August 2010

August 31, 2010

EOHHS has set up a new website to be the central source of official information on the implementation of the Affordable Care Act in Massachusetts: mass.gov/NationalHealthReform.

The site includes grant and demonstration opportunities, letters of intent, an implementation timeline and information for employers, as well as links to outside resources. The state promises that after this initial offering, the site will grow as more information and funding opportunities become available.

We're pleased to see the site and look forward to more and more information coming online.
-Brian Rosman

August 31, 2010

The Quality and Cost Council’s newest committee, the Committee on the Status of Payment Reform Legislation, is holding its first meeting tomorrow, September 1, 10:30-11:30am at 1 Ashburton Place, 21st floor (download agenda (pdf)). HCFA is one of a number of organizations represented on the committee.

As described on this QCC webpage, the committee is charged with reviewing drafts of payment reform legislation, soliciting input from interested stakeholders, and giving recommendations to the QCC on key decision points regarding payment reform legislation. The committee will meet the first Wednesday of every month and meetings are open to the public.
-Deborah W. Wachenheim

August 30, 2010

Compartmentalization of mental health within the medical profession and stigma related to mental illness has meant that definitions and diagnosis are often difficult to nail down. Not too long ago, mental health was thought to be inapplicable to adolescents because since they were still developing physically, they could not suffer from mental illnesses. Now we know that many young people, including teenagers and even grade school students have mental health needs.

But what about children as young as 3 or 4?

Yesterday’s New York Times Magazine asks an important question: Can Preschoolers Be Depressed?

To be sure, this is a controversial subject. From where we stand today, there are many who cannot accept that there are very young children who have very real mental health needs. As the article points out, there is a difference between the sadness a child experiences when they drop their ice cream cone and deep, lasting depression that becomes debilitating.

There is a strong case to be made for early diagnosis and treatment. We are still somewhat in the early phases of this, but clinicians have found that children as young as 4 years old appear to respond to treatment better than older children – perhaps due to similar brain development factors that allow younger children to better learn new languages.

Here in Massachusetts, we have experienced first hand the positive impact of identifying and treating mental health needs at an early age. Worcester’s Together For Kids Coalition worked in early education settings, providing mental health counselors to work with children displaying behavioral health issues. They found that not only did expulsions from preschools go down, but special education costs the following year in kindergartens across Worcester fell.

The earlier we find children with mental health needs, the better the outcome for everyone – including taxpayers.

The time is NOW to reform the children’s mental health system so all young people can get the help they need.
-Matt Noyes

August 30, 2010

In 2008, Lisa Knapp Stillman shared her personal story of caring for her twenty-four year old son with severe mental illness (SMI). Of all of the struggles she has faced, she emphasized the effect of his illness on his oral health:

“Within one year of my son’s diagnosis, after taking the prescribed medications, his teeth began to disintegrate. Because his medications caused him to have dry mouth coupled with the negative symptoms of his SMI, his teeth developed severe decay that led to over $15,000 in dental reconstruction. We were fortunate that we could provide dental treatment for him, whereas many others with SMI are not that fortunate and consequently lose their teeth.”

After several years of hard work, Ms. Stillman has created the “Dental Voice for Mental Health” project with her sister. The goal is to increase awareness of oral health needs for people receiving mental health treatment, as “mental health care recipients are being left out in the cold when it comes to oral and dental health.”

This project is just one of many that demonstrates how oral health is a critical part of overall health. Ms. Stillman has done a fantastic job of using her voice to speak up for oral health. For more information on how you can be part of this movement, please visit www.hcfama.org/oralhealth.
-Christine Keeves

August 30, 2010

Last Sunday's Boston Globe lead editorial echoes many of the concerns of consumers across the Commonwealth who are questioning the proposed sale of the Caritas Christi hospital chain to the Wall Street private equity firm Cerberus.

While acknowledging that the proposal “sounds good” and would bring capital and jobs to the state, The Globe raises a number of questions that need to be answered before the state moves ahead with the largest conversion of a non-profit hospital chain to a for-profit business in the state’s history.

Just as important, the Globe puts the responsibility of protecting the interests of Main Street over the interests of Wall Street exactly where it should be, on the desk of Attorney General Martha Coakley. Coakley’s review of the sale and subsequent conditions and stipulations on the sale are the key to keeping this deal safe for consumers.

For the past three months consumers have been demanding to see more details of Cerberus’ business plan. They asked, “How are they going to meet all its new financial obligations as a for-profit (local taxes, state taxes, and healthy dividends to its investors) while maintaining accessible, affordable and high quality health care?” The Globe editorial demands, “a clearer sense of how [Cerberus] plans to achieve these goals. . .” The Globe question the process saying the “firm should have already shared a detailed business plan with the public.”

As with residents in host communities, the editorial highlights concerns about the long-term commitment of this private equity firm (which has never run a hospital) to operating these six hospitals and serving the communities. “The Attorney General should press Cerberus to extend its time commitment to at least 7 years. . . it would illustrate the firm’s commitment to the long term viability of the state’s health care system.”

In a perfect world, private equity deals are win-win situations in which the public gains and the investors make a lot of money. We all know that there are always bumps in the road and The Globe asks the public and Attorney General Coakley - “Consider what happens if Cerberus’s gamble goes bust? . . . Will Caritas raise prices? Cut services? Close facilities?”

With the health of so many residents at stake, we need to make sure Attorney General Coakley puts conditions in place to ensure that the new owners will have the capacity and the will, now and in the future, to continue to provide accessible, affordable and high quality care across the Commonwealth.
-Matt Wilson

August 26, 2010

Last January, Massachusetts’, and the world’s, attention was drawn to South Hadley when tragic events made the issue of bullying a front page story. The legislature acted quickly, passing and enacting new legislation designed to address the issue.

Earlier this week, the Department of Elementary and Secondary Education announced guidance to assist schools in designing plans to respond to bullying.

In working to address bullying, we need to remember that mental health is an important component. Not only is there the obvious implications of the mental health impact on bullying victims, but there is a lesser-known and more uncomfortable component: in some cases, young people who engage in bullying have mental health needs of their own that are insufficiently addressed.

This is not to excuse bullying by any means – schools must do everything they can to ensure that their students have a safe environment in which to learn. However, we can’t effectively deal with bullies unless we are able to see the whole field – all of the factors that come into play to make a bully.

The Children’s Mental Health Campaign was pleased that the final version of the so-called Bullying Bill included language from Chapter 321 of the Acts of 2008 (the omnibus Children’s Mental Health statute) directing schools to follow the guidelines set up under Chapter 321 when developing a bullying policy.

We still have a long way to go when it comes to both bullying and mental health. But it is heartening to see that both the Legislature and the Patrick Administration recognize the significance of each and the interconnectedness of both.

The time is NOW to end bullying and reform the children’s mental health system!
-Matt Noyes

August 26, 2010

As described in a NY Times article Tuesday, Governor Paterson of New York last week signed into law a bill requiring physicians treating patients with terminal illnesses to offer to share information with them or their representatives about end-of-life care options, including palliative and hospice care and other options for life-sustaining treatment. You may remember that something similar was included in drafts of national health reform bills until the provision (to reimburse doctors for taking the time to have these discussions with patients) was described as creating “death panels” and legislators then retreated from any support for it in fear of the response. The New York law requires doctors to provide the information only if the patients want to know the options. As is described later in the article, it is one thing to require doctors to have these conversations and another to train them so they feel prepared to have the conversations. More training needs to be done in nursing and medical schools in how to have these discussion with patients families.

In Massachusetts, the Expert Panel on End of Life Care presented its draft recommendations to the Quality and Cost Council last spring (see the presentation (ppt)). We are awaiting the final report and then next steps on implementation of the recommendations. One project that is already under way in MA is the MOLST demonstration project. A MOLST (Medical Orders for Life-Sustaining Treatment) form is completed by a patient or health care agent and a health care provider and it describes the treatments a patient wants or does not want at the end of life. The demonstration project, mandated by the MA legislature, is currently taking place in the Worcester area. Lessons learned from the project will be applied toward expanding the MOLST program statewide.
-Deborah W. Wachenheim

August 26, 2010

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The room at a recent MassHealth regulations hearing was packed, as some 100 people came out to show their support of oral health. Among these participants, 17 chose to stand up and explain why access to dental care through MassHealth is important to them.

Speakers at the hearing came from a wide array of backgrounds, but all agreed on one thing: oral health is a crucial part of overall health. Highlights of the testimony are in the video above.
-Christine Keeves

August 26, 2010

Apparently, it's in the blogger code to preface all discussion on the formerly-arcane issue of health insurers' "medical loss ratio" (MLR) with a comment on the term. It does always strike me as odd that, from an insurer's accounting point of view, paying for medical care for the members is considered a loss. Isn't that what they're there for?

But the MLR issue is very real. This key definition tells consumers and regulators how much of a health care premium is being spent on medical and medical-related expenses and how much is being spent on administration, fees and profits. Under the Affordable Care Act (ACA), federal health reform, plans are required to give rebates to customers if they spend too much of their revenue on non-health spending. It has been estimated that if insurers had to use the new definition for MLRs for 2009, rebates would have totaled more than $1.9 billion. For Massachusetts, Chapter 288 of the Acts of 2010, the newly minted small group health insurance cost containment law, requires our carriers meet a MLR standard of 88% next year and 90% thereafter, or face presumptive disapproval of their rates.

So the definition of MLR - what's medical care, what's not - is critical to making sure health plans provide good value.

Round one for the federal MLR definition is complete. The National Association of Insurance Commissioners (NAIC), as required under the ACA, just approved its MLR definition for 2010.

One key issue is over what is quality improvement. Plans can count spending "to improve health care quality and increase the likelihood of desired health outcomes" as medical benefits. A battle has raged over the past few months as the NAIC has parsed out what actually improves quality from what insurers have argued improves quality (carriers have requested computer claims system upgrades, taxes and fees be considered quality improvement). Caught up in the middle of this battle are consumers and employers- who want value for their health care premiums. Brokers entered the fray too, wanting their commissions to be excluded from administrative expenses.

This battle reached an apex last weekend in peaceful Seattle where everyone anxiously waited to see if the last-ditch efforts by some ‘interested parties’ would prevail. The tension at the meeting was palpable with many constituencies declaring victory in one way or another by meeting’s end (see coverage in Politico, and commentary from the brokers), and others vowing to fight another day.

How consumers will fare under this definition remains to be seen and some states, like Massachusetts, will have to grapple with whether they will use this definition. It is up to DOI, with the assistance of DHCFP, and many stakeholders, to determine what constitutes our MLR definition and the federal definition provides a base from which to start. It is likely that the carriers will argue that the state should just adopt the federal definition, but that may not be what is best for Massachusetts consumers and employers. Some states, like Maine, have learned a lot about how they structure their MLR review and their definition does not mirror the federal definition.

For now we wait for the federal standard to get certified by HHS and the state to start the process of evaluating what works best for us.
-Georgia Maheras

August 26, 2010

Check out the new and improved CommonHealth blog, from WBUR.

In the early days of health reform, CommonHealth was an important forum for serious and off-the-wall debates about the issues facing state health policy. Reporter Martha Bebinger opened it up to a multiplicity of voices who used the site to advocate for their points of view. The comments got unwieldy at times, but it reflected the true excitement of creating a new health coverage paradigm in a single state.

CommonHealth 2.0 is curated by Rachel Zimmerman (who took over while Martha was a Nieman Fellow), and Carey Goldberg, former Boston bureau chief of The New York Times. They plan to reduce the number of guest posts from health industry folks, and dramatically increase reporting and interviews. A key focus will be health cost control, though other health and medical topics will be covered, too. The blog remake is part of a broader public broadcasting effort to fund a number of stations as definitive sources of news on a topic.

The blog is still in a soft launch phase, but with 5 posts today and yesterday, a new tagging/search system, a twitterstream, and an inviting design, it looks ready for prime time. All it needs is lots of comments. One other request - bring back the the archives. I don't want to lose forever the entertaining 2007 rants against health reform.
-Brian Rosman

August 26, 2010

As we reported last week, the Quality and Cost Council accepted the recommendation of an expert panel that there should not be public reporting of a hospital-wide mortality measure for now. The presentation that was given to the Council from the expert panel is now available on the Council’s website (.ppt). A brief report in the Globe quotes us as agreeing that there appears to not yet be a clearly right measure to use right now for public reporting.

However, HCFA strongly supports revisiting this issue over time to work toward public reporting of an all-hospital mortality measure. The vendors who developed the mortality measures should determine where the flaws are and work to come up with an acceptable yardstick. While it is clear that many individuals will be interested in condition-specific mortality measures so they can see how a hospital does in treating a particular condition, we believe that whole-system measures, like mortality and infection rates, point to the overall level of quality of care being provided in the hospital. By looking at trends over time, one can point to which hospitals are making the extra effort to improve quality and, in turn, reduce mortality and infection rates. For the time being, the expert panel discussed alternatives to public reporting to ensure that work is being done within hospitals to look at mortality measures, determine where there are areas needing improvement and then work toward that improvement, and we hope that these alternatives are seriously considered by the Quality and Cost Council.
-Deborah W. Wachenheim

August 25, 2010

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The room at a recent MassHealth regulations hearing was packed, as some 100 people came out to show their support of oral health. Among these participants, 17 chose to stand up and explain why access to dental care through MassHealth is important to them.

Speakers at the hearing came from a wide array of backgrounds, but all agreed on one thing: oral health is a crucial part of overall health. Highlights of the testimony are in the video above.
-Christine Keeves

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