February 2012

February 29, 2012

Yesterday the Joint Committee on Public Health, chaired by Senator Susan Fargo and Representative Jeffrey Sanchez recommended favorably 27 bills, and moved along two additional bills to the Committee on Health Care Financing.  Among the bills were some important HCFA priorities that will make a difference in improved health for people in Massachusetts. We thank Chairs Fargo and Sanchez for approving these measures, and hope they will quickly move through the legislative process.

Unbiased Prescription Drug Information: The Committee approved H. 3367, sponsored by Rep. Jason Lewis, to strengthen the Massachusetts “academic detailing” program. The program sends trained medical educators to physicians who provide evidence-based educational materials on the best use of prescription drugs. The program counters the often biased promotional sales pitches offered by the pharmaceutical representatives, and instead allows prescribers to rely on science when deciding on drug therapies. The proposal also calls on DPH to identify a funding source for the program. The program will help reduce health care costs by promoting improved provider education, and appropriate, effective drug use.

Improve Children’s Medical Security Plan: The Committee discharged H. 1501, introduced by Rep. Liz Malia, to the Health Care Financing Committee. The bill updates our antiquated statute governing the Children’s Medical Security Plan, which provides basic coverage to uninsured children. The current law caps benefits such as prescription drugs, dental care and mental health services.  The bill will expand coverage by eliminating these hard limits, and allow the administration to set benefits based on the needs of children in the program.

Community Outreach and Enrollment: Also approved was H. 598, introduced by Rep. Stephen Kulik (including a companion bill sponsored by Sen. Sal DiDomenico), which will establish a permanent Outreach and Education unit within EOHHS. The office would distribute grants statewide to community and nonprofit groups for outreach, enrollment assistance and retention of coverage assistance, and education on effective and appropriate use of health care coverage. The bill would institutionalize the outreach grant program, which was critical in building enrollment and helping people maintain their coverage. Funding for the program was eliminated this year, ending an effective program.
-Gisela Bryan and Brian Rosman

February 27, 2012

Last Friday, the Center for Medicare and Medicaid Services (CMS) posted the state’s final Duals Demonstration proposal. The proposal would set up a fully integrated care program for people with disabilities under age 65 who are covered by both Medicaid and Medicare. Here's how the proposal's introduction frames the issue:

Dual eligible individuals under age 65 have among the most complex care needs of any MassHealth or Medicare members, yet the current delivery system for this population strains, unevenly and inefficiently, to meet those needs. The Demonstration will provide comprehensive services that address members’ full
range of needs, beyond currently covered standard Medicare and Medicaid benefits. It will ensure that the services are effective by delivering them in a setting of integrated care management and coordination within a primary care centered model. And the Demonstration will employ a payment structure that realigns the conflicting incentives between Medicare and Medicaid.

Following the release of the draft proposal in December, MassHealth held a 30-day comment period, during which it held two public listening sessions and collected written comments from dually eligible members, community organizations, providers and health plans. In response to substantial public input, MassHealth incorporated a number of changes into the final proposal.

CMS is now seeking public input through a 30-day comment period. We strongly encourage all interested individuals or groups to submit comments to help inform CMS’s review of the proposal. Comments are due by 5 pm on March 19 and should be submitted to MedicareMedicaidCoordination@cms.hhs.gov.

Pending approval of the state’s proposal, MassHealth is seeking continued public input on implementation topics and will hold the next Open Meeting with stakeholders as follows:

February 28, 2012, 3:00-5:00 PM
1 Ashburton Place, 21st Floor
Boston, MA 02108

Stay tuned for more information on the duals initiative.

-Kaitlyn Rhodes

February 24, 2012

Today, the Connector Board voted to approve consultant contracts for project management assistance to transform the Connector into an ACA-compliant Exchange and to provide analysis and strategy guidance around implementing ACA-required reinsurance, risk adjustment, and risk corridor programs. Connector staff also gave a comprehensive overview of the improved Business Express program.

Materials from the meeting are here; our full report is after the flip.

February 24, 2012

The Journal of Health and Biomedical Law at Suffolk Law School is hosting a symposium on end-of-life care on Feb. 29, 11:30-3:00pm, at the school (120 Tremont Street, Boston). Panelists come from Compassion and Choices, the law school at the U. of Minnesota, the Hastings Center, Harvard Medical School, and the law office of William J. Brisk. Lunch will be provided and RSVP’s are required. Learn more about the event and how to RSVP here
-Deb Wachenheim

February 22, 2012

Last week, the Mass Medicaid Policy Institute released another policy brief entitled Stabilizing MassHealth Funding: Options to Break the Recurring Cycle of Expansion and Contraction (pdf).

MassHealth (Massachusetts’ Medicaid program) is counter-cyclical in nature. When state economic growth slows and people lose their jobs (and their employer-sponsored health insurance), the low-income population needing health care coverage from MassHealth grows. And, as the economy weakens, revenues available to cover the state share of the cost of MassHealth shrink, just as the need for coverage increases.

The MMPI paper discusses options within state government control for reducing the reactive swings in MassHealth funding and scope of services that come with each economic downturn. The report advocates for the importance of a stabilizing mechanism specifically for MassHealth because of:

  • its entitlement nature, which limits the state’s spending discretion;
  • its size, accounting for about 30 cents of every state budget dollar;
  • the concurrent loss of federal Medicaid revenue resulting from any cuts made to the program;
  • the impact of cuts on the health care sector, an economic engine of the state’s economy; and
  • the impact on a program that over 20 percent of state residents depend upon for their health care needs.

Thus, MMPI suggests three potential options for stabilizing mechanisms, each intended to meet the goals of improving MassHealth’s long-term planning abilities, including robust oversight and transparency, and applying lessons learned from past experiences.

  • Establish a Medicaid Stabilization Fund: This Fund could serve as a MassHealth- specific “rainy day fund.” A portion of additional federal money flowing to the state under the ACA, plus any appropriated but unexpended MassHealth dollars from a given fiscal year, could be retained in the Fund.
  • Adopt Multi-year Budgeting for MassHealth: Adopting this practice for just the MassHealth program could allow MassHealth time to invest in improvements and infrastructures that would ultimately have a bigger impact on containment of costs.
  • Create a Public Authority: Converting administration of MassHealth from an executive branch agency to a public authority could allow more flexibility for longer-term financial arrangements and the program stability that comes with it.

A stabilizing mechanism could not only ensure the long-term stability of MassHealth, it could also benefit other health and human service agencies, hospitals, other health care providers, and businesses that may otherwise be called on to absorb some of the consequences of decreasing Medicaid funds.
-Suzanne Curry

February 22, 2012

Chairman Steven Walsh of the Committee on Health Care Financing will be meeting tomorrow, Wednesday, February 22, with the Quality and Cost Council's Advisory Committee to discuss payment reform. Meetings are open to the public. The meeting is 2:30-4:00 at Division of Health Care Finance and Policy, 2 Boylston Street, 5th floor, Daley Room, Boston.

February 21, 2012
Children's Hospital Boston Asthma intervention reduced ER use and missed school days

Boston Globe graphic

Yesterday's lead Kay Lazar story in the Globe, Children’s Hospital reports progress on asthma: Program cuts costs, trips to ER (paywalled, of course), is evidence of exactly why we need comprehensive reform of how health care is paid for in Massachusetts.

If you didn't see the story, it describes how Children's Hospital Boston successfully used community health workers to reduce acute asthma attacks, and save money:

Hospitalizations for asthma have been dramatically cut by a program that helps families reduce the conditions that trigger attacks, saving $1.46 in hospital care for every $1 spent on prevention, according to a Children’s Hospital Boston study being released today.

The hospital’s program, the Community Asthma Initiative, targeted 283 children with asthma in some of Boston’s poorest neighborhoods. Health workers taught families how to correctly use medications and eliminate triggers of attack, such as contaminated bedding and feather dusters. They also provided each family a vacuum cleaner with special filters.

After the first year, asthma-related emergency room visits for children in the program plummeted 68 percent compared with their emergency room trips in the year before enrolling, and there was an 85 percent drop in hospitalizations, according to the study published online in the journal Pediatrics.

Additionally, there was a 43 percent decrease in the number of children who had to limit physical activity and a 41 percent reduction in reports of missed school days. For their parents, that translated into a 50 percent drop in the time they had to miss work to care for ailing youngsters, the study found.

The program's success led MassHealth to begin a similar pilot among children it covers. Under the new waiver agreement with the federal government, selected primary care sites will receive a payment to provide home visits and care coordination by community health workers and supplies to mitigate environmental asthma triggers in the home. These services are typically not provided under Medicaid.

The project points out two implications for the upcoming payment reform legislation:

First is the value of flexibility in covered benefits, which is a key advantage of global payments. Our friends at Commonwealth Care Alliance, which covers dual eligible (Medicare+Medicaid) seniors under a global payment, calls it "giving the checkbook to the care managers." Insurance doesn't normally cover vacuum cleaners, yet the Children's program found that advanced filter vacuums were critical to keeping the kids healthy. We think global payments provides the best opportunity for expanding services with a focus on health, rather than the details of the reimbursement system.

Second is the role Community Health Workers (CHWs) can play in a reformed health care system. The Children's Hospital program depended on CHWs, who come from the community they serve, to provide the needed education and care. Massachusetts DPH is helping building a strong CHW workforce, and is setting up a CHW Certification Board to assure high standards and continuing education and development. We have urged the legislature to specifically direct ACOs to include CHWs as part of care teams. CHWs can make the link between patient and health care in a culturally-connected way, reducing disparities and improving health.
-Brian Rosman

February 15, 2012

NPR aired two stories over the last two days looking in depth at Massachusetts health care reform, and the prospects for cost control. The stories (audio and transcripts for both stories are here), by veteran NPR health report Richard Knox, are good summation of where we are, and where we're going in Massachusetts health policy.

The first story, looking at the current status of chapter 58, checks in with business owner Dieufort "Keke" Fleurissaint. Back in the 2005-2006 days, Keke was a GBIO leader, speaking movingly about the critical need to find affordable coverage for his employees. Back then he was featured in a Channel 5 report on the May 2005 GBIO campaign kick-off, and then after the law passed, the Blue Cross Foundation included him in their "Voices of Reform" video project for their 2008 summit.

Today, Keke's still happy with the law:

"Close to 500,000 people didn't have health insurance," Fleurissaint says. "Now, because of the passing of the law, they have health insurance."

And one of them, it turns out, is Fleurissaint. He used to be a mortgage broker, but his business crashed in 2008. He couldn't pay his health insurance premiums.

But under the new law, Fleurissaint qualified for state-subsidized insurance.

"My premium ... dropped from $1,200 on a monthly basis [to] $770 for the same coverage for the same family of four," he says. And when his income dropped again during the recession, so did his health insurance costs.

"The law has been extremely good for me," he says, but he admits that not all his business colleagues like the law.

But Knox looks for business opposition, and doesn't find much. The Mass Restaurant Association said all of its members offer coverage. Bill Vernon, head of the NFIB, a vocal opponent of health reform in 2005, opposes the ACA but now says the law "works for Massachusetts." "My guess is that we would probably be pretty much split on the issue of whether to repeal the law or not. That suggests repeal is not something we would favor. And I don't think it's politically realistic, either."

Knox also finds real progress on the cost control front. He reports on Blue Cross and other insurers move to global payments, and the impact the administration pressure and DOI's rate review process had in moderating rates for 2012. Governor Patrick is not letting the lull in premium growth distract him from the need for comprehensive legislation:

[Governor Patrick] says Massachusetts needs to pass some legislation to lock in these changes and go further: cut down on administrative costs, reform the malpractice system, and other steps.

The big idea you hear being talked about these days is to hold total health spending to a target tied to the state's overall economic growth.

PATRICK: What I want to assure, and why I think we need legislation, is that it's sustainable, that we don't continue to have increases above the rate of growth in the economy, so that over time, without a check on that, health care eats up everything else.

Knox ends the report with "If Massachusetts can do that, it might become a national model again."

Putting Massachusetts in the national spotlight ups the ante for our payment reform legislation. We hear from legislative sources that bill drafting is happening now, and that a bill might emerge during March. Our Campaign For Better Care is talking around the state, and up at the State House, every day. GBIO is fully engaged. We're moving.
-Brian Rosman

February 14, 2012

The Health Care Quality and Cost Council is holding its monthly meeting on Wednesday, February 15, 1-3pm. The location for this month has been changed to the Division of Health Care Finance and Policy, 2 Boylston Street, 5th floor, Daley Room. Topics on the agenda (pdf) include a presentation on the recently-released reports on healthcare-associated infections and serious reportable events and a report on the new Statewide Quality Advisory Commission. Meetings are open to the public.
-Deb Wachenheim

February 14, 2012

Site header for Connector's small business coverage page

Today, the Connector relaunched its Business Express program with offerings from the state’s eight leading health insurance carriers. Business Express provides small businesses with 50 or fewer employees an enhanced shopping experience, including easy comparison of health plans. The program started a couple years ago, but with limited carrier participation — until now. Blue Cross Blue Shield of Massachusetts, BMC HealthNet Plan, CeltiCare Health Plan, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan and Tufts Health Plan now offer plans – all without membership dues or monthly fees, and all with the Seal of Approval from the Connector. Small business owners can shop for Business Express at www.MAhealthconnector.org. The application takes about 15 minutes and quotes are generated within seconds.

The Connector’s Wellness Track, a workplace wellness program that promotes healthy lifestyles, provides yet another source for real value, as participating small business owners may qualify for a 15% rebate of the premium contributed towards their employees’ coverage.
-Kaitlyn Rhodes

February 13, 2012

CSpan photo of Attorneys General Martha Coakley (MA) and Ken Cuccinelli (VA) discussing ACA constitutionality

As the nation awaits the fate of the federal Affordable Care Act (ACA) slated to go before the United States Supreme Court late next month, Attorney General Martha Coakley jump-started the debate with a recent trip to Washington. On Thursday, Attorney General Coakley co-led a National Press Club event debating the constitutionality of the ACA. She and Virginia Attorney General Kenneth Cuccinelli, an ardent ACA opponent, argued over several facets of the Supreme Court case, including the health care coverage mandate, the tax basis, the general welfare aspect, expansion of Medicaid, and severability of the law’s provisions (watch the C-Span video).

Attorney General Coakley fervently defended the law, explaining why the results in Massachusetts show that Congress had a constitutional basis to enact health care reform. She highlighted the benefits Massachusetts has experienced under our state law, including greatly expanded access to health care and a reduction of people seeking emergency care at hospitals.

The Massachusetts Attorney General’s office is amicus curiae on one of three amicus briefs submitted to the U.S. Supreme Court from Massachusetts organizations. We (Health Care For All) collaborated on a brief with Health Law Advocates, Mass Hospital Association, Mass League of Community Health Centers, GBIO and Community Catalyst. Blue Cross Blue Shield of MA also filed an amicus brief defending the constitutionality of the federal law.

As Massachusetts served as the blueprint for the federal law, these briefs underscore how the Commonwealth’s unique experience provides an important context for assessing the constitutionality of the ACA and continues to provide a model for successful reforms. The three amicus briefs focus in particular on defending Congress’ power to enact what's termed the “minimum coverage provision” of the law - which will require non-exempted individuals to maintain a minimum level of health insurance or pay a tax penalty. In other words, the briefs defend the constitutionality of the so-called individual mandate.

As the first State in the nation to enact health care reform requiring individuals to purchase health insurance, our experience confirms that Congress had a rational basis for finding that the individual mandate would advance the critical goals of reduction in barriers to insurance coverage and improving access to health care.

The brief of Health Care For All and our partners makes the point that health insurance and health care markets inherently involve activities between and among states that cannot be successfully regulated without federal involvement. The Massachusetts health system continues to be affected by the decisions of uninsured and underinsured people from other states who seek care in Massachusetts but remain outside the scope of many of the state’s reform laws, including its minimum coverage provision. Without assistance from the federal government, one state’s desire to create workable health care reform would be held captive to the decisions made by out-of-state individuals and surrounding states.

The Brief of Blue Cross and Blue Shield of Massachusetts described the the individual mandate as an integral part of Massachusetts health reform, essential to the nearly universal health insurance coverage gained for the Commonwealth’s 6.5 million residents. Looking at Massachusetts as a model, Congress therefore acted rationally in determining that the individual mandate provision is a necessary and proper regulation of health care market activities.

The brief of Commonwealth of Massachusetts concluded that through effective efforts to stop healthy people from opting out of purchasing health insurance, the Massachusetts reforms increased health plan enrollment and helped decrease the rate of premium growth, prompting a significant reduction in governmental and private free-care expenditures. Based on the Massachusetts experience, Congress acted rationally in drawing the same link to justify its regulation of activity affecting interstate commerce.

While these briefs highlight different aspects of the Massachusetts experience in defending the ACA, a common theme runs throughout the briefs: as a leader in health reform, the Massachusetts experience serves as a model for how health reform can work successfully on a national level.
-Alyssa Vangelli

February 12, 2012

2012 DPH hospital acquired Infections Report

As mentioned earlier this week, the Department of Public Health has released its latest public report on healthcare-associated infections in acute care hospitals. Friday they posted information specific to every hospital in the state. Go to the DPH website to find the information.
-Deb Wachenheim