January 2011

January 31, 2011

HCFA has a full plate of legislative proposals for the upcoming session. Last week we highlighted bills from ACT!!, our health reform coalition, and Massachusetts Prescription Reform Coalition. Two more coalition bills are summarized in this post. CHAC, the Children's Health Access Coalition, is sponsoring three bills to improve children's coverage in Massachusetts:

  • An Act Improving the Children’s Medical Security Program and Simplifying the Administration Process, sponsored by Senator Katherine Clark and Representative Liz Malia. This bill allows the Secretary of Health and Human Services to administer the Children’s Medical Security Plan (CMSP), bringing it in line with other state health programs and improving care and administration.
  • An Act Regarding Continuity of Care for Children and Their Eligible Parents, sponsored by Senator James B. Eldridge and Representative Ellen Story. This bill proposes continuity of coverage for both children and families and advises the Executive Office of Health and Human Services to seek with the federal government an amendment to provide 12-month continuous eligibility under MassHealth for children and their eligible parents. The federal government currently allows states to establish 12-month continuous eligibility for children under Medicaid and CHIP.
  • An Act Ensuring Access to Health Care for Children and Young Adults, sponsored by Senator Thomas M. McGee and Representative Kay Khan, bill expands MassHealth eligibility to cover youth through age 20. Extending MassHealth coverage through age 20 provides continuity of care for low income young people during a life transition period and the cost of expansion would fall largely on the federal government, not Massachusetts.

The Consumer Health Quality Council is advocating for 4 bills that seek to improve quality of care and patient safety:

  • An Act to Improve the Delivery of Healthcare through the use of Checklists, sponsored by Senator Richard Moore and Representative Provost. This bill would require hospitals to implement checklists that are approved by the Department of Public Health. Checklists are simple tools that have been shown to decrease medical errors and infections.
  • An Act to Investigate the Use of Computer Tomography (CT) Scans in the Commonwealth, sponsored by Representative Kulik. This bill would require an already existing Advisory Council on Radiation Protection to look at the health risks to children and adults from CT scans and recommend how to track and reduce lifetime risk.
  • An Act Promoting Patient Engagement in Health Care Decisions, sponsored by Senator Chandler and Representative Khan. This bill would require DPH, with the assistance of an advisory committee, to develop a plan for the use of Shared Decision-Making in Massachusetts. It would also require insurers to reimburse providers for the use of decision-making tools.
  • An Act Relative to Adverse Event Management, sponsored by Representative Sannicandro. This bill allows providers to apologize following an adverse medical event and the statement of apology could not be used in a court of law. The bill also requires hospitals to develop Adverse Event Management Plans with the guidance of DPH.

Please contact your legislators and ask them to cosponsor these bills. -Dayanne Leal and Deborah Wachenheim CH

January 28, 2011

Ask Kelsey Williams, Boston University School of Public Health alumna.

Kesley Williams generously donated her time and expertise to help Health Care For All and the Oral Health Advocacy Taskforce put together a fantastic video that illustrates why oral health IS health.

Read on to learn the social science theories behind the video, according to Kelsey:

Framing Theory: Framing Theory says that you can take an issue and frame it in a way that is most useful to your cause. In the case of oral health, we want people to understand that dental care is not just cosmetic, and not all dental problems can be prevented with proper brushing and flossing. However, oral health is a key part of overall health and well-being. Going to the dentist for a check-up is as integral as your annual physical, and receiving care when a dental problem arises is akin to going to your primary care doctor when you are ill. This new frame is the basis for the slogan of the campaign, as well as the video.

Marketing Theory: Marketing theory says that every communication should have a message and an execution; a good communication will have the two working in tandem to successfully convey the message. In the case of the oral health video, the message is: “My Health is Oral Health; Please Restore MassHealth Dental Benefits.” For execution, there are personal stories of the impact of oral health on people’s lives, visuals of healthy people being active and happy, panoramic, pride-inducing shots of Boston, and pensive music, all working towards conveying the message and (hopefully) motivating legislators to reinstate benefits.

Aspects of Storytelling: Techniques employed by authors and scriptwriters are extremely helpful when applied in the context of health communications. Historically, communications about health are based on statistics and facts. These are not compelling! To get people to listen and respond to your cause, use the four main elements of a good story:

1. Characters with a story or challenge

2. Precipitating event

3. Conflict

4. Resolution

In the video, we have three characters with a story and a challenge – needing dental care but not being able to pay for it. They cannot afford services because of a precipitating event – the cuts to restorative MassHealth adult dental benefits. The conflict is that each individual needs to choose between living in pain at a great risk of infection, or having his or her problem tooth pulled (as teeth extractions are covered.) The resolution? Having Massachusetts Legislators reinstate the funding for these services!

Check out the video for yourself to see these theories employed to help Restore MassHealth Adult Dental Benefits!

January 28, 2011

[This is our second report on the Governor's FY 12 budget proposal. Our earlier entry looked at public health.]

The Governor released his recommended FY 2012 budget yesterday, and saving money in health care programs, particularly MassHealth, was a major focus. The budget is accompanied by detailed information from the administration (see the main budget page with links to everything). There are two somewhat overlapping budget policy papers from the administration, here and here. Together they start to explicate the administration’s take on health care in the budget.

As always, the best instant summary analysis comes from the Mass Budget and Policy Center; their health care summary gets all the highlights onto a single, readable page. The T&G and Globe each did stories on the health side of the budget that include interest group reactions.

In total, MassHealth spending will be $800 million less than it would otherwise be. Because of the federal match, the subtraction of $800 million in overall spending only saves the state budget half that amount, or $400 million. If passed, we would be foregoing $400 million in federal revenue to the state, which could be used to support jobs and the economy.

The State House News Service put the subtitle “Health Care Puzzle” over their report on the health budget. We join them in still having more questions than answers in figuring out how the savings are going to happen.

To start, the key health coverage programs for the poor – MassHealth, Commonwealth Care and the Health Safety Net – have their benefits and eligibility mostly maintained. Cuts made in the past few years, like eliminating many dental services for adults, are not restored. Given the need to find deep savings to balance the budget, we are grateful that deeper cuts, like those other states are considering, are not being proposed in Massachusetts. The budget does tighten MassHealth adult day health benefits, and raises copays yet again. The total savings from this is $66 million. Given that this is a “no-tax” budget, we don’t understand the justification for raising fees on the poorest of the poor, particularly because the state has to share half of the copay revenue with the federal government.

Provider rates of payment are mostly frozen, and some are rolled back, pushing out further the promise of chapter 58 of getting closer to rate parity. The savings from rate actions is $150 million. Some savings ($50 million) are anticipated from the start of a program to integrate care for disabled dual eligibles, those getting both Medicare and Medicaid benefits. A similar program for seniors has improved care while saving money.

But the bulk of the savings comes from ill-defined “Capitation Cost Controls” - $169 million; and “Procurement and Payment Strategies - $351 million. The narrative doesn’t really say what this entails, other than a commitment to reorganize provider arrangements to ensure access and improve quality, at a lower cost. That’s the puzzle.

The Medicaid populations are sicker than average, and have unique social needs. While we strongly support using payment incentives to provide integrated care and promote health and wellness, it is critical that any dramatic steps be carefully considered before being imposed on providers and beneficiaries. We want to make sure that MassHealth members have meaningful pre-input in these changes. While we all support the goal of improving quality and access at a lower cost, getting from here to there is going to take enormous effort and communications. We see that the supplemental budget, also filed yesterday, includes funding for a new "medicaid delivery model commission." We want to know more about that, and look forward to learning about the administration’s plans, and for true engagement aimed at a solution that works for the neediest Bay Staters.
-Brian Rosman

January 27, 2011

Oral health IS health. We want your opinions to help shape a new campaign focused on improving access to critical oral health care, including restoring full MassHealth benefits for adults and ensuring care for kids.

Northeast Center for Healthy Communities
1 Canal Street, Entrance C
Lawrence, MA 01840
9:30-10:30AM, Friday January 28, 2011

$20 giftcard to Market Basket provided to first 10 participants to RSVP.

Download the updated event flyer.

For more information or to RSVP, please contact Christine Keeves at ckeeves@hcfama.org or 617-275-2919.
-Christine Keeves

January 27, 2011

[Note - We're going to cover yesterday's release by Governor Patrick of the FY2012 budget recommendations in two blog posts. This entry focuses on the cuts to public health]

The startling statement from Senator Richard Moore, chair of the Health Care Financing Committee, is stark and pointed:

What is surprising in this budget proposal though is the 'penny-wise, pound foolish' cuts in public health prevention and other health accounts that save money and, most importantly, save lives. If our goal is to cut health costs - and indeed it is – then we must continue the fight for infection prevention, patient protection, and the research needed to measure quality and safety in our health care system. The cuts levied today to the Department of Public Health and to Adult Day Health programs are a serious error in judgment!"

Health Care For All appreciates the need to make deep cuts in a budget that reflects the loss of hundreds of millions in federal funds and the slow growth in tax revenue. It is because of the need to lower health care costs now and for the long-term that we find the public health cuts so perplexing. As we are acknowledging in the payment reform process that lower costs and better care can come from moving our system towards prevention and wellness, this budget moves in the opposite direction.

The MPHA statement (pdf) provides the details and context, so we'll just quote at length:

Governor Patrick’s fiscal year 2012 budget proposal released this afternoon slashes $25 million in public health funding, continuing a trend of disinvestment from our state’s public health infrastructure as we face a $1.8 billion deficit. The proposed cuts to the Department of Public Health (DPH) follow on the heels of more than $90 million in cuts over the last three years, representing a cumulative loss of more than a quarter of state funding for DPH community-based programs in the last 3 years.

The Commonwealth’s infrastructure to prevent, monitor, and respond to chronic and infectious disease is in jeopardy. Programs which regulate and monitor healthcare quality, food, air, and water safety, and programs which provide critical family support to overcome food insecurity and promote learning and health for children with disabilities are being undermined by these unrelenting cuts. Initiatives which help to reduce skyrocketing healthcare costs through prevention and early detection of disease are being abandoned.
Some of the most troubling cuts proposed by the Governor include:

  • Elimination of $12 million in funding for Health Promotion and Disease Prevention, forgoing millions in federal funds. The Governor’s proposal would eliminate $6 million in state funding for programs which prevent and detect disease early, reduce disability, and prevent healthcare costs. This cut would result in the loss of $6 million in federal matching funds from four federal grants, for a combined loss of $12 million in funding.

    As the state struggles to support the health of hundreds of thousands of residents that suffer from chronic diseases and reduce health care costs that are rising at unsustainable rates, it is foolish to cut these funds and walk away from federal money that is available to help us tackle these serious health issues.

    These cuts would result in the elimination or curtailing of numerous initiatives, including: loss of breast and cervical cancer screening and care coordination for 15,000 under- and uninsured women at 28 community health centers; elimination of state funding for Mass in Motion grants that are currently funding 13 communities as part of the state’s signature obesity-prevention initiative; elimination of colorectal cancer screenings for 1500 hard-to-reach individuals; and elimination of grants to 26 communities to improve community health and promote health equity.

January 27, 2011

The 6th Annual Oral Health Heroes Event is undergoing a transformation!

As you know, oral health and school success are inextricably linked. Nationally, children miss more than 51 million school hours each year due to dental disease. Dental decay can hinder kids’ ability to learn and advance in school by affecting attendance and concentration. Dental disease also affects some of the most basic activities in life, such as speaking and eating.

That’s why this year, Health Care For All and the Massachusetts Association for School-Based Health Care are teaming up to honor legislators, community leaders and organizations that have improved the state of oral health in Massachusetts at the 6th Annual Oral Health Heroes event. This year’s Oral Health Heroes Event will take place at Marshall Middle School in Lynn on Tuesday, February 8 at 9:00AM.

School-Based Health Centers (SBHC) are an integral part of the health care safety net for children in Massachusetts. With parental consent, School-Based Health Center clinicians provide developmentally and culturally appropriate health care services such as annual check-ups, immunizations, sports physicals, nutrition education, oral health services, and mental health services including screening and treatment for depression and suicide prevention. By ensuring access to and the provision of comprehensive, high-quality, preventive health care in the school setting, school-based health center clinicians recognize that meeting the physical, mental, and oral health care needs of children increases students' opportunity for learning and academic success.

You can get involved by nominating a community hero(es) (individuals, organizations, or groups in Massachusetts) that have demonstrated:

Outstanding leadership in oral health advocacy and/or organizing;
Strong commitment to improving the state of oral health in Massachusetts

Please contact Christine Keeves at ckeeves@hcfama.org or 617-275-2919, or visit www.hcfama.org/oralhealth for more information.

-- Christine Keeves

January 26, 2011

Last week Massachusetts Representatives and Senators introduced over a dozen bills supported by HCFA and the various coalitions we lead. These bills would improve access to and the quality of care for everyone in Massachusetts, particularly those with the most needs. We will summarize the bills over the next few days. The ACT!! Coalition, which supports health reform implementation, is working on three bills:

  • An Act to Encourage Preventive Care, sponsored by Sen. Jehlen. This bill eliminates co-pays for preventive services in Commonwealth Care to align with requirements of the Affordable Care Act. The bill will codify the intended policy of the Connector to comply with the ACA's efforts to promote preventive care.
  • An Act Relative to Health Care Affordability, sponsored by Sen. Montigny and Rep. Scibak. The bill requires the individual mandate's affordability schedule to include all out-of-pocket costs – in addition to premiums – in the calculation of whether coverage is affordable. Under the current standards, people could be stuck with high, unaffordable out-of-pocket costs even in a plan deemed affordable.
  • An Act to Improve Health Care Access, sponsored by Sen. DiDomenico and Rep. Kulik. This bill codifies and strengthens the MassHealth Outreach & Access to Care Program to ensure all residents get the help they need to navigate the health care system.

The Massachusetts Prescription Reform Coalition is supporting An Act Prohibiting the Use of Prescriber-Identifiable Data for Marketing Purposes, sponsored by Sen. Montigny and Rep. Kulik. The bill safeguards the confidentiality of prescriber-identifiable data in order to protect the integrity of the doctor-patient relationship, maintain the integrity and public trust in the medical profession, and further the state interest in protecting public health and lowering the cost of health care. More to come!

January 25, 2011

Mass Prescription Drug Reform CoalitionIf given a choice between a name-brand drug and its generic equivalent, which drug would you prefer to take?

If you spent more than two seconds contemplating the answer to this question, then drug companies know you better than you know yourself. Price is the only reason patients choose the drab generics over the name-brands they’ve seen in ubiquitous advertisements. Co-pays for name-brands are often much higher than for generics, forcing patients to go with the generics. To even out the prices, drug companies offer coupons that cover most of a name-brand drug’s co-pay.

A recent New York Times article grapples with the heated dispute over co-pay coupons. The argument in favor of the coupons seems, at first glance, to be very persuasive. Drug companies insist that all patients should have equal access to all drugs. Patients maintain that lower co-pays make it more possible for them to get the medical care they need. And after all: if drug companies are willing to pay the difference in cost between their drug and the generic, then why not let them?

The answer is simple: they’re not. Sure, the coupons cover the co-pay, but this co-pay covers only a fraction of the cost of the medication. For example, the co-pay for Novartis’s multiple sclerosis pill Gilenya covers only 20% of a total cost that is between eight and eighteen thousand dollars higher than that of rival pills. The insurance companies pay the difference, and the difference is substantial. One union health insurer in New York paid over $17 million extra when patients began choosing prescription statins. The insurance companies, of course, are funded by the patients’ monthly insurance payments. If the insurance company starts paying for the pricey name-brand prescriptions, then the payments patients make each month go up.

This is why an embattled Massachusetts law currently blocks drug companies from offering co-pay coupons. The New York Times article fails to emphasize that increased health care costs means that patients ultimately pay the price for switching to the expensive name-brand drugs. The Massachusetts law banning co-pay coupons protects patients from a deceptive marketing ploy that will skyrocket insurance rates without providing any medical benefits. We thank our legislature for recognizing the importance of the coupon law and maintaining our ban.
-Karen Marcus

January 24, 2011

 Campaign for Better CarePlease join us next month for a special event hosted by Health Care For All, the Massachusetts Campaign for Better Care and the Suffolk University Law School Health and Biomedical Law Concentration on Friday, February 11, 2011 at 8:30a.m. at Suffolk University Law  School. Our event will feature a keynote address by Dartmouth Medical School professor and health care innovator, Dr. John Wasson as well as a roundtable discussion with health care experts entitled:

"Patient Empowerment: More Than a Slogan"

The debate about the best way to curtail health care costs and improve quality in the Commonwealth continues to be the focus of state leaders and members of the media.  We at the Massachusetts Campaign for Better Care are actively working to ensure the debate to stem rising costs is focused on healthier outcomes for patients by encouraging consumers to raise their voices and become engaged in the process.  In an effort to explore the best ways to engage consumers and improve patient outcomes, the Campaign for Better Care has invited health care experts to discuss best practices.  Panelists include:

* Commonwealth Care Alliance
* Foundation for Informed Decision-Making
* and more!

Our event will begin with a keynote address delivered by Dr. John Wasson, who has pioneered a nationally-recognized program to improve patient outcome through the Ideal Medical Practice project (see www.idealmedicalpractices.org) and the Institute for Health Care Improvement.  We will then launch our panel discussion and close with remarks from a guest speaker who be announced in the coming weeks.  Light refreshments will also be served.

To RSVP to our event please email Jekkie Kim at jkim@hcfama.org or call Jekkie at 617-275-2944.

We look forward to seeing you on the 11th at 8:30am.

January 21, 2011

Wednesday’s Quality and Cost Council meeting (see materials here) included committee updates, the proposed FY12 budget, a few details about payment reform and a patient engagement presentation by the Institute for Healthcare Improvement.

Both the Cost Containment Committee and the Quality & Safety Committee provided updates on their work. The Cost Containment Committee is taking a hard look at the Roadmap to Cost Control (ppt) measures and how they can best use these measures to attain the Roadmap’s goals. The Quality & Safety Committee reported on the state’s efforts to reduce Hospital Acquired Infections, which is launching an information sharing initiative that will lead to cultural changes and better patient safety.

The FY 12 budget, as discussed, is for level funding in FY12 from the FY11 amount. The staffing is staying the same and many of the specific allocations are also staying the same.

In a quick update on the Committee on the Status of Payment Reform (arguably the most avidly watched QCC committee), Secretary Bigby announced that due to snow, the Committee did not meet last week and the expectation is that they will meet next week and their proposal will come before the full QCC at the Council’s February meeting. Jessica Moschella also updated the full QCC on the response to the public forum on payment reform that took place on Dec. 2, 2010. There was a bit of discussion over the various comments made at the public hearing including a highlight that the majority of the comments came from the provider community. The conversation mirrored that held many times before with some participants wanted to proceed with extreme caution and others requesting that we not protect the status quo. GIC Director Dolores Mitchell wins for the best quote of the day by saying that “too much protection of the status quo is a narcotic of gradualism.”

The bulk of the meeting was a presentation made by IHI, and Jim Conway, on the Partnership for Healthcare Excellence’s recent work in patient engagement. The work has focused on created a common framework in which many models of engagement could fit. The theory is that the nature of the engagement would be to do some set of activities that would incent the patient to act. During the discussion, several people brought up the need to engage providers too, so that there can be a partnership in the treatment decisions that are made.

Julia Feldman, who has been working with the Committee on the Status of Payment Reform, presented the QCC with the goals that the subcommittee worked on at their last meeting. There was a lot of discussion around the goals (available here), and the QCC will continue this at the next meeting.
-Georgia Maheras

January 18, 2011

Advocates from Across the State Gather to Protest Dental Cuts

Braving icy sidewalks and waist-high mountains of snow, supporters turned out in force to the Rally to Restore MassHealth Adult Dental last Thursday. Co-hosted by the Legislative Oral Health Caucus and the Oral Health Advocacy Taskforce, advocates held a press conference to announce legislation to restore MassHealth Adult Dental benefits. Speakers included Speakers included Russet Morrow, Chair of the Oral Health Advocacy Taskforce, Harriette L. Chandler (D-Worcester) and Representative John Scibak (D- South Hadley), Co-Chairs of the Massachusetts Legislative Oral Health Caucus, and Amy Whitcomb Slemmer, Executive Director of Health Care For All. “Due to recent cuts in the state budget, approximately 700,000 adults on MassHealth, many of whom are low income seniors, disabled individuals, and people with chronic diseases such as HIV will be impacted,” Morrow explained. “These cuts will cause pain and suffering and eliminate coverage for fillings, treatment of gum disease, and the dentures that many of our vulnerable elders need to eat. Left untreated, dental decay can spread throughout the body, causing serious health issues. These cuts to dental benefits are drastic and would leave extraction as the only course of treatment for cavities or oral infections.” Morrow also shared several stories of MassHealth consumers struggling with the impact of the cuts, including that of Shirley Royster, longtime HIV advocate and MassHealth member. “I need dental care to stay healthy, eat well, and take my medication,” Royster explained. “Without adequate dental coverage, I am trapped in this situation: I can either pay to have my teeth fixed out of my own pocket with money I don’t have, or have them extracted. I bought this apple, but I am in too much pain to eat it. It’s impossible to eat well and stay healthy this way.” According to Senator Chandler, Co-Chair of the Massachusetts Legislative Oral Health Caucus, “this means that for anyone with a small oral health issue, the only solution is to extract the tooth or risk infection spreading through the rest of the body. This is akin to amputating a hand because or a broken wrist, instead of actually fixing the problem.” “It is essential that we reinstate dental benefits in MassHealth,” affirms Representative John Scibak, Co-Chair of the Massachusetts Legislative Oral Health Caucus, “Massachusetts has a long legacy of innovation and leadership in protecting the health of all our residents. Dental services were determined fundamental during the passage of Chapter 58. We have moved backwards by eliminating access to this vital care- we must stay at the forefront of health reform and reinstate these benefits as soon as possible.” There is also a strong financial argument for protecting these benefits. As Amy Whitcomb Slemmer, Executive Director of Health Care For All explained, “Although the Committee estimates that $56 million in services will be eliminated, we are saving only $11 million at most. Massachusetts will actually lose approximately $35 million in federal funds and will suffer additional costs because people will be forced into emergency rooms with preventable illnesses due to dental pain and infections.” - Christine Keeves

January 18, 2011

The Connector Board met last week to discuss their upcoming Seal of Approval RFR for Commonwealth Choice plans, Young Adult Plans (YAPs), and approval of a contract extension for their communications firm, Weber Shandwick (see the materials here).

The bulk of the meeting focused on changes to the Seal of Approval for CommChoice.

The next contracts will be for 18 months to ease the burden on both carriers and the Connector. The biggest contractual changes are that carriers will be required to participate in both CommChoice and Business Express. Carriers will be allowed to offer limited networks, but they must also provide full network plans in each tier in which they participate. Based on new focus group testing (done in December 2010) and conversations with the carriers, the Connector will make some changes to the benefit specifications. The medium rung of the Silver package will be eliminated. Additionally, certain service categories (Inpatient SNF, Office visit for outpatient mental health, Routine vision, Ambulance) will be removed from the standardized specifications, which will allow the carriers to modify the cost-sharing for these products. The Connector will review the coverage and cost-sharing for all of these services as part of the Seal of Approval process. The final change to the Seal of Approval process is that the Connector is removing the $10 PSPM administrative fee charged under Business Express for small groups of 1-5 as of July 2011. Business Express will also include a wellness program component that is currently under development.

After significant discussion, the Connector approved a new RFR. The discussion around the Seal of Approval came from Dolores Mitchell, Celia Wcislo, Nancy Turnbull, and Lou Malzone who expressed concern that the changes in the benefit standardization will make the plans more complicated and allow for adverse selection. None of these members held up the release of the RFR, but wanted to make sure that their concerns were noted as the trade-off did not appear equal – the carriers seemed to gain with these changes.

A quick update on the YAP plans included a preview of the decisions that need to be made over the next year: the Connector needs to determine if they will ask for another waiver from the annual and lifetime cap requirement under the Affordable Care Act for renewals and whether they will add in a High-Deductible Health Plan product to the YAP portfolio. In order to make these decisions, they are going to seek information from the carriers about the YAP expenses including how many hit the caps and the costs to remove the caps.

The meeting also included a quick update on the Student Health Plan RFR. This went out on January 14th and includes coverage for about 30,000 students from the Community Colleges and UMass campuses.
-Georgia Maheras