September 2010

September 30, 2010

“Massachusetts, the birthplace of public health, has long led the nation in disease-fighting crusades, vaccinating children at high rates and crafting antismoking campaigns exported around the world. But it ranks 36th when it comes to providing residents with fluoridated water,” a recent article in the Boston Globe reports.

Community water fluoridation is a safe and effective preventive measure that can easily be added to public water supplies. Fluoride keeps tooth enamel strong and prevents tooth decay and the serious problems that occur with dental infections. With an average cost of $.50 per person per year, water fluoridation also saves millions in dental treatment and insurance costs.

As the article explains, some groups have fought fluoridation in their community under the misconception that there are health risks associated with fluoridation. However, sixty years of scientific research show overwhelmingly that there are no health risks associated with the consumption of optimally fluoridated water. Over 170 million people have been drinking fluoridated water for over 60 years. Trusted community and professional health authorities such as the US Surgeon General, the American Medical Association, The American Academy of Pediatrics, the American Cancer Society, and the American Dental Association recognize the public health benefits of community water fluoridation.

In order to keep our communities healthy, people all across the Commonwealth should have access to this safe, cost-effective preventive measure. To learn more about how to stand up for oral health, visit
-Christine Keeves

September 30, 2010

Tomorrow is the state-mandated deadline for all hospitals in Massachusetts to have Patient and Family Advisory Councils (PFACs) up and running. Massachusetts is the first state in the nation to have such a requirement. A little bit of a recap of how this came to be: The Consumer Health Quality Council, HCFA’s coalition of consumer volunteers who are advocating for improvements in the quality of care in the Commonwealth, wrote and advocated for an omnibus health care quality bill during the 2007-2008 legislative session. Four of that bill’s measures were incorporated into Senate President Therese Murray’s health care cost containment and quality improvement bill that became law in August of 2008: public reporting of Serious Reportable Events (SREs) and Healthcare Associated Infections (HAIs), non-payment for care needed following the occurrence of a preventable SRE (later amended to include HAIs), the development of Rapid Response Methods at all hospitals that can be activated by staff and by patients and family members, and the establishment of Patient and Family Advisory Councils at all hospitals. In 2009, the Department of Public Health finalized the regulations for implementing all of these measures. The regulations required all hospitals to have PFACs established by October 1, 2010 and also required them to have written plans in place by September 30, 2009 describing how they would establish the PFACs. Learn more about all of these measures and regulations on the HCFA website. Since the regulations were finalized, much work has been done by the hospitals themselves as well as the Consumer Health Quality Council and the MA Coalition for the Prevention of Medical Errors. The Consumer Council requested all hospitals’ work plans soon after the September 2009 deadline. As of today, we have received plans, or found plans on-line, for all except four hospitals. You can visit our PFAC page to learn more about PFACs and see a list of all MA hospitals with links to those with information about their PFACs on the hospital’s website. The MA Coalition for the Prevention of Medical Errors has worked to educate all hospitals about PFACs and facilitate the sharing of information, challenges, and questions across hospitals. Health Care For All and the Consumer Council applaud the hard work that many hospitals have put into creating and nurturing their PFACs. All hospitals are required to produce an annual report about the PFAC by October 1 of each year, and the Consumer Council has started to reach out to hospitals to request their 2010 reports. The Council looks forward to learning about the many activities that have been undertaken by PFACs across the state. Hospitals that have had PFACs in place since before the law was passed have seen how vital they are to helping the hospital improve care and patient and family satisfaction. Massachusetts is leading they way in so many areas of health care, and this is a powerful example of the importance the Commonwealth has placed on the voices of patients and family members. It is also a fantastic example of the power of the consumer voice in terms of advocacy. The Consumer Council, a passionate group of volunteers, has helped pave the way toward many positive changes for all patients and families in Massachusetts. -Deborah W. Wachenheim

September 29, 2010

We're Number One!Today the Census Bureau came out with its annual American Community Survey, which provides much more detailed information on income levels, poverty, health insurance and many other demographic statistics for 2009.

Like the earlier Current Population Survey, a more rough measure (see our post from 2 weeks ago), the more fine-tuned ACS confirms the continued progress Massachusetts is making on insurance coverage. We remain by far the best in the country in health insurance coverage, and despite the deep recession, we have not lost significant ground.

The Mass Budget and Policy Center, as always, has the definitive summary of the survey findings. In addition to the summary of the health insurance statistics, they also analyzed the poverty and household income results, both of which showed no significant increase.

Massachusetts has the highest insurance coverage rate nationally

Our overall uninsurance rate was around 4%, with about 271,000 uninsured. The national rate was 15%. For kids, only around 20,000 children are uninsured, around 1.4% of the under-18 population. The national uninsurance rates for kids was about 9%.

The study findings reflected the ongoing racial, ethnic, age and income disparities in uninsurance in Massachusetts.

Here are the uninsurance rates for various Massachusetts subpopulations:

Population Uninsurance Rate
Under 18 years old 1.4%
18-24 years old 8.1%
25-34 years old 9.5%
35-65 years old 4.3%
Male 5.3%
Female 3.1%
White 3.5%
Black or African American 6.1%
English spoken at home 2.8%
Spanish spoken at home 7.9%
Employed 4.8%
Unemployed 15.3%

-Brian Rosman

September 28, 2010

Every other week or so, we will bring you what think is the latest and greatest in payment reform. Some will be local, some will be not-so-local, but all will be important and fresh. So here is the first installment:

  • Karen Davis from the Commonwealth Fund shows us the Promises and Pitfalls of Global Payments. A good explanation of where we don’t want to go (capitation) and where we could go (integrated care).
  • The Administration hosted a stakeholder meeting on National Health Reform and highlighted the payment reform opportunities in that bill. We covered it on our blog.
  • The QCC Committee on the Status of Payment Reform met a few days ago. The first topic tackled was ACOs. Online, the Committee posted a number of recommended reading materials, a collection of academic articles, and a paper from the Mass Hospital Association.
  • DMH released a white paper on Shared-Decision Making in mental health. While some think this may be impossible, this paper lays out the opportunity to provide critical patient engagement to those with mental health conditions.
  • Political leaders are making sure the public knows that payment reform is a top priority for the next session. Today's Globe reported that "Governor Deval Patrick’s administration is reviving the state’s ambitious plan to change how doctors and hospitals are paid, aiming to hand the Legislature a specific proposal by Jan. 1 and end months of disagreement." Over at WBUR's CommonHealth Blog, Senate President Therese Murray says payment reform continues to be a top Senate goal: “I would like to see the entire legislature and the administration pass something within the next calendar year, but we’ll keep working at it until we get something done.” Watch the full 1:12 interview below:
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    That’s all for this installment- we’ll see you in a couple of weeks!
    -The Campaign for Better Care:

    September 28, 2010

    Today’s Globe features an interview with Dr. Melissa Mattison at BIDMC. She oversees the Global Risk Assessment and Care Plan for Elders (GRACE program) and has seen results based on the program’s work to make sure care for elders is tailored to their special needs and concerns.

    One piece of this program is the use of a checklist for providers to review when they are working with elderly patients-questions to answer relating to things like whether or not the patient is confused, can walk around, etc. The checklist helps the providers to not skip over or forget anything important relating to the patient’s care.

    At HCFA we have been advocating for all hospitals to use surgical safety checklists and checklists for reducing infections in the ICU. The GRACE checklist is another wonderful example of how checklists can reduce errors and improve quality of care for all patients. In addition to checklists, the GRACE program looks at how to minimize harm that could be done to the patient because of hospital protocols-such as waking up patients in the middle of the night to check vital signs or looking at medications being used and if they could potentially increase confusion in elderly patients.

    The interview closes with the following words of advice from Dr. Mattison: “Be an advocate for your family. Be knowledgeable about your situation. Speak to the team caring for your loved one. Ask whether there are safeguards in place for the care of older patients at the institution.”
    -Deborah W. Wachenheim

    September 24, 2010

    All hands are on deck at several state agencies to implement the Affordable Care Act (ACA). EOHHS held their first stakeholder meeting on Tuesday, during which heads of agencies outlined the major policy decisions ahead (see the presentation).

    The high attendance at the presentation shows strong interest among stakeholders in the implementation process. We look forward to continuing to work with EOHHS to ensure that the ACA complements and strengthens Massachusetts health reform.
    -Suzanne Curry

    UPDATE : See Secretary Bigby's detailed post on the meeting, on the state's Commonwealth Conversations blog.

    September 24, 2010

    Recent news from Michigan indicates that Medicaid dental benefits for adults may soon be restored. Like Massachusetts, Michigan cut their dental program to balance the budget. A House-Senate conference committee reinstated the dental program this week. There are still several more steps in the approval process- however, MI residents should remain hopeful, and decision-makers in the Commonwealth should take note of the importance of oral health care.

    Oral health IS health- it is linked to a multitude of complex, costly health problems, such as heart disease, stroke, and diabetes. Infections in the mouth can cause needless pain and suffering, and can spread throughout the body. With regular access to preventive measures such as dental screenings, information about prevention, fluoride treatments, and appropriate referral to a dentist, dental disease is almost entirely preventable.

    As the economy begins to turn around, we need to follow Michigan’s lead in ensuring that access to oral health services is prioritized and restored as quickly as possible. To find out more about how to speak up for oral health, visit
    -Christine Keeves

    September 23, 2010

    Today's 6-month anniversary of health care reform is more than a time to celebrate - it's also a time to begin reaping the real rewards of policies that begin taking effect, helping people get insurance coverage that provides real health security. Many of the Patient's Bill of Rights provisions take effect today. A quick summary of the new provisions are at

    Even in Massachusetts, which implemented a number of insurance reforms in the 1990s and as part of the 2006 chapter 58, these changes will make a real difference. One of HCFA's student interns will now be able to join her parent's coverage, since she was not eligible under the weaker Massachusetts version of the young-adults-can-stay-on-their-parents-plan law.

    A critical new federal provision taking effect today is the requirement that plans not charge copays or impose deductibles for preventive services (read the summary; or see full list of which services are covered). Co-payments for preventive care are a deterrent to getting appropriate health care. This Affordable Care Act provision will remove a barrier for many patients who need preventive care and find the costs unmanageable.

    However, there's a catch. The no co-payments provision goes into effect only for new plans starting after today. If a plan is does not have significant changes, the insurer could consider it "grandfathered" under federal law, and exempt from the requirement.

    We have heard from two carriers that they are going beyond the requirements of the ACA on this issue: Harvard Pilgrim is implementing a no co-payments policy for all individual and group plans with fewer than 2000 members. Blue Cross Blue Shield is also allowing no co-payments for individual and group plans with fewer than 100 members. Unfortunately, at the time of writing this blog, we had not heard back from the other major carriers in the state (plans: feel free to comment here regarding your policy). While these carriers have taken bold steps and we support them, we feel that more could be done for the residents of Massachusetts.

    All carriers doing business in Massachusetts should reject the loophole and eliminate co-payments for preventive care regardless of whether a plan is technically grandfathered or not. Preventive care often pays for itself. More importantly, it is a huge step on the path to integrated care that focuses on keeping people healthy and out of more expensive treatment.
    -Georgia Maheras

    September 22, 2010

    The Boston Globe reported Wednesday on letters signed by 23 legislators, health care providers, and state and local advocacy groups sent to Attorney General Martha Coakley and Public Health Commissioner John Auerbach to make sure that the review of the proposed conversion of the Caritas hospitals to a for-profit business continues in a deliberative and transparent manner.

    September 22, 2010

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    With the big six-month anniversary of the Affordable Care Act coming tomorrow, lots of groups are rolling out some outstanding online resources on national reform. Here's a sample:

    -Kaiser Family Foundation: They produced the animated film above, which clearly and humorously explains how national reform works. Their health reform mega-site,, contains a wealth of information, including links to state-by-state analysis (see the MA page) and a searchable list of official documents.

    -The Commonwealth Fund: Their Health Reform Resource Center includes a very easy-to-follow implementation timeline, that links to analysis and regulations in progress. The links to the summary of the provisions of the law are well organized and easy to digest.

    -White House: Today the President unveiled, which includes stories on health reform is helping people now from every state. The Massachusetts story is about Patricia Liberti, a retired nurse from Salem who consistently hits the prescription drug donut hole. This year, Patricia received a $250 rebate check to help cover the cost of her prescription drugs. Next year, Patricia will receive a 50 percent discount on brand name prescription drugs she purchases when she hits the donut hole. By 2020, the donut hole will be eliminated.

    Even better is the New Hampshire story, which features a powerful video:
    -Brian Rosman

    September 21, 2010

    Just months after the Health of Boston report found that black and Latino residents continued to experience higher levels of chronic disease, mortality, and poorer health outcomes compared to white residents, the Boston Public Health Commission launched a new health equity campaign to educate Boston residents about striking health disparities that exist between different neighborhoods in the city. Put simply: where you live matters to your health.

    The campaign features an animated website - - with neighborhood-specific health information, videos, Facebook page, billboards, and T advertisements.

    With this campaign and multiple other efforts, the Boston Public Health Commission continues to be a driving force for health equity.
    -Suzanne Curry

    September 20, 2010

    The Connector Board met on Friday afternoon, returning from their August break. Materials from the meeting can be found here.

    Glen Shor kicked off the meeting with a quick Executive Director’s report. As of September 1st, CommCare has 155,142 members, an increase of 607 members from August. Shor noted that previous months’ decreasing enrollment is typical during open enrollment, which occurred in June.

    CommChoice currently has 36,649 paid members. Shor attributed the fluctuation in CommChoice memberships over the past few months to counting only paid members and billing idiosyncrasies. Shor expects that there will be a more stable membership moving forward as a result of rate settlements between DOI and carriers.

    Shor and Nancy Turnbull also pointed out results from this year’s Current Population Survey, which was released yesterday. The rate of uninsurance rose substantially across the nation, except in Massachusetts (we covered this too).

    As a first order of business, the Board unanimously approved a two-year extension of the Connector’s contract with Dell Systems, which performs call center, enrollment and premium billing functions for Commonwealth Care.

    Next, Bob Nevins presented the Connector’s FY11 plan of operations, outlining the organization’s program, policy, administrative/organizational, and national health reform implementation goals. As part of the goal to enhance members’ experience, Celia Wcislo suggested the Connector look into the reasons why people may be wrongfully denied eligibility for CommCare and why some members are wrongfully terminated.

    At the end of the presentation, Board chair Jay Gonzalez reiterated Dolores Mitchell’s point that the Connector should be focusing on opportunities for cost control (and reduction). Turnbull requested that the Board and staff discuss Board development as one of the FY11 goals; she also requested that Connector staff provide regular updates to the Board on CommCare Bridge and the Student Health Insurance program.

    Last, Joan Fallon presented key provisions from Chapter 288 (the small business health care cost bill) that impact the Connector. Among the sections that impact the Connector are:

    • Small Business Wellness Incentive Program: With a $15 million budget, the amount of subsidy the Connector will be able to provide depends on how many small businesses come through the Connector. Rick Lord commented that this section is a good idea; Terry Dougherty commented that this section does not address the underlying cost of premiums. Jon Gruber and Wcislo commented that the Connector should create an evaluation framework to judge this provision's success.
    • Broker Added to the Connector Board: Wcislo suggested that the Connector look into conflict of interest issues here.
    • MCC Notice: the statute requires the Connector to give 90 days notice to the Legislature before making any changes to Minimum Creditable Coverage.
    • DOR/Connector Outreach Provision: Stipulates that the Connector cannot utilize any data received from DOR for solicitations or advertising.
    • Special Commissions: the Administration and Finance Secretary and Connector ED are named to commissions, including Special Commission on Provider Price Reform, Special Commission to Study the Impact of Reducing the Number of Health Benefits Plans That a Carrier May Maintain, and Administrative Simplification Working Group.
    • Open enrollment periods: DOI will establish two open enrollment periods for the individual market, intended to address concerns about individuals jumping in and out of coverage.
    • Limited/Tiered Networks: Connector will evaluate potential inclusion in Seal of Approval process.
    • Small Group Purchasing Cooperatives: Up to 6 cooperative with total enrollment of 85,000 lives permitted. Shor clarified that the Connector could potentially be a distribution center for a small group cooperative. Turnbull, Duncan, and Gruber voiced strong opposition to small group purchasing cooperatives (also known as association health plans), citing the grave harm splitting off these groups will do to the individual and small group merged market, ultimately raising prices.

    With that, the Connector Board went into executive session. The next Board meeting is on October 14th.
    -Suzanne Curry