August 2012

August 31, 2012

Yesterday, State House News ran what on the surface appeared to be a strange story. They devoted an entire article about an aide moving from a legislative office over to the executive branch. Traditionally, legislative staffers are anonymous to the general public. They don’t grab headlines. If they do their jobs right, it’s their bosses who show up in the news, not them. Under most circumstances, an aide changing jobs is not newsworthy. But when David Seltz leaves the Senate President’s office to go to work for the Governor, it’s a different story. In many ways, David is a typical legislative aide. He does his job out of a deep commitment to his work and loyalty to Senate President Murray, not out of a desire for self-aggrandizement. What sets him apart, however, is how good he is at what he does. David always has intimate knowledge of every health care issue in play, where they are in the legislative process, the interest groups on either side, and how best to move the process forward. His willingness to put in the long hours and to tackle complex issues in unmatched. When Governor Patrick signed the Health Care Cost Control bill into law last month, we're sure that there wasn’t another person in Nurses Hall that day who was more knowledgeable about the contents of the 349 page bill than David was. The Governor acknowledged this by singling out David in his remarks, and the applause was loud and sustained. Over the past nine years, David has worked for Senator Murray, and Health Care For All has been privileged to have been able to work with him. From leading the staff work on behalf of the Senate during the conference committee for chapter 58 in 2006, to the major insurance and cost reforms in 2008 and 2010, to children’s mental health, to prescription drugs, to oral health, David was there at the most critical times. Yesterday’s word that David was leaving the Senate President’s office was a shock and a disappointment to many here at HCFA. But word that he would be the Governor’s point-person on the implementation of payment reform brought many smiles. Bringing health care costs under control in the Commonwealth while maintaining access to high quality care is no small undertaking. Knowing that David will be at the helm of this effort makes us more confident about its success. David, for everything that you have done while working for Senator Murray, thank you. For everything that you will do working for Governor Patrick, thank you even more. We look forward to tackling this next health policy challenge with you. -Matt Noyes and Brian Rosman

August 29, 2012

NY TImes dental story screenshot

Oral Health Advocacy Task ForceMore than 800,000 low-income residents of the Commonwealth have been impacted by the 2010 cuts to MassHealth and Commonwealth Care adult dental benefits. When Governor Deval Patrick signed the FY13 budget into law, it authorized the restoration of two procedure codes that will allow consumers who rely on MassHealth and CommCare for their dental coverage to get composite fillings for their front teeth, starting January 1. This compromise decision is a promising first step toward full restoration of benefits that consumers, providers, and the Oral Health Advocacy Taskforce are calling for.

This morning’s New York Times includes a story on the impact of the cuts and the steps Massachusetts is taking toward restoration. As Illinois joins the growing list of states to slash dental benefits, the recent move by the Commonwealth is a sign of hope for other states that have experienced cuts. Restoring fillings for front teeth will help to keep people employed in a service-based workforce, but there is a long way to go to ensure that Medicaid patients have consistent access to quality oral health care. Oral health is essential to overall health, and dental insurance is health insurance. That is why advocates will continue to fight for whole body health coverage, including full restoration of MassHealth adult dental benefits.

If you’d like to get involved, share your story, or find out more about our efforts to restore Medicaid dental benefits, please fill out this web form, or contact Courtney Chelo at 617-275-2935 or

You can find the full story from the New York Times here, or in today’s print edition on page A16.


August 27, 2012

 Therese Fitzgerald, director of the Women's Health Policy & Advocacy Program; Christie Hager, regional director for Region I of the U.S. Department of Health and Human Services; Paula Johnson, chief of the BWH Division of Women’s Health and executive director of the Connors Center for Women’s Health and Gender Biology; Kate Bicego, consumer education and enrollment manager for Health Care for All; Edith Kenneally, of BWH Patient Financial Counseling Services; and Nyjah Wyche-Alexis, of YWCA Boston.

August 1st was a historic day for the health and well-being of women and their families. Thanks to the Affordable Care Act millions of women across Massachusetts and the country now have access to eight preventative health services without cost sharing. This means that women receiving any of these services will no longer have to delay care due to unaffordable co-pays, deductibles, or coinsurance.

These new preventive care services for women are part of a general expansion of preventive care for children and adults under the ACA; see more details on this fact sheet.

One of the HCFA HelpLine’s many roles is to educate consumers about how the Affordable Care Act impacts the lives of themselves and their families. As each provision of the ACA goes into effect, we receive calls from on-the-ball consumers looking for health care coverage answers.

But we know that answering HelpLine calls is not the only space for educating folks about the ACA. We were honored and grateful to recently take part in an educational session at Brigham and Women’s Hospital’s Women's Health Policy & Advocacy Program. (download comprehensive session materials (pdf) on women's health and the ACA).

Paula Johnson, MD, MPH, chief of the BWH Division of Women's Health and executive director of the Connors Center for Women's Health and Gender Biology, and the BWH Women's Health Policy & Advocacy Program hosted the discussion (download her presentation (pdf).  Christie Hager, JD, MPH, regional director for Region I of the U.S. Department of Health and Human Services, spoke about the strong consumer protections unveiled by the ACA (presentation (pdf)). Our HelpLine Manager, Kate Bicego, gave an overview of Massachusetts health care coverage post ACA implementation and used examples of HelpLine callers to help participants identify patients that will benefit from the law (presentation (pdf)).

This event was made possible by support from the U.S. Department of Health and Human Services Office on Women's Health Region 1 (New England) Office. We thank HHS, Dr. Paula Johnson, and the BWH Women’s Health Policy & Advocacy Program team for this opportunity to collaborate and educate ACA stakeholders.

August 20, 2012

As of October 2010, all hospitals in Massachusetts were required to have established a Patient and Family Advisory Council (PFAC). DPH’s regulations for PFACs require hospitals to write annual reports describing their PFACs' activities over the previous year and to make those reports available to any member of the public upon request. Members of HCFA's Consumer Health Quality Council (CHQC) ( reviewed and summarized all of the annual reports that were made available to them. The CHQC members identified two hospitals' PFACs as role models for other hospitals-one community hospital (Milford Regional Medical Center) and one academic medical center (Beth Israel Deaconess Medical Center). Leaders of those hospitals' PFACs described their activities at last week’s monthly meeting of the Massachusetts Coalition for the Prevention of Medical Errors. Kim Munto, the Director of Risk Management at Milford Regional Medical Center, described their PFAC's activities in her presentation, elaborating on them in a later interview. Since their PFAC members are particularly attuned to health literacy, the application for prospective PFAC members is available in Spanish, Portuguese, and English. Milford's PFAC completely reworked the hospital's discharge instructions, translating clinical language into terms more often used by laymen. The PFAC's suggestions greatly clarified the instructions about medications, e.g., which ones to stop taking, which to continue taking, and in what doses. The PFAC also stimulated changes to the forms used to convey information on patients as they transitioned from the hospital to each of three extended care facilities (ECFs). The PFAC performed several rounds of intensive review, working with the three outside ECF organizations, in an example of collaboration across healthcare organizations that is all too rare. To help Milford begin providing mealtime menus to patients for the first time, the PFAC reviewed the menus and the presentation of the food, and then at a PFAC meeting, ordered dinners from the menu, which were delivered to the conference room. For Beth Israel Deaconess Medical Center, Barbara Sarnoff Lee, the Director of Social Work, and Elana Premack Sandler, Project Leader for Patient and Family Engagement, described their four PFACs as components of a broader strategy of engaging patients. BIDMC's Neonatal Intensive Care Unit (NICU) had been the first to set up a PFAC, followed by PFACs for the ICU, the entire hospital, and Universal Access (focusing on the needs of patients and staff with disabilities and other access challenges). BIDMC also engages 100 patient advisors in pairs on committee seats, department-specific groups with embedded advisors, focus groups for patients especially concerned with a single issue, and ad hoc projects. A PFAC member had mentioned how much easier it was to heal when it was quiet at night. The hospital applied best practices to quiet the patient areas, creating a notable improvement in the eyes of patients surveyed in HCAHPS (patient experience surveys): 33% more patients said it was always quiet at night after these changes (60%) than before (45%). This positive change was discussed in a recent Boston Globe article. BIDMC had noticed an opportunity for improvement in pastoral and spiritual support for patients, based on FS-ICU (Family Satisfaction - Intensive Care Unit) data. Following redesign efforts with feedback, the FS-ICU scores improved. Another effort, to improve the ICU's waiting rooms, also raised FS-ICU scores. In a ripple effect of the improvement, seeing the change, hospital administrators then awarded more funds for renovating the waiting rooms. These are merely a few examples of many more at these hospitals, and indeed, at many other hospitals in the state. The Consumer Health Quality Council hopes to encourage hospitals to test and adapt these practices so their patients can also benefit. Keep an eye out for the release of the Consumer Council’s summary report of all of the PFAC reports, where you will be able to read about more PFAC accomplishments. In the meantime, go to the hospital PFAC page on the HCFA website to learn more about any individual hospital’s PFAC. [This blog post was written by Ken Farbstein, a long-time member of the Consumer Health Quality Council, and professional patient advocate at Patient AdvoCare. Ken writes Patient Safety Blog to empower patients to partner with their doctors and nurses.]

August 16, 2012

MMPI - MLRI- MBPC masthead They read the bills, so you don't have to. The collaboration between the Mass Medicaid Policy Institute, Mass Law Reform Institute and the Mass Budget and Policy Center continues to provide us with great summaries and insight into the often arcane provisions enacted into law as part of the budget process. This stuff is complicated in Massachusetts for two reasons. First, in addition to an annual budget covering the fiscal year (starts on July 1), the legislature enacts each a number of additional, supplemental budget statutes during the year, including usually one after the fiscal year as ended. These "supps" add or subtract spending from the original budget, and are crucial to understanding how much agencies are authorized to spend for state programs. Health care programs are typically a major focus of these supplemental budgets. Second, budget laws include numerous legislative provisions apart from the funding allocations in the line item sections. Some of these legislative provisions complement budget provisions, but many are unrelated riders than hop on the budget train and get enacted into law along with the budget. The MMPI/MLRI/MBPC team has put out two very helpful summaries of recent budget laws, superbly edited and formatted to make all this stuff very understandable and accessible. First is MassHealth and Health Reform Funding in the FY 2013 General Appropriations Act (pdf) which charts out the FY 2013 budget numbers, categorizes the savings and additions assumptions built into the budget allocations, and summarizes all of the policy provisions that impact MassHealth, Commonwealth Care and other health programs. An appendix has a line-item by line-item listing of each of the applicable accounts, showing last year's amount, the Governor's request, and the final spending authorization. Second is MassHealth and Health Reform Provisions in the June FY 2012 Supplemental Budget (Chapter 118) (also pdf). A budget law enacted in June (Chapter 118) included a host of provisions to implement the Affordable Care Act in Massachusetts. The 3-page deftly explains each of the provisions. Included is a first-in-the nation legislative authorization for the Basic Health Program, an option that would allow Massachusetts to continue Commonwealth Care-like coverage for some low income people who don't qualify for Masshealth. Congrats to the threesome of groups that worked on these briefs. -Brian Rosman

August 13, 2012

Nancy Turnbull blog post image on payment reform law

Writing today in the Health Affairs blog, Harvard School of Public Health Associate Dean and Connector Board Member Nancy Turnbull posts a summary and analysis of chapter 224, the new payment and delivery system reform law.

Turnbull rightly focuses on the implementation challenge:

After a two-year gestation period for its payment reform and cost control bill, the Massachusetts legislature finally delivered … an exoskeleton. Time will tell whether the law will be transformed through the magic of implementation genetic engineering into an effective cost control creature with strong and vital organ systems. Some of the essential DNA is there but the challenges ahead are formidable. However, regardless of whether Massachusetts is ultimately successful at “cracking the code” on cost control, as Governor Deval Patrick and others hope, the state is going to learn a lot over the next few years, much of which will no doubt be useful to other states.
History suggests that the law will be revised, perhaps many times, in the next few years. But for now, attention shifts to the important implementation decisions that lie immediately ahead. In particular, the appointments of the 9 public members to the new 11-member Health Policy Commission will be critical, as will the selection of its chairperson and executive director. Unless the Commission becomes a strong and independent entity, the promise of the law cannot be realized.

Implementation of the payment reform and other provisions will spell the difference between success and status quo (or worse). HCFA will be looking to continue to play its role as the voice of consumers in the implementation process, much as we have done in the implementation of Chapter 58.

Turnbull concludes with some optimism, which we share:

We won’t know for several years how well the Massachusetts law will work, and whether it could be a model for other states or the nation. What is a model is that Massachusetts is again taking on, as it did with coverage in 2006, one of the most challenging and important health care issues in the country. While it’s very likely that the new cost control law will turn out to be less than is needed to solve the problem, it’s much more than is happening in almost any other state. And that’s a cause for celebration, and some hope.

Now it's up to us, collectively.
-Brian Rosman

August 9, 2012

Campaign For Better Care member logos

Back in January 2010, we launched our Campaign For Better Care, a consumer-driven coalition focused on working to educate the public and policymakers on the consumer stake in payment and delivery system reform. After much internal discussion, the campaign formulated 10 "Principles For Better Care," and we posted them on our website and this blog.

Based on the principles, we came up with a sheaf of specific policy recommendations. We passed them on to the legislature, produced colorful fact sheets and highlighted them in a series of blog posts this spring.

Our goal was to see these principles and policy recommendations incorporated into the final legislation. We worked hard during the House and Senate debates to add policy provisions that were not included in the committee bills.

So on Monday, when the Governor signed Chapter 224 into law, we asked, how did we do?

Pretty good, we think. We've posted a detailed chart (pdf) listing each of our policy recommendations, and the corresponding provision of Chapter 224 relating to the recommendation. The chart shows that just about every one of our recommendations is reflected in the statute, though some are not mandatory. The real test will come with the implementation, of course. The Campaign For Better Care will be working out its role in the implementation over the next few months.
-Brian Rosman

August 7, 2012

Governor Patrick Payment Reform Signing

This one's got a name, now. Chapter 224 of the Acts of 2012. Nobody will call it by its mouthful of a title, An Act improving the quality of health care and reducing costs through increased transparency, efficiency and innovation. The health care bill joins the pantheon of laws that old-timers know by chapter number - 23, 495, 203, 47, 141, 58, 305, 288 and so on. Calling a law by its chapter number is how you let everyone know that you know your way around the healthpolicyworld.

Being the first to announce the chapter number is a tradition of ours, of course.

There's probably an old joke variation here, too.

The hardest thing is for people to stop calling it a bill, and start calling it a law. Months from now, though, it will just be a law. As we have been saying to everyone, the next stop, implementation, is what really counts. We can't wait.

August 7, 2012

In Massachusetts' Decisive Move to Attack Health-Care Costs, published in The Atlantic, HCFA Executive Director Amy Whitcomb Slemmer explains how the just-signed health care delivery and payment reform law can transform care for patients in Massachusetts. Excerpt:

For the first time on a statewide scale, we will move away from the current fee-for-service system, which pays for every procedure, test, and office visit, but does not pay for phone consultations, e-mail exchanges, home visits, health education, or wellness and nutrition education. In short, the system pays when stuff is done to us, but it does not support efforts to keep us healthy.

Your doctor is paid when you have an office visit, but if you have a question about whether or not you need to be seen, she will not be paid for that phone conversation. And if you need to be seen after hours, what happens? You are sent to the emergency room, where you will receive the most expensive care in our system. Chances are that the treatment that you receive or the tests that are performed to diagnose you will not be reflected in your overall medical record: you will be responsible for self-reporting to your primary care doc, or more often than not, tests will be repeated in a different setting.

The law signed by Patrick will change the way doctors, hospitals, and other providers are paid so that they are paid to keep us healthy. If your doctor was able to save you a trip to the ER, to take just one example, they will be rewarded for saving the whole system money -- as they aren't now.

In the improved delivery system, the relationship between the primary-care provider and the patient is highly valued. The expectation is that providers will have more time with each patient, and we as patients will be more engaged in our care. Efficiency will come as doctors and other providers organize to deliver team-based care that is better integrated and patient-centered.

Our new law also establishes a first-in-the-nation Prevention and Wellness Trust Fund: a four-year commitment to community-based public health initiatives that have proven track records, as demonstrated in improvements in overall health statistics for participating jurisdictions. At Health Care For All, a consumer-advocate organization that has worked to guarantee high-quality health care to everyone, we expect this investment -- a down payment on improving our populations' health -- to return rapid results.

She concludes that "But one thing we know: what we learn in Massachusetts will again provide valuable insight and success that the rest of the country would do well to emulate." As with our Medicaid and kids coverage expansions of 1996, which became a model for the federal CHIP law, and the 2006 reforms which of course provided a template for much of the ACA, the law Governor Patrick signed yesterday will reverberate far beyond the Bay State.

August 1, 2012
Benefits for Women under ACSA starting 8/1/12 Click for the full graphic from the Center For American Progress

[Our guest blogger is Megan Amundson of NARAL Pro-Choice Massachusetts. We're also active supporters of the Countdown to Coverage campaign, an effort to help women understand the concrete ways that the Affordable Care Act is already helping women and our families stay healthy. They have highlighted all the new benefits for women's health in a series of posts this week.]

Today (August 1) marks an historic step forward for women across Massachusetts and the United States. From this point on, new health insurance plans must begin covering women’s preventive services like contraception, breastfeeding counseling and support, and screenings for sexual transmitted diseases, including HIV and HPV without charging any additional costs, like co-pays. As exciting as these new services are, the underlying message is that women’s basic health care is just that—basic health care. And now basic health care must be available to every woman regardless of where she lives or how much she earns. This change in how we define preventive care is what inspires me the most.

As a new mother, I find myself in the middle of my life wishing that the Affordable Care Act had been law when I was younger. Never mind the years of anxiety trying simply to get health insurance as I entered the workplace in my early 20s, wishing I still had my parent’s insurance rather than the cut-rate version I could afford. Never mind all the money I spent on birth control for 14 years on prescription co-pays and paying for birth control outright when I was in between insurance coverage. Rather, it was when I had my baby last winter that I realized how challenging accessing basic health care services can be.

When I became the mother of a beautiful, healthy baby girl, I found out firsthand how difficult and expensive it is to find the kinds of support new mothers need, first and foremost breastfeeding support. You can’t be pregnant in our society without being regularly told about the importance of breastfeeding. But no one prepares you for how hard it will be, and support isn’t guaranteed when you need it most – as soon as your baby is born.

My own stay in the hospital after giving birth was lengthy. Despite all of my efforts and pushing the nursing staff to get me access to a lactation specialist, I went days without breastfeeding support. It seems that the fact that my daughter was born healthy worked against her in getting assistance to keep her healthy. By the time I saw the specialist I was unable to breastfeed entirely. Then it was entirely unclear what my insurance would cover. Would it provide us with a breast pump to allow me to continue to provide her with breast milk or ongoing access to a lactation specialist? Every health insurance is different, we were told.

As the Executive Director of NARAL Pro-Choice Massachusetts, I am thrilled to be working toward a world where no woman will have to fight like I did to get basic health care. I am overjoyed that today marks the day when breastfeeding won’t be possible only for women with incredible luck or financial resources. But more than that, women in every phase of life will be able freely access services to keep herself and her family healthy. The Affordable Care Act has brought us this welcome respite from the war on women, but we must remember the work is far from over.