September 2011

September 29, 2011

The factcheckers at FactCheck.org are continuing to debunk the bunk.

When the Rick Perry campaign started picking up the illogical conclusions of the latest Beacon Hill Institute study, the issue started getting national attention. The FactCheck.org reporters started checking around, and found an inconvenient fact:

Massachusetts’ unemployment rate mirrored the nation’s back in April 2006, when the law was enacted — 4.8 percent for the state compared with 4.7 percent for the nation. But the state has fared better than the U.S. overall since. Its rate is now 7.4 percent, compared with 9.1 percent for the country. Of course, the Beacon Hill study claims the state would be doing even better.

They got the study's authors to admit that their projected job loss figure that got all the headlines is just over half a percent of all jobs in the state, and that a survey methodology would be more accurate than just projecting based on a line on a chart. Mike Widmer of Mass Taxpayer's Foundation said it best:

"Widmer also doesn’t buy the Beacon Hill study. “There is no evidence to conclude that Massachusetts health reform has cost jobs,” he said.

Case closed.
-Brian Rosman

September 28, 2011

Today I spoke with a man who has been put into a desperate situation caused by a hole in our health care system. Jim has been on Commonwealth Care for the past couple of years. He recently completed an annual renewal form for his coverage. MassHealth determined that he was no longer qualified for Commonwealth Care.

The MassHealth Enrollment Center told him it was because he is now earning too much to qualify.

He figured that MassHealth had miscalculated his income and got to work trying to have them re-evaluate his case. After many conversations with MassHealth, it was determined that he was just a few hundred dollars over the limits (he is earning $33,000/year which puts him just over the $32,696/year limit). Unfortunately, because Jim had assumed that he would get back onto Commonwealth Care, he refrained from looking into his other insurance options. Jim had gone over the 30-day period which allows you to be eligible for a qualifying event for the private insurance options through Commonwealth Choice. Jim figured this out after he was out of time. At this point Jim, a diabetic who has prided himself on being on top of his care, had run out of insulin. He cannot afford the cost of insulin. He is facing having to go to the Emergency Room for his care. This is a health care advocate’s nightmare. Our mission is to educate our clients to utilize our health care system in the most cost-effective and quality driven manner. Spending hours (and moving the cost burden to the taxpayers) in the Emergency Room to get the medication he needs to be healthy is not that.

Due to the passage and implementation of the Affordable Care Act, I was able to tell Jim that once he hits the six month mark of being uninsured he could go through the federal Pre-existing Condition Insurance Plan (www.pcip.gov). The PCIP plans were created by the ACA as a temporary workaround before pre-existing conditions restrictions were eliminated nationally.

For Massachusetts residents this is becoming a welcome solution to consumers who are unable to purchase private insurance because of other restrictions. In Massachusetts state law does not allow insurers to restrict coverage or eligibility due to pre-existing conditions. But because of the limited-time enrollment procedures now implemented in individual coverage plans, some people are able to go through PCIP when they are denied coverage based on applying for insurance outside of their enrollment period. If you have been denied health insurance and have been uninsured for at least six months you now have the option of picking up a plan thanks to national health reform. I am hearing from more callers interested in looking into the PCIP plan, because they have missed the July/half-of-August open enrollment and are not able to get coverage. These are consumers that are not looking to scam the system; they are looking to pay for an insurance plan and did not understand the complex rules about going through private insurance.

For now, we need broader public education on the open enrollment rules. Consumers do not understand what limited open enrollment is and cannot comprehend how they would not be allowed to purchase insurance. They say to me, “But I am looking to pay them for the plan!” This will be no small task. The other solution is look at the impact of the state law closing down enrollment 87% of the year. Is this law helping or hurting? Do we need to build in more flexibility and access?
-Hannah Frigand

September 28, 2011

An article in The New Yorkerby Dr. Atul Gawande looks at how coaches can help improve performance in any number of careers…from the obvious ones like sports and entertainment to some that may not be so obvious such as teaching and healthcare. After talking with and observing individuals who have coaches in, for example, music and teaching, Dr. Gawande decided to ask a former colleague and mentor to be his coach…to observe him during surgery and give him feedback afterwards. He found that some seemingly small changes that were recommended by his coach could make a big difference. Dr. Gawande has seen his complication rate go down and the efficiency of his operations improve. As Dr. Gawande writes, it is awkward and can be embarrassing to have a coach observing you and seeing your mistakes but it is worth it.

Think about any profession, including your own, and how a coach could be helpful. For that matter, think about other parts of your life and how a coach could be helpful (as embarrassing as it would be to have my “mistakes” pointed out, I could see the benefits of having a coach give me tips on my parenting skills!). So why not encourage the use of coaches in health care?

When Dr. Gawande spoke with other surgeons about the use of coaches in health care they would often respond by saying they know someone who could use a coach, but they rarely said that they themselves could use one. And when a patient noticed Dr. Gawande’s coach and asked about him, the patient seemed uneasy when Dr. Gawande said he was a coach trying to help him improve. We like to think that doctors don’t need to improve, and certainly not when they are at the point of doing surgery on you or a loved one, but everybody can improve their work, and doctors are no exception.

Coaching teachers has become a more widespread practice. Could coaching surgeons and other medical providers be next?
-Deb Wachenheim

September 27, 2011

Sunday night, HCFA and Greater Boston Interfaith Organization gathered together to kick off our campaign to control healthcare costs. With about 200 people in attendance at Roxbury Presbyterian Church, participants celebrated together in all that HCFA and GBIO have achieved in helping pass health reform in 2006, but to say that now is the time to act to make care truly affordable for all.

HCFA Executive Director Amy Whitcomb Slemmer Speaking at our Joint Health Care Cost Control Campaign Kick Off!

Members celebrated that in reaction to our call to freeze premiums, the premium increases this year are the lowest they have been in years, at 5.9%. But we know – and the crowd chanted – that this is not good enough. What we need is comprehensive, meaningful reform that recognizes the consumers role with a seat at the table.

Reverend Hurmon Hamilton gave a rousing speech, which you can hear just a bit of in this great WBUR story about the event. Recognizing the national importance of this work, Hamilton asked and declared: “Will you join me in this effort? Will you rise up tonight and say it’s time to get busy, it’s time to go into action, it’s time to believe we can change this state now? We can change the nation one more time!” There are some people, however, who might think that this issue is too complicated for real consumers and congregations to get involved. But it’s not, and this rally was proof of that. Folks are ready to have their voices heard, and that’s also why GBIO and HCFA unveiled our five benchmarks of success in payment reform. This is the list of demands we want included in any payment reform bill that passes the Legislature. Here are these benchmarks:

1. Hear Our Voice: Include Consumers in Payment Reform Decisions. Patient and consumer representatives must have a meaningful role in guiding payment reform in Massachusetts, and in the decisions of health care delivery systems.

2. Health Care, Not Just Sick Care: Restructure Payments to Promote Value. The current payment system does not adequately reward primary care and prevention, nor does it support coordinated care or patient education. Transparent payment systems must be created which focus on quality and value.

3. Protect Everyone’s Health: Comprehensive Care For All: The payment system must assure everyone–including people who are ill or part of a vulnerable population–that their care needs will be met. This includes a choice of quality providers, a fair process to appeal denials of care, and the availability of all necessary services. Provider payments should be adjusted for health status and social and economic factors.

4. Public Health Pays Off: Invest in Community Prevention and Public Health. Community efforts to prevent disease and injury are an essential part of cutting the cost of medical care. Payment reform must include dedicated funding for cost-saving public health and community prevention efforts.

5. Fair Payment: Effective Public Oversight of Health Care Costs. Unregulated, private market negotiations have failed to produce affordable, fair and equitable payment levels for health care. State government must have authority to require reasonable charges by insurers, hospitals and other medical providers.

So what’s next? Well, we have heard that in any payment reform bill, the “devil is in the details.” But as Brian Rosman said, “This is GBIO! These are our congregations! We believe that the Divine is in the details.” HCFA and GBIO’s congregations are excited to dig into the details and learn all that they need to know to become great advocates on these details at house parties on October 24th. These house parties will be opportunities for folks to meet other people interested in real reform, but most importantly get educated on this issue so that we can start harnessing the collective power of these congregations as the debate heats up. To learn more or get involved e-mail Ari at afertig@hcfama.org.

-Ari Fertig

September 27, 2011

Last year's health insurance law (Chapter 288) requires Governor Patrick to appoint a member of the Massachusetts chapter of the National Association of Health Underwriters to the Connector Board. George Gonser, CEO of Spring Consulting Group, has been appointed to fill this seat on the Board.

Previously, Gonser was CEO of the Massachusetts Dental Association Insurance Services and a vice president of sales at Chickering Group.

We welcome Gonser to the Board and look forward to working with him in this new role.
-Suzanne Curry

September 23, 2011

The National Institute for Health Care Reform recently published a paper examining shared decision-making (SDM), the challenges to its widespread implementation, and policy options for increasing its use.

Health Care For All and the Consumer Health Quality Council are advocating for legislation to promote SDM in Massachusetts by establishing an advisory committee to work with DPH and by requiring insurance coverage of the use of shared decision-making tools. We think these concepts should be included in part of any payment reform legislation.

Shared decision-making is a process by which the medical provider and the patient and/or family member have a two-way exchange of information in order to allow for a more fully informed decision on medical treatment. The patient/family receives materials, possibly in a variety of media, to explain their options and the risks and benefits of each option. The provider gains a better understanding of the patient’s preferences and personal situation. And together they come to a treatment decision. Right here in Boston, the Foundation for Informed Medical Decision Making has been working to develop tools to better inform patients.

The article lists some of the challenges to wider adoption of SDM:

  • A fee-for-service system that incentivizes the use of more intensive and expensive treatments and does not reward time taken to thoroughly discuss treatment options;
  • Lack of training for doctors and other providers on how to conduct SDM;
  • Concerns about liability if the chosen decision leads to an adverse outcome;
  • The challenges of engaging patients in SDM especially in cases with low health literacy, multiple chronic conditions, and concerns about being denied care;
  • Political hyperbole, such as that seen during debates on national health reform when the phrase “death panels” led to the elimination of Medicare coverage of discussions between providers and patients regarding end of life care.

With all of those challenges, the authors are optimistic that policy changes can advance the use of SDM. While SDM is mentioned in the national health reform law, the steps needed to promote its use have yet to receive funding.

Some of the policy options to advance SDM include:

  • Paying providers for time spent with patients having these discussions about treatment options. This would need to be paired with measures of the quality of patient decisions to ensure it does not just become a “check the box” exercise.
  • Also giving financial incentives to patients to use SDM tools, such as reduced or eliminated co-pays.
  • Requiring Accountable Care Organizations (ACOs) to demonstrate SDM use and training of staff.
  • Teaching SDM in medical schools and providing continuing medical education programs on SDM.
  • Legislating the use of SDM in health care systems.
  • Reducing concerns about liability by, as Washington State has done, giving a higher standard for informed consent when SDM is incorporated into the process.
  • Requiring health plans to provide access to SDM tools for their members.
  • Utilizing health information technology to advance the use of SDM tools by, for example, “prescribing” them via electronic health records, as is done as Massachusetts General Hospital.

An article in today’s New York Times about a gift given to the University of Chicago Medical Center to teach future doctors how to have effective and compassionate relationships with their patients is yet more evidence that all stakeholders in the health care system recognize the need to make it more patient and family-centered. Shared decision-making is an integral part of moving the system in that direction.
-Deb Wachenheim

September 22, 2011
Census Data shows Massachusetts has most health coverage

graphic from Mass Budget and Policy Center

The latest census figures on health coverage are out, and the Mass Budget and Policy Center has the results:

Health insurance coverage in Massachusetts far surpasses coverage nationally and in all other states, detailed statistics released by the Census Bureau today confirm. These data, from the American Community Survey, are more detailed and precise than the estimates released earlier this month, and show that 96 percent of residents in the Commonwealth had health insurance coverage in 2010. Nationally, 85 percent of the population had health insurance coverage in 2010. Texas and Nevada show the poorest coverage, with only 76 and 77 percent coverage respectively.

Massachusetts also continues to lead the nation in the percent of children with health care coverage. In 2010, 98.5 percent of children in the Commonwealth had health insurance coverage. Nationally, 92 percent of children had health care coverage in 2010....

Health care coverage for adults tells a similar story, but the success in coverage of adults since the passage of health reform is dramatic. Massachusetts leads the nation in health care coverage for adults under age 65, with health care coverage rates at more than 95 percent. Only Vermont comes close to the Commonwealth, with coverage rates for adults close to 93 percent. Nationally, health care coverage for adults under age 65 is close to 78 percent, and ranges as low as 65 percent in Texas and 67 percent in Nevada. In 2010, Massachusetts also had among the highest rates of employer-based health insurance coverage – both for people who worked full time (86 percent) and for those who worked less than full-time (63 percent).

The ongoing success of reform in advancing coverage, despite the deep recession, is a tribute to the state and all of us who worked to pass and implement Chapter 58. As a friend would say, Yay us!
-Brian Rosman

September 22, 2011

gbioflyerfixed

September 21, 2011

The air we breathe could not be more fundamental to our health. HCFA is part of the Massachusetts Healthy Air Campaign which is holding a press conference on Tuesday, Sept 27, at 11 am at the Codman Square Community Health Center in Dorchester. The Clean Air Act, which protects the air that we breathe, is under assault at the federal level with some members of Congress aggressively attempting to weaken it. The Massachusetts Healthy Air Campaign – a coalition of over 20 health organizations, led by the American Lung Association in Massachusetts - was created to defend the Clean Air Act. HCFA is a member of the campaign.

Press event speakers will include Megan Sandel, MD, Associate Professor of Pediatrics and Public Health at the Boston University Schools of Medicine and Public Health and leading authority on pediatric asthma; Jon Levy, Professor of Environmental Health at the Boston University School of Public Health, and foremost researcher on health risks from air pollutants regulated under the Clean Air Act; Peter Iwanowicz, American Lung Association National Campaign Director, who is in the know about all Congressional activity relating to the Clean Air Act; Rachael Lemire Murphy, mother to 5-year-old Mia, who suffers from asthma; and, Jeffrey Seyler, President and CEO of the American Lung Association of New England.

For more information, contact Candace Lavin at cplavin@verizon.net or 508-520-1098.

September 20, 2011

The Health Care Quality and Cost Council is meeting this Wednesday, September 21, 1:30-3:30pm (NOTE the change in the regular time), 1 Ashburton Place, 21st floor. See the agenda (pdf). Meetings are open to the public.
-Deb Wachenheim

September 16, 2011

[vimeo http://vimeo.com/28940439]
Both WBUR's CommonHealth and the Globe's White Coat Notes have appropriately linked to this wonderful, creative and smart video, created by Gregory Warner of Marketplace.

But there's an important policy implication for us that the video illustrates. Massachusetts used to have a robust health planning process. With input, public officials would figure out how many hospitals and other medical facilities and equipment the state needed, and then use the policy and permitting process to work towards achieving the agreed-upon goal. This was abandoned in the early 90s, and now the "Determination of Need" (DON) process and other regulatory decisions are not guided by a public plan.

Governor Patrick recognizes this, and has proposed a fix. His payment reform bill includes provisions creating a Division of Health Planning, guided by a Health Planning Council. The Council includes state officials (including the Medicaid director) and 3 experts: a health economist; a health policy and planning expert, and someone with experience in health care market planning and service line analysis. They will oversee the creation of a state health plan that includes an inventory of current health care facilities (like hospital beds, surgical capacity, and advanced technologies or equipment) and an assessment of the need for these services or supply on a state-wide or regional basis, including projections for at least 5 years. The plan will guide DPH in making its DON decisions.

We strongly support the Governor's plan. So legislators: as you watch the great video of Hobbs vs. Otherton, don't forget the policy implications for Massachusetts.
-Brian Rosman

September 15, 2011

CRISIS STANDARDS OF CARE IN DISASTERS AND PANDEMICS:

Testing a Process for Community Conversations

September 17, 2011 from 9:00-4:00, Harvard Medical School, Boston, MA

September 22, 2011 from 12:00-4:30, Lawrence Senior Center, Lawrence MA

If a disaster or pandemic strikes, overwhelming the healthcare system’s ability to provide care as usual to everyone in need, who should receive scarce medical resources?  And how do we ensure the most fair, ethical and nondiscriminatory treatment of all members of our communities?  Recent events at home and abroad--from Hurricane Katrina to the H1N1 pandemic to the Haiti earthquake—show the importance of addressing these concerns in advance.

The Institute of Medicine of the National Academies (the IOM), at the request of the US Department of Health and Human Services, has been working on guidance for state and local public health authorities to use in developing “Crisis Standards of Care”  to address medical decision making in extreme crises.

The voice of the community is an important part of planning for Crisis Standards of Care. The IOM has designed tools for “Community Conversations” to help state and local authorities hear that voice. It will hold two Community Conversations in Massachusetts to test how effective these tools are at learning about community opinions and values.

If you are a member of the Greater Boston community, please join us for the session on Saturday, September 17, 2011 from 9:00-4:00 at Harvard Medical School.  Pre-registration is required. For more information and to register go to: medethics.med.harvard.edu/public_programs/cec/.

If you are a member of the Lawrence community, please come to the session on Thursday, September 22, 2011 from 12:00-4:30 at the Lawrence Senior Center. Pre-registration is required.  For more information and to register contact Vilma Lora at vlora@cityoflawrence.com or (978) 620-3526.

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