are not between identical plans. One would have to know the differences in benefits to better understand the price differential.

We applaud the Governor and DOI for bringing some transparency and accountability to the insurance premium process. We have long called for a public process that opens up the insurance market. While auto insurance rates have long been considered in the public domain, health insurance has been shrouded for too long. We look forward to the hearings.
- Brian Rosman

UPDATE: DOI also announced yesterday special sessions to look at group purchasing cooperatives for health insurance. These sessions will be held on five Tuesday afternoons, starting November 10. The sessions are as follows:

November 10: general discussion of small group laws
November 17: Group purchasing coops - guaranteed issue, product design and rating rules
December 1: health promotion programs
December 8: consumer protections
December 15: other concerns

October 28, 2009

DangerAs we wait to hear how Governor Patrick plans to make cuts in the state budget to make up for the $600 million dollar deficit, we are fearful that this will include crucial dental benefits for adults on MassHealth. The MassHealth adult dental benefits provide access to dental care for nearly 700,000 vulnerable adults, including more than 120,000 low-income seniors and 180,000 disabled individuals

When left untreated, dental disease can lead to death. Last week, a Michigan woman with disabilities suffered an entirely preventable death caused by an untreated dental infection. This woman was unable to access the treatment that she needed because Michigan recently cut adult dental Medicaid benefits. This is a tragic story, but one that occurs too often when essential services are not available.

Although oral health is a critical part of overall health, it has historically been kept separate from the rest of the body. However, adult dental disease is linked to a multitude of complex health problems such as heart disease, stroke, diabetes, and low-birth weight and premature infant births. It is almost entirely preventable when people have access to prevention and treatment services.

Oral health can also take a toll on our quality of life. Dental disease affects some of our most basic activities of life such as speaking, eating, learning and working. Nationally, more than 51 million school hours and 164 million work hours are lost each year due to dental-related illnesses. Lack of access to dental services leads to needless pain and suffering,

Oral health services provided through MassHealth reduce costs to the state by preventing costly emergency services and decreasing the severity of other chronic diseases. A Kaiser study found the 2002 elimination of dental services merely shifted the cost of care to other parts of the health care system. Cutting adult dental from MassHealth will cause the state to waste millions in extensive and costly services in emergency and inpatient hospital settings.

The Governor is expected to announce his budget cuts soon. Today could be our last day to speak up to protect these vital benefits. Click here to learn how you can help!

-Christine Keeves

UPDATE: The deans of the Commonwealth’s three dental schools, Boston University, Harvard and Tufts University Schools of Dental Medicine and President of Forsyth Institute all agree that dental cuts are dangerous. Click here to read their letter (pdf).

October 28, 2009

I was dying to make a reference to the Jane Curtin-Dan Akroyd point/counterpoint catchphrase in commenting on yesterday's Wall Street Journal, but after hardly anyone on the staff recognized the reference when I used it at a staff meeting a few weeks ago, I'll refrain here. Even fewer remembered the Shana Alexander/James J. Kilpatrick debates used as the model.

Yesterday's WSJ featured a classic he-said, she-said on Massachusetts health reform. The affirmative side, A Great Success, was taken by Michael Widmer of the Massachusetts Taxpayer's Foundation. Mike appropriately starts off his piece with "Facts are a stubborn thing." He then runs down the unquestionable positive impacts of health reform, using real facts and figures:

  • coverage increased by over 400,000, with the uninsurance rate down to 2.6%
  • "the incremental cost to taxpayers has been modest and consistent with projections, an average increase of $88 million each year from fiscal 2006 to 2010, out of a state budget of about $30 billion"
  • "employer-sponsored enrollment has grown by 100,000 since health reform was adopted, during a recession in which total state employment has declined by 100,000"
  • "the number of individuals who have purchased insurance in the private market has more than doubled—to 86,000 from 40,000"
  • "uncompensated care fell 38% during the first six months of 2008,"
  • "employers supported reform by almost a two-to-one margin in a 2008 poll"

Mike describes individuals whose lives were dramatically improved due to health reform, and questions the critics: "the overwhelming success of the effort in our state makes a compelling statement that national reform can succeed. One wonders why critics have been so zealous in distorting the facts to "prove" that the Massachusetts reform is a failure. This is not some theoretical discussion but a real achievement and lifeline for hundreds of thousands of Massachusetts citizens."

On the other side is Grace-Marie Turner, who titles her piece, "Costs Keep Rising." Turner heads an the Galen Institute, a far-right policy center funded almost exclusively by the pharmaceutical and medical industries. For example, their 2007 IRS filing (see page 23) shows $1 million coming from Pfizer, and large donations from Aetna, Eli Lilly, Phrma, Aventis Pharmaceutical, Amgen biotech, and GlaxoSmith Kline.

Turner hammers at the high health costs in Massachusetts, ignoring the fact that everything is more expensive in Massachusetts, and that our plans here are on average much more generous than those in other states. She cites a smattering of other problems, like continued use of emergency rooms for non-urgent care, problems with fair share compliance, or funding difficulties at safety net hospitals. None of these issues affect the core of Widmer's solid argument.

By the way, Turner didn't need any evidence to convince her that Massachusetts health reform is a failure. She argued against the plan in October 2006, before much the law even began implementation.

On the other hand, Widmer's Taxpayers Foundation is fiercely independent, and uses detailed fact-based inquiry as the starting point for their analysis.

The Wall Street Journal has been a strident opponent of Massachusetts health reform from the start. The juxtaposition of Mike Widmer's solid analysis with some tendentious arguments by an ideologue shows the sorry state of their opposition.
-Brian Rosman

October 28, 2009

Last week, the Legislature’s Joint Committee on Public Health held a hearing on health insurance and financing related bills. The hearing was chaired by Senator Fargo and Representative Sanchez and began with an executive session to favorably report out S. 810. This bill establishes a permanent Office of Health Equity in the Executive Office of Health and Human Services, and is priority of the Disparities Action Network.

Two HCFA priority bills were heard:

Dr. Cathryn Samples of Children’s Hospital Boston testified on behalf of S. 54. Dr. Samples testified that expanding MassHealth services to all recipients through age 20, “is right and fiscally responsible.” As a physician in a clinic that provides 15,000 visits to 5,000 patients per year, she noted that most of her patients were MassHealth beneficiaries. She also explained that this bill could provide access to healthcare for the majority of uninsured youth who come from poor households and would qualify for MassHealth services. In her testimony, Dr. Samples gave three specific reasons for supporting the bill. The continuity of coverage would provide stability for youths and keep any of their chronic conditions under control. Keeping youths covered under MassHealth until age 21 would also simplify administration of the program which is often a daunting process to adults let alone youths. MassHealth in its implementation is a simpler and more straightforward way to ensure that young people have health insurance coverage. We blogged more details last week.

The ACT!! Coalition panel testified on behalf of H. 4258/S. 873. Neil Cronin from the Mass Law Reform Institute set the tone for the content of the panel. He explained that this bill seeks to make some “policy tweaks” to Chapter 58 including CommCare eligibility provisions, reimbursement of interim services, and the inclusion of a Fair Hearings officer in the appeal process. He explained how CommCare provisions often lead to gaps in coverage because eligibility only occurs a month after the month of enrollment in the plan. Mike Sroczynski of Mass. Hospital Association described how the bill would allow the Health Safety Net coverage to be retroactive to all eligible patients.

In her testimony, Suzanne Curry, the ACT!! Health Reform Coordinator explained that the bill makes permanent the EOHHS health outreach unit. It would also create an advisory committee to oversee the program. She also spoke about the importance of outreach and the way it helps people navigate the health care system by connecting people to coverage, as well as to care and providers. A major component of the bill is to employ culturally and linguistically competent outreach workers who will be able to strengthen the lines of communication surrounding healthcare reform. Allyson Perron from the American Heart/American Stroke Association demonstrated the need to prohibit lifetime caps in all health insurance by telling the story of Jake. Jake needed to have three heart surgeries within the first two years of his life and by age four, had used half of his $1 million lifetime cap. He is 14 years old now and doing well but has about $750,000 in medical bills each year and thankfully now has a plan without a lifetime cap.

Several other bills were heard. The single-payer bill, H. 2127 (“An Act to Establish the Massachusetts Health Care Trust”) received extensive testimony. Co-sponsors Rep. Matt Patrick and Senator Patricia Jehlen spoke passionately in support of the bill, while Jehlen acknowledged its lack of political feasibility.

Testimony was also heard for S. 848, “An Act Relative to MassHealth Enrollment for Persons Leaving Correctional Facilities,” from James Walsh of the Massachusetts Association of Sheriffs and Marilyn Morningside of the Health Services Administration at a western MA correctional facility. They explained that most prisoners were MassHealth eligible when entering the corrections system, but have no MassHealth card when released. They believe enrolling this population of approximately 15,000 people will not add significant costs to the state’s bottom line because this population was already part of the state healthcare system whether through MassHealth or the corrections system. Furthermore, they argue that without proper healthcare services, these inmates could wind up back in the corrections system, which would cost the state even more money.

The public hearing was a powerful display of ideas and Massachusetts ingenuity. Panelists provided very touching and informative testimony aimed at improving and streamlining health care processes in Massachusetts.
- Yelena Kuznetsov

October 27, 2009

The Health Disparities Council held its monthly meeting on Monday. Chaired by Representative Rushing and EOHHS Secretary Bigby, the members focused on legislative opportunities to address health disparities in Massachusetts. Public Health Committee Chair Jeffrey Sanchez opened the meeting with a report on recently moved bills S.810 and S. 811, that codify the EOHHS level Office of Health Equity and establish community based disparities grants. The Representative emphasized the Committee’s dedication to health equity and the need for Council support and advocacy to maintain momentum for the legislation. Disparities Action Network (DAN) Co Chair Elmer Freeman also reported on the legislation, providing additional details on the bills and current advocacy efforts. Secretary Bigby thanked the Public Health Committee Co Chairs for the legislation’s progress, and acknowledged the advocacy support of the DAN. The Disparities Council voted and approved a new working group to monitor and advocate for legislation such as S.810, that support the Council’s mission and efforts. The Council continued engagement in legislative matters with two presentations and a discussion on the state’s emerging work on payment reform. After an overview of the Health Care Cost and Quality Council’s roadmap by Katherine Shea Barrett, Health Care For All’s Georgia Maheras provided a consumer framework for the payment reform challenge. She highlighted issues of particular relevance to the Council including medical homes, workforce development, social determinants of health and consumer engagement. Members posed questions and discussed issues around disincentives to treat high risk patients, payments for mental health and medical interpretation services, and malpractice reform. The Council agreed to further discussions and possible advocacy through the newly developed legislative working group. The Council holds its next meeting on November 16th from 2pm-4pm. Please visit the Health Disparities Council webpage for more information. Camille Watson

October 27, 2009

Martha Bebinger, on leave from WBUR to participate in the Nieman fellowship at Harvard University, has written a solid, hopeful summary of the Massachusetts payment reform process for the journal Health Affairs. Bebinger's article, Mission Not Yet Accomplished? Massachusetts Contemplates Major Moves On Cost Containment, is an editor's choice selection and is thus currently available for free on the Health Affairs site.

And Rep. Jason Lewis (D-Winchester) has published an op-ed lauding payment changes as the next phase for Massachusetts reform.

Rep. Lewis clearly lays out the advantages of global payments over the current system:

Under the current fee-for-service system, doctors, hospitals and other healthcare providers are compensated for each test and procedure they perform. This creates incentives to provide more tests and procedures, and more expensive services. Doctors and hospitals tend to be divided into silos, which makes it difficult to coordinate care. Primary and preventive care are under-compensated and thus underutilized. In sum, we have a system today that rewards “inputs” rather than what really matters, the health and well-being of patients.

Conversely, a system of global payments would reward doctors and hospitals for keeping patients well. Groups of coordinated providers would receive a payment designed to cover all of a person’s needed care over a period of time, adjusted for health status and other risk factors. They would work closely together to manage all of the care that a patient requires. Patients would receive more preventive care, and better overall management of their health needs.

Bebinger's article affirms Lewis' point. She describes in detail the success Mount Auburn Hospital and its physician network, the Mount Auburn Cambridge Independent Physician Association (MACIPA). They have been receiving global payments from insurers for years, and making it work:

The main reason that global payments work, says [MACIPA president Barbara] Spivak, is that the system has been motivated to invest money up front in care management and coordination. Taking aim at the costly problem of hospital readmissions, for example, Mount Auburn now employs case managers who conduct home visits with patients who’ve recently been discharged from the hospital. The case managers do home safety evaluations, checking for something as simple as whether there are slip-proof mats under rugs to prevent falls—a common and particularly dangerous injury for seniors. When a patient goes into a hospital for a hip fracture, Dr. Spivak notes, the cost can run $40,000–$50,000; by contrast, preventing the fracture costs about $1,000, she says.

The shift to global payments has also produced a very different medical culture within the system—starting with primary care physicians, who are now at the front lines of managing patients’ care in a way that is "completely upside down from the way a lot of other places are structured," says Mount Auburn president and CEO Clough. In most health systems, specialists are in charge on the physician side, and the hospital runs its own show. "It takes a lot of different thinking on the part of the hospital to be at the mercy of a primary care network" and let doctors largely control risk-based contracts, Clough says. ...

Patients also get the benefits of having close contact with their personal physician while still being part of a system. They get letters signed by their primary care doctors reminding them that it’s time for a colonoscopy or a mammogram; few if any probably have any idea that these letters are generated en masse by the IPA through electronic review of patient records. When patients do see their physicians, they also get an earful about the importance of preventive measures. During recent office visits, Dr. Haft pushed one patient to try one more method to quitting smoking, and another to get a colonoscopy.

Bebinger explains in detail the political obstacles involved in getting fundamental change implemented in Massachusetts, and cites cautions from major providers and a comparison to the Big Dig. She quotes consumer groups (er.. me, and GBIO's Rev. Hamilton), saying that consumer protections need to be upfront. Overall, both pieces provide a good preview of the payment reform debate to come.
- Brian Rosman

October 27, 2009

Lots of interesting reports out in the past few days looking at Massachusetts health care access. Individually, each presents a slightly different picture, based on what they looked at and how they looked at it. One theme is that while Massachusetts health reform has done a remarkable job of increasing access for hundreds of thousands of residents, we still have a long way to go to address the striking health disparities that exist among racial and ethnic minority populations. Here's a rundown:

1. First, DHCFP's new 2009 Health Insurance Survey (ppt). The survey confirms the progress made in extending coverage. The overall uninsurance rate was 2.7%, statistically identical to last year's 2.6%. The report estimated that about 171,000 people did not have coverage at the time of the survey, which was conducted between March and June 2009.

The survey found uninsurance was highest among Hispanic residents at 5.1%. In contrast, the uninsurance rate for white, non-Hispanic residents is less than 3%. Some 73% of those surveyed said they support health reform in Massachusetts, up from 64 percent in 2006.

2, Second, DPH released their annual Behavioral Risk Factor Surveillance System (BRFSS) survey (click here for all the reports). This report is the first MA BRFSS publication that summarizes health survey results for selected cities. This is supplementary to the statewide annual BRFSS report and aims to provide health behavior data at the sub-state level, targeting specific population groups. “A Profile of Health Among Massachusetts Adults in Selected Cities, 2008” details results from 7 Massachusetts cities chosen for their racial and ethnic diversity: Boston, Worcester, Springfield, Lawrence, Lowell, Fall River, and New Bedford. The report includes great information about overall health; health access and utilization; risk factors and preventive behaviors; chronic health conditions, cancer screening, and trends on these measures between 2000-2008.

Considering several social factors, include race/ethnicity, income, education level, disability, age group and gender, the survey finds that the seven cities studied have higher rates of uninsured adults and many have worse health outcomes than the state average.

Some of the major findings include:

  • Overall health measures: Adults in six of the seven cities were more likely to report fair or poor health than adults living in Massachusetts overall.
  • Health Insurance Status: New Bedford, Lowell, and Lawrence had a higher uninsurance rate than the state overall; Boston, Fall River, Worcester, and Springfield met the state average. In each of the cities, Hispanics are anywhere from two to four times as likely to be uninsured than whites.
  • Access to Providers: Adults in Boston, Lawrence, Lowell, and New Bedford were more likely to report that they did not have a personal health care provider than adults in Massachsuetts overall.
  • Affordability: More adults than average in Lawrence, Lowell, Springfield, and New Bedford reported that they were unable to see a doctor due to cost in the past 12 months.

3. Finally, the Connector released its annual report for 2009 (pdf).

The report is full of detailed information on the Connector's accomplishments and progress. Detailed appendices present statistics and reference information. The report puts in context the issue of access to care, comparing MA to national average:

These reports all add to our updated picture of the health reform in 2009.
- Brian Rosman, Dayanne Leal and Suzanne Curry

October 26, 2009

NPR’s Morning Edition today featured a story about efforts by certain colleges to more effectively address the mental health needs of their students. A wide-ranging piece, there were some points worth pulling out and thinking about.

Stigma remains a tragically persistent barrier for many individuals and families touched by mental illness. That colleges are recognizing that this is a major issue and are devoting resources to helping their students is to be commended. Every time there is an acknowledgement of mental health needs, it is one more step we are taking toward a day when illnesses of the brain are treated no differently than those of kidneys or lungs.

One troubling anecdote in the story was the way in which local police responded to a 911 call about what the caller believed to be a potentially suicidal student. Of course, the caller was 100% correct in calling for help (far better to err on the side of caution than to do nothing and risk tragic consequences) and the police did what they thought necessary to prevent a death. However, certain aspects of the police response (shouting, aggression, threats of involuntary hospitalization) show a lack of training and understanding of how to deal with mental health needs. The Parent-Professional Advocacy League has prepared a guide for police responding to youth with mental health needs that should be mandatory ready nationally.

Some of the challenges highlighted in the article are almost exactly the same as what we have found here in Massachusetts: long wait lists for young people to see mental health providers; high costs associated with care; undiagnosed mental illnesses that developed during early teen years; and a reexamination of the role of schools (either secondary or post-secondary) as health providers for students.

In state advocacy work, it’s always nice to see how what you’re doing connects to a larger, national scene. The omnibus legislation passed last session and this session’s coordination of care bill are both significant steps down the path toward addressing the very concerns raised by NPR.

Matt Noyes
Policy Manager

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