May 2010

May 28, 2010

When the omnibus Act Relative To Children’s Mental Health (Chapter 321 of the Acts of 2008) was signed into law last year, there was one provision that was not included: reimbursement for collateral contacts by commercial insurance.

Collateral contacts can be more accurately referred to as coordination of care. When an adult is working with a mental health professional, the adult can typically express what is going on in his or her life directly to the clinician in such a way as to make treatment effective. When it is a seven year old, it’s not so simple.

Children are not little adults. To have treatment of mental health needs be effective, it is vital that the treating clinician speak to other people in the child’s life – parents, teachers, pediatrician, etc. Only through this coordination will the child have the best chance to have his or her mental health needs addressed properly.

Of course, to protect the privacy of the young people involved, this type of coordination would only be done with parental consent.

In Massachusetts, the state already reimburses mental health clinicians for collateral contacts when children are covered under MassHealth. Commercial insurance, on the other hand, does not provide this benefit. Mandating reimbursement for collateral contacts will ensure that care coordination is the standard practice rather than an exception to the rule.

The collateral contacts piece of Chapter 321 was not included in the final version of the law because a cost analysis had not been completed by the Division of Health Care Financing and Policy. The cost review was completed late last year and it found that collateral contacts are extremely inexpensive – 5.5 cents per member per month or 0.01% of total premium costs.

This piece of the original omnibus bill was refiled for the current legislative session as H. 3586 / S. 757, An Act Relative To Coordination of Children’s Mental Health Care, and was heard yesterday by the Joint Committee on Mental Health and Substance Abuse.

Testimony was given in support of the legislation by two panels.

On the first panel, Dr. David DeMaso, Psychiatrist in Chief at Children’s Hospital Boston and Professor of Psychiatry and Pediatrics at Harvard Medical School, illustrated the importance of coordination of care by asking Senate Chair Jen Flanagan to imagine herself as a third grade teacher with a student displaying mood swings and classroom outbursts. In an effort to more effectively attend to the behaviors while also teaching the other students, isn’t it a good idea to talk with the child’s psychiatrist, Dr. DeMaso asked.

Similarly, Dr. DeMaso asked House Chair Liz Malia to put herself in the shoes of a pediatrician treating a young woman with severe asthma. Before changing her patient’s medication to address her asthma, wouldn’t it be responsible for her to speak to her patient’s mental health clinician to avoid a potentially dangerous interaction with her antidepressant medication?

The second panel featured testimony from Central Massachusetts: Cathy Apostolaris from the Winchendon Project, Tony Poti from the Choices Program, and Dr. David Keller, a pediatrician from Webster. For all three of these individuals, care coordination has been vital to the success of their work.

Passage and enactment of An Act Relative To Coordination of Children’s Mental Health Care is the top legislative priority of the Children’s Mental Health Care. More effective coordination of care is an important step in addressing the mental health needs of Massachusetts’ children.

Matt Noyes
Children's Health Coordinator

May 28, 2010

In our last blog post, we detailed a number of the budget amendments HCFA supports. Most of the amendments would add spending to the budget. We also support a number of proposals that would add spending that are not being considered for next year's budget, like re-integrating legal immigrants into Commonwealth Care, or rebuilding our tobacco control and other public health programs that have been drastically cut over the past 5 years.

Which leads to the legitimate question - how can the state afford to increase spending on these health programs you advocate for?

For one, we think there are number of real, immediate savings that can be found in the state's health budget that would save costs and improve care. For example, other states are beginning to reduce payments to hospitals with high rates of preventable complications. This flips the current incentives, where hospitals make more revenue from poorly coordinate care.

May 28, 2010

April begins the federally recognized National Minority Health Month -an opportunity to examine the health of communities of color across the nation and in the Commonwealth. Despite notable health insurance reforms at both the state and national levels, there is still significant work to do to improve the health of communities of color. Costly health disparities continue to plague the state and the nation, and health insurance alone is not sufficient to improve these inequalities. A broader strategy that allows everyone to live in a healthy community is critical for improving the health status of racial and ethnic minorities.

Communities of color suffer disproportionately from a host of diseases including asthma, obesity, heart disease, diabetes, and specific cancers. Even when individuals of color have access to insurance, they often face challenges to good health due to other social issues including employment and education barriers, insufficient housing and transportation, food insecurity, and stress. These barriers to good health must be addressed in addition to health insurance reforms, in order to truly reduce health disparities.

With much of the nation’s future dependent upon the health and productivity of all its citizens, eliminating health disparities must become a community and policy priority.

This National Minority Health Month, learn more about health disparities and how to advocate for health equity by visiting HCFA’s Health Disparities pages.

Also, visit the federal Office of Minority Health’s site, which this year, celebrates the role of men of color in reducing health disparities.
-Abby Animashaun

May 28, 2010

Given the current economic climate, states are searching for ways to cut back costs.  Eight months ago, California made drastic cuts to dental benefits for adult Medicaid recipients, leaving 3 million poor and disabled Californians uninsured for dental cleanings, exams, filings, root canals and dentures.  Massachusetts threatens to follow their lead with similar cuts. 
Oral health is an essential part of overall health. If left untreated, dental disease can impact other chronic health conditions such as heart disease and diabetes, and can interfere with basic life activities, such as eating, speaking, learning and working. 
Unable to pay for dental services out of their own pockets, California Medicaid patients are forced to delay care until dental pain is intolerable and their only option is extractions, the only dental service still covered.  A recent story on NPR reported that dental schools and free clinics in California have been overrun or have been forced to close and while dentists are offering discounts and payment plans, low income adults cannot afford these options.  (www.npr.org/templates/story/story.php?storyId=123855834&ft=1&f=1027)

Proposed cuts in Massachusetts would leave almost 700,000 residents, including more than 120,000 low-income seniors and 180,000 disabled adults without critical oral health benefits.  Like California, many easily-solved oral health problems will instead become needless pain and suffering.  Extractions will remain the only option to prevent infections from spreading throughout the body. 

Massachusetts has led the country on healthcare reform and yet, threatens to cut oral health out of the picture despite the link between oral health and overall health.  Dental prevention and treatment services also 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.

Let’s learn our lessons from California’s experiences.  We must preserve MassHealth adult dental benefits to ensure healthy communities and avoid unnecessary healthcare costs. 

Tiana Wilkinson
Oral Health Intern

May 28, 2010

 

Given the current economic climate, states are searching for ways to cut back costs.  Eight months ago, California made drastic cuts to dental benefits for adult Medicaid recipients, leaving 3 million poor and disabled Californians uninsured for dental cleanings, exams, filings, root canals and dentures.  Massachusetts threatens to follow their lead with similar cuts. 
Oral health is an essential part of overall health. If left untreated, dental disease can impact other chronic health conditions such as heart disease and diabetes, and can interfere with basic life activities, such as eating, speaking, learning and working. 
Unable to pay for dental services out of their own pockets, California Medicaid patients are forced to delay care until dental pain is intolerable and their only option is extractions, the only dental service still covered.  A recent story on NPR reported that dental schools and free clinics in California have been overrun or have been forced to close and while dentists are offering discounts and payment plans, low income adults cannot afford these options.  (www.npr.org/templates/story/story.php?storyId=123855834&ft=1&f=1027)

Proposed cuts in Massachusetts would leave almost 700,000 residents, including more than 120,000 low-income seniors and 180,000 disabled adults without critical oral health benefits.  Like California, many easily-solved oral health problems will instead become needless pain and suffering.  Extractions will remain the only option to prevent infections from spreading throughout the body. 

Massachusetts has led the country on healthcare reform and yet, threatens to cut oral health out of the picture despite the link between oral health and overall health.  Dental prevention and treatment services also 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.

Let’s learn our lessons from California’s experiences.  We must preserve MassHealth adult dental benefits to ensure healthy communities and avoid unnecessary healthcare costs. 

Tiana Wilkinson
Oral Health Intern

http://www.npr.org/templates/story/story.php?storyId=123855834&ft=1&f=1027

May 28, 2010

Given the current economic climate, states are searching for ways to cut back costs.  Eight months ago, California made drastic cuts to dental benefits for adult Medicaid recipients, leaving 3 million poor and disabled Californians uninsured for dental cleanings, exams, filings, root canals and dentures.  Massachusetts threatens to follow their lead with similar cuts. 
Oral health is an essential part of overall health. If left untreated, dental disease can impact other chronic health conditions such as heart disease and diabetes, and can interfere with basic life activities, such as eating, speaking, learning and working. 
Unable to pay for dental services out of their own pockets, California Medicaid patients are forced to delay care until dental pain is intolerable and their only option is extractions, the only dental service still covered.  A recent story on NPR reported that dental schools and free clinics in California have been overrun or have been forced to close and while dentists are offering discounts and payment plans, low income adults cannot afford these options. 

Proposed cuts in Massachusetts would leave almost 700,000 residents, including more than 120,000 low-income seniors and 180,000 disabled adults without critical oral health benefits.  Like California, many easily-solved oral health problems will instead become needless pain and suffering.  Extractions will remain the only option to prevent infections from spreading throughout the body. 

Massachusetts has led the country on healthcare reform and yet, threatens to cut oral health out of the picture despite the link between oral health and overall health.  Dental prevention and treatment services also 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.

Let’s learn our lessons from California’s experiences.  We must preserve MassHealth adult dental benefits to ensure healthy communities and avoid unnecessary healthcare costs. 

Tiana Wilkinson
Oral Health Intern

May 28, 2010

Our partners at Community Catalyst have

May 28, 2010

Many people are unaware that the health reform bills being debated in Congress are packed with ways to make health care safer and more accountable to patients. While Massachusetts has made strong strides in this area, national reform would strengthen our state's ability to provide safe, high quality care.

Too often, patients are getting harmed by their medical care. In American hospitals, a patient dies every 5 minutes from a largely preventable infection. Medical harm, including hospital-acquired infections and medical errors, accounts for more than 100,000 deaths every year—our parents, grandparents, children, loved ones, and friends are among the millions harmed each year. Hospital infections alone add an extra $45 billion to our national health care costs each year. As Congress continues to debate over health care, the American people should understand that current health reform proposals would improve the safety and quality of our health care.

The House health care bill (HR 3200) includes public reporting of infections for all hospitals and outpatient surgical centers. States with hospital infection public reporting laws are more likely to be motivated to improve the quality of their care, according to Dr. Peter Pronovost. In the past two years, Pennsylvania’s public reports documented an 8% drop in the statewide infection rate, with a majority of the state’s hospitals showing a decrease. Twenty-seven states now have reporting laws in place, but only 17 have published reports so far (the first Massachusetts report is coming out this spring) – it’s time for a national law so all US patients can see their hospitals’ infection rates.

The Senate health care bill also includes public reporting of hospital-acquired infections and medical errors on Medicare’s list of “hospital-acquired conditions” that the federal program no longer pays for.

Both bills include new policies that will reduce payments to hospitals when too many of their patients have unplanned readmissions after a prior hospital stay. This will create a strong incentive for hospitals to ensure that patients are receiving appropriate care – some have to come back because of an error or infection or because discharge procedures or care transitions are not done well. A 2009 study found that almost 20% of Medicare patients were readmitted within 30 days of their hospitalization, and 34% were back in the hospital within three months at a cost of $17.4 billion.

As Congress puts the final touches on health care reform, they should also ensure that the health care we get is safer and better.

Lisa McGiffert, Campaign Manager, Consumers Union Safe Patient Project

May 28, 2010

Remember that study by researchers from the Cato Institute, where we claimed the authors "ignore relevant evidence, make egregious errors and unwarranted assumptions, and reach a pre-ordained conclusion." The study, quoted in the Wall Street Journal and the Washington Times, claimed health reform is a major failure in Massachusetts.

Experts at the Urban Institute reviewed the study, and wrote a detailed response. Here's the conclusion of researcher Sharon Long:

Contrary to what YC [Cato authors Aaron Yelowitz and Michael F. Cannon] report, we find no evidence of an increase in nonresponse on the health insurance questions in the CPS and, thus, no support for YC’s conclusion that available survey data understate the current levels of uninsurance in Massachusetts and no support for the conclusion that prior studies have overstated the impacts of health reform. We also find no evidence that public coverage has crowded out employer-sponsored insurance coverage for higher income families, the appropriate focus for an analysis of crowd-out. Finally, we find reason to question YC’s findings related to health status and in-migration given the limitations of the data and methods used.

That's polite academic talk for what Congressman Wilson yelled at the President last year.

The Urban study is a detailed rebuttal of the Cato claims, properly footnoted and attributed. We thought we should post the link, to close the circle on this.
-Brian Rosman

May 28, 2010

Back in August, we wrote a blog about young people with mental health needs ending up in prison for lack of community resources.http://blog.hcfama.org/?p=3386

While it doesn’t take much of an intellectual leap to imagine how inappropriate this setting would be for mentally ill youth, earlier this week, the New York Times published a story http://www.nytimes.com/2009/12/14/nyregion/14juvenile.html?_r=1&hp=&pagewanted=all highlighting the conditions faced by these young people.   

Most official estimates of the numbers of young people involved with the juvenile justice system who have mental health needs are typically in the 75% range.  Talk to anyone who is familiar with the system, and they will tell you the percentage is much higher. 

Locking up a mentally ill young person does not address the underlying reason why they were imprisoned in the first place, and without adequate treatment while incarcerated, the reasons are not going to go away. 

As the Times article shows, youth correctional facilities are dramatically unsuited to address mental health needs of inmates. 

We must get out in front of this issue – not only should we improve treatment for those behind bars, but we have to do more to identify and treat mental health needs early.  Only then can we hope to reduce the numbers of young people involved with the juvenile justice system. 

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