December 2011

December 28, 2011

Please Donate to Health Care For All The season of giving is almost over and there are only a few days left to donate to HCFA in 2011. Please help us provide health care education, enrollment services and advocacy that the people of Massachusetts deserve. In order to continue the important work we do and improve the quality and accessibility of health care for all Massachusetts residents, we depend on your generosity. We invite old and new friends to consider making a gift today. If you have not already made a donation to our annual fund and appreciate the work we do, please help out. Click here to make a fully tax deductible contribution. Thanks to you, HCFA’s good work can continue. -Melissa S. Freitas

December 28, 2011

Oral Health Advocacy Taskforce logoLast week the legislature's Joint Committee on Public Health gave its approval to S. 1079, legislation filed by Senator Harriette Chandler to restore full dental benefits to adults on MassHealth. Some 700,000 adults, including low income seniors, disabled adults, and people with serious chronic disease lost full dental benefits over a year ago.

We thanks the Co-Chairs of the Public Health Committee, Rep. Sanchez and Senator Fargo, for supporting advancement of this bill. The bill moves to the Health Care Financing Committee.

HCFA's Oral Health Advocacy Task Force - OHAT and many other groups will be working hard to restore dental benefits during this year's budget debate. OHAT will be arguing that oral health is critical to overall health, and that cutting dental benefits results in worse (and more expensive) health outcomes, far beyond the teeth and mouth.

Coincidentally, today's Wall Street Journal goes into detail on the medical evidence linking good dental care with overall health:

The eyes may be the window to the soul, but the mouth provides an even better view of the body as a whole.

Some of the earliest signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue — sometimes long before a patient knows anything is wrong.

There's also growing evidence that oral health problems, particularly gum disease, can harm a patient's general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications.

"We have lots of data showing a direct correlation between inflammation in the mouth and inflammation in the body," says Anthony Iacopino, director of the International Centre for Oral-Systemic Health, which opened at the University of Manitoba Faculty of Dentistry in Canada in 2008. Recent studies also show that treating gum disease improves circulation, reduces inflammation and can even reduce the need for insulin in people with diabetes.

....An estimated six million Americans have diabetes but don't know it — and several studies suggest that dentists could help alert them. A 2009 study from New York University found that 93% of people who have periodontal disease are at risk for diabetes, according to the criteria established by American Diabetes Association. ...

There's also growing evidence that the link between periodontal disease and cardiovascular problems isn't a coincidence either. Inflammation in the gums raises C-reactive protein, thought to be a culprit in heart disease.

"They've found oral bacteria in the plaques that block arteries. It's moved from a casual relationship to a risk factor," says Mark Wolff, chairman of the Department of Cariology and Comprehensive Care at NYU College of Dentistry.

The OHAT campaign needs your help. People who are interested in joining the campaign should contact Courtney Chelo, at
-Brian Rosman

December 25, 2011

For the quiet week coming up, the Blue Cross Foundation and Mass Medicaid Policy Institute released some good wonkness to read and learn from. We're so fortunate as a policy community to have these institutions supplying high-quality materials to further the conversation:

  1. Improving MassHealth: The Mass Medicaid Policy Institute released Innovations in Medicaid: Considerations for MassHealth (pdf). The paper looks at cutting-edge Medicaid strategies to improve on the delivery of care and optimize value for the state. Among the opportunities reviewed are aligning purchasing with other state agencies, and structuring contracts to reward outcomes. One suggestion we particularly endorse is engaging stakeholders around member materials and outreach methods. For years we've had ready to go suggestions for improving the complex, easy to ignore and misunderstand mailings received by MassHealth recipients, but our proposals have languished.
  2. Risk Adjustment in Exchanges: I know, risk adjustment is the most eye-rolling topic in all health policy wonkdom. For years, I've always gotten a laugh telling people that HCFA used to march under the banner of "Health Insurance for Everyone," and now our slogan is "Risk Adjustment Must Go Beyond Actuarial Factors And Include Socio-Economic Considerations." But this is important stuff, and the Foundation's latest entry in their Health Reform Toolkit series, Mitigating Risk in a State Health Insurance Exchange, should be required reading for exchange planning people in other states. It's also a good review for Massachusetts folks, reminding us how the Connector uses a number of techniques to make their insurance market more fair and efficient.

Happy reading!
-Brian Rosman

December 23, 2011

Put Patients First.As the halls of the Massachusetts State House are emptying out for the holidays, the pharmaceutical industry is working hard to push through special interest legislation when they think no one is paying attention.  On Tuesday of this week, the Joint Committee on Public Health gave a favorable recommendation to H. 1507, a bill that would repeal most of the Prescription Drug Gift Ban and Disclosure Law, initially passed in 2008.  This law limits drug industry salespeople from wining and dining physicians in order to promote the prescribing of their higher-cost, brand-name products. The law also requires annual reporting for these industries to disclose details about permitted payments made to physicians and other prescribers.

Now we’re concerned that this bill may go to the House floor next week, where it could pass without debate or a formal vote, and when many legislators are away for the holidays.

While repealing the Gift Ban may be a nice holiday gift for pharma, it certainly wouldn’t be the case for consumers across the Commonwealth. Repealing the ban would allow pharma to spend millions of dollars on fancy physician meals. These costs are ultimately passed on to individuals and families through higher copays and premiums.

In addition, repeal of the Gift Ban would compromise doctor-patient relationships. A patient shouldn’t have to wonder whether they are being prescribed a drug because it is useful, or because their doctor is influenced by benefits and perks provided by a manufacturer.  Doctors have the duty to act in the best interest of their patients, not to help industry increase profits.

Health Care For All, as part of the Massachusetts Prescription Reform Coalition (MPRC), urges the members of the House to oppose H. 1507 and stand up for ethical marketing, transparency, and lower health care costs.  So what’s on the top of our holiday wish list? We ask that drug marketing and industry profits do not come at the expense of patients.
-Alyssa Vangeli

December 22, 2011

[Note: HCFA Policy Coordinator Paul Williams is our resident comic book guy, and he penned this review of Connector Board member Jon Gruber's new comic book, Health Care Reform.]

Peanut butter and chocolate, macaroni and cheese, Batman and Robin, all things that go great together. With the publication of Jonathan Gruber’s book “Health Care Reform: What It Is, Why Its Necessary and How It Works” we can add graphic novels and health care policy to the list of great pairs.

We in health care policy often wrestle with taking very wonky concepts and attempting to translate them to a language that is people friendly. When it comes to the ACA and its 1,900 pages this task becomes even more difficult.

Gruber (along with co-author HP Newquest and illustrator Nathan Schreiber) manages to lay out in clear language and pictures how four very different people that are insured differently would deal with the aftermath of a heart attack. He narrates the possible scenarios in a Scott McCloud-like manner presenting the outcomes of an employee who is fully insured to the senior citizen on Medicare to the uninsured working poor. Gruber then lays out the double headed monster of rising costs and growing numbers of uninsured. His manner of presenting the opposition of the ACA in the form of four movie monsters both guarantee a laugh and key points to remember. He even manages to suss out the details of what an insurance exchange is and what it does in only a few effective panels.

Of course I was delighted to see that Massachusetts health reform was used often as the example on how this could be done, and it gives a great primer for those wanting to know more about our past successes as we move towards payment reform next legislative session.

All in all I would recommend people pick up this graphic novel for those looking for a clear and understandable explanation of health care reform. It would also make a great holiday gift for that one person in your life that wants to argue about the ACA but doesn’t understand what it entails.
-Paul Williams

December 21, 2011

Hamlet contemplatingToday, Secretary Bigby convened the fifth in a series of stakeholder meetings to discuss Affordable Care Act (ACA) implementation in Massachusetts (see slides from today’s meeting).

One of the big ACA decisions facing state policymakers is what subsidized insurance coverage will look like in 2014. The EOHHS subsidized insurance workgroup established a set of principles to guide their work, and have a keen focus on simplicity and continuity of coverage. While the Massachusetts subsidized coverage framework will look a lot different in 2014, there are several populations whose program eligibility will not change – among them children, dual eligibles, and persons with disabilities. EOHHS explored several options for the populations that will transition to new coverage.

After thorough analysis, the EOHHS subsidized insurance workgroup has narrowed their options to either establish a Basic Health Program or go with the “baseline” Affordable Care Act framework.

Subsidized Coverage options under ACA

Slide showing coverage options under ACA. "BHP" stands for the Basic Health Plan, a federal option where the state offers coverage. "QHP" stands for Qualified Health Plan, which is commercial coverage obtained through the Connector (our Exchange), with sliding scale tax credit subsidies

The Basic Health Program is an option within the ACA that allows states to cover residents who earn 139-200% of the federal poverty level [fpl] (or 0-200% fpl for “special status” legal immigrants). The state would receive 95% of the premium and cost-sharing credits BHP-eligible individuals would have gotten if they purchased coverage through the Exchange. The BHP must provide at least the yet-to-be defined Essential Health Benefits (EHBs) package (federal officials released a bulletin (pdf) on Friday, giving states broad flexibility in determining EHBs).

The Basic Health Program has the potential to reduce cost sharing for consumers who would otherwise purchase coverage through the Exchange, but questions remain around benefits, cost-sharing, state cost, and how the plan will be administered. Manatt/Mercer – the consulting agency the state hired to analyze subsidized insurance options – will provide further evaluation on some of these questions. We expect EOHHS to share their findings in January. The ACT!! Coalition will be looking closely at the findings, and making recommendations for the best way to protect current members and maximize affordable coverage. The issue will eventually go to the legislature, possibly this summer, or more likely early next year.
-Suzanne Curry

December 21, 2011

(Guest post by Wells Wilkinson, Director, Prescription Access Litigation, and Marcia Hams, Director of Prescription Access and Quality, Community Catalyst. Follow their work to make prescription drug prices more affordable on the Postscript Blog.)

Yesterday, the Massachusetts Attorney-General’s office announced a $24 million dollar settlement resulting from an investigation of pricing fraud in state programs by fourteen different drug makers. This settlement follows a ground-breaking national settlement of a lawsuit filed by the Prescription Access Litigation project at Community Catalyst in 2001, with Health Care For All, Mass Senior Action, MassPIRG and eleven other consumer groups nationwide representing the interests of consumers.

Drug industry pricing fraud became widespread in the mid-1990s, when high but fictitious list prices were used as an incentive to sell products. Doctors or pharmacies made more money using a drug whose actual cost was far less that the amount they were paid by Medicare and Medicaid. This fraud led to our class action lawsuit and a ground-breaking 2007 trial on behalf of Massachusetts consumers and private sector insurers. It was found that AstraZeneca, Bristol-Myers Squibb and Warrick (a subsidiary of Schering-Plough, which was bought by Merck in 2009) had violated consumer protection laws through their deceptive pricing tactics. This victory ultimately convinced 28 different drugmakers to pay over $360 million to settle claims with the private sector health plans and consumers. (See more here).

And now, on behalf of public programs here in Massachusetts, the Attorney-General has recovered funds from a number of these companies for the same kind of unfair and deceptive pricing. For example, manufacturer Warrick sold an albuterol drug from 1995 to 2003, all the while reporting a list price that was nearly seven-times the actual sales price. The State’s trial in 2010 found that Warrick had cost Massachusetts $4,563.328, and had made 28 false statements in violation of the state’s False Claims Act. After treble damages, 12% interest, and legal fees, a $24 million settlement looked like a good deal to Warwick’s new owner, Merck.

How can Massachusetts better protect its public programs from deceptive pricing in the future?

Currently, Massachusetts uses industry-published list prices as a basis to reimburse pharmacies. One option is to adopt the Average Acquisition Cost (AAC) method of paying pharmacies for the drugs MassHealth purchases for its members. The AAC method does not use easily manipulated manufacturer “list” prices (at issue in the court case). Instead, pharmacies are paid based on their actual cost of acquiring the drug from the manufacturer, plus a dispensing fee, thereby reducing overpayment and saving money for MassHealth. This evidence-based pricing method has been adopted by Alabama and Oregon, and it has been recommended by Medicaid headquarters in Washington D.C. And like Alabama and Oregon, Massachusetts could make these regularly-audited drug prices available to the public, so that private insurance plans could also adopt this method and save money, hopefully reducing premium costs. Community Catalyst describes more about AAC in its new Medicaid Report Card.

December 20, 2011

The Department of Public Health will release the latest public report on Serious Reportable Events (SREs) this Wednesday during the monthly meeting of the Public Health Council. The meeting takes place 9am-12:00 at DPH, 250 Washington Street, Boston, in the Public Health Council meeting room. The meeting agenda is here.

HCFA and the Consumer Health Quality Council advocated for the law requiring public reporting of SREs. SREs are very serious events that happen in hospitals or ambulatory surgery centers that cause serious harm or death. Some examples are wrong-site surgery, wrong-person surgery, serious mediation errors, pressure ulcers, falls, and more. Look for a blog later this week summarizing the latest report. 

December 20, 2011

The Department of Public Health will release the latest public report on Serious Reportable Events (SREs) this Wednesday during the monthly meeting of the Public Health Council. The meeting takes place 9am-12:00 at DPH, 250 Washington Street, Boston, in the Public Health Council meeting room. The meeting agenda is here.

HCFA and the Consumer Health Quality Council advocated for the law requiring public reporting of SREs. SREs are very serious events that happen in hospitals or ambulatory surgery centers that cause serious harm or death. Some examples are wrong-site surgery, wrong-person surgery, serious mediation errors, pressure ulcers, falls, and more. Look for a blog later this week summarizing the latest report. 

December 16, 2011

Connector Board member Nancy Turnbull asked an important question on the 'BUR CommonHealth blog on Tuesday, Why Are So Many Low-Income People In Massachusetts Still Uninsured?

Nancy reviewed the just-released 2009 Department of Revenue data on tax-reported health insurance coverage, and found that some 114,000 low-income uninsured taxpayers are likely eligible for state assistance, either through MassHealth or Commonwealth Care. Nancy asks how can we reach these people, and get them into coverage which will improve their health and protect against unaffordable medical costs.

HCFA's Suzanne Curry added an important comment, reminding us that the state is backing off of its role working with community groups to find and enroll people eligible for health coverage:

Local community organizations are key partners in reaching hard-to-reach uninsured populations. With the inception of Massachusetts health reform, state policymakers recognized this and created a grant program to fund outreach, education, enrollment, and retention activities at local, trusted community organizations and community health centers. This funding is due to run out at the end of this month, and I know of several organizations that are shutting down or reducing services due to lack of funding. We need to make sure the state continues to invest in this outreach, education, enrollment, and retention work - it could mean the difference between reaching the "chronically" uninsured and maintaining the status quo, or worse, regressing.

We think that outreach funding is a worthy investment, and hope the state can find some way to keep these programs up and running. Funds run out in just 2 weeks, and as workers are laid off and programs closed, the long-term costs will only rise.
-Brian Rosman

December 14, 2011

We want to remind everyone of the listening sessions on the state's proposal to provide integrated care for disabled adults who receive both Medicare and Medicaid.

The first session is this Friday, Dec. 16, 1 pm at the Worcester Public Library.

You can distribute this flyer (pdf), prepared by Disability Advocates Advancing our Healthcare Rights.

The flyer invites people to raise a number of issues critical to the DAAHR coalition:

  • Protect your choice of clinicians and providers!
  • Demand control of your care team!
  • Make sure there’s an independent long term supports coordinator!
  • Let MassHealth know you support dental coverage, PCA and peer services, and improvements in durable medical equipment services.

These and many other issues will be raised at the hearing. We're hoping that many interested people turn out.
-Brian Rosman

December 9, 2011

In a talk at the Institute for Healthcare Improvement annual forum this week, Don Berwick encapsulated his wisdom of how health care change can happen, his rage at the politics and cynicism that accompanied his work at CMS, and his optimism for a more humane and efficient health care system. I'd strongly urge everyone to read the entire speech.

It's so hard to pick out the highlights, but here are some excerpts:

Inscribed on the wall of the great hall at the entrance to the Hubert Humphrey Building, the HHS Headquarters in Washington where my office was, is a quotation from Senator Humphrey at the building’s dedication ceremony on November 4, 1977. It says: "The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped." I believe that. Indeed, I think that Senator Humphrey described the moral test, not just of government, but of a nation. This is a time of great strain in America; uncertainty abounds. With uncertainty comes fear, and with fear comes withdrawal. We can climb into our bunkers, each separately, and bar the door. But, remember, millions of Americans don’t have a bunker to climb into – they have no place to hide. For many of them, indeed, the crisis of economic security that we all dread now is no crisis at all – it is their status quo. The Great Recession is just their normal life.
Cynicism diverts energy from the great moral test. It toys with deception, and deception destroys. Let me give you an example: the outrageous rhetoric about “death panels” – the claim, nonsense, fabricated out of nothing but fear and lies, that some plot is afoot to, literally, kill patients under the guise of end-of-life care. That is hogwash. It is purveyed by cynics; it employs deception; and it destroys hope. It is beyond cruelty to have subjected our elders, especially, to groundless fear in the pure service of political agendas.

If you really want to talk about “death panels,” let’s think about what happens if we cut back programs of needed, life-saving care for Medicaid beneficiaries and other poor people in America.

What happens in a nation willing to say a senior citizen of marginal income, “I am sorry you cannot afford your medicines, but you are on your own?” What happens if we choose to defund our nation’s investments in preventive medicine and community health, condemning a generation to avoidable risks and unseen toxins? Maybe a real death panel is a group of people who tell health care insurers that is it OK to take insurance away from people because they are sick or are at risk for becoming sick.

Enough of “death panels”! How about all of us – all of us in America – becoming a life panel, unwilling to rest easy, in what is still the wealthiest nation on earth, while a single person within our borders lacks access to the health care they need as a basic human right? Now, that is a conversation worth having.

And, while we are at it, what about “rationing?” The distorted and demagogic use of that term is another travesty in our public debate. In some way, the whole idea of improvement – the whole, wonderful idea that brings us –thousands – together this very afternoon – is that rationing – denying care to anyone who needs it is not necessary. That is, it is not necessary if, and only if, we work tirelessly and always to improve the way we try to meet that need.

The true rationers are those who impede improvement, who stand in the way of change, and who thereby force choices that we can avoid through better care. It boggles my mind that the same people who cry “foul” about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people – elders, the poor, the disabled – who are least able to bear them. When the 17 million American children who live in poverty cannot get the immunizations and blood tests they need, that is rationing. When disabled Americans lack the help to keep them out of institutions and in their homes and living independently, that is rationing. When tens of thousands of Medicaid beneficiaries are thrown out of coverage, and when millions of Seniors are threatened with the withdrawal of preventive care or cannot afford their medications, and when every single one of us lives under the sword of Damocles that, if we get sick, we lose health insurance, that is rationing. And it is beneath us as a great nation to allow that to happen.

And that brings me to the opportunity we now have and a duty. A moral duty: to rescue American health care the only way it can be rescued – by improving it.