December 2012

December 31, 2012

HCFA staff photo

Happy New Year from all of HCFA (see our staff picture above)! The year 2013 will be a critical year for health care in Massachusetts. State government will be making numerous decisions that will directly impact the availability, cost and quality of the care that everyone depends on.

Health Care For All will be there, making the sure the voices of consumers and patients are heard on Beacon Hill, and throughout the state.

Among the key issues we anticipate focusing on for 2013 are:

1. Implementation of the Affordable Care Act. Major portions of the Affordable Care Act (ACA, or “Obamacare”) take effect in 2014. These will require big changes to the health care coverage programs set up by the 2006 health reform law. By October 1, 2013, the Health Connector will need to implement changes so it can enroll people into the new programs. The legislature is likely to consider legislation this spring on how to implement the ACA in Massachusetts. HCFA will be fighting to make sure that we protect affordable coverage for low income families,  and that the enrollment and eligibility systems work for everyone.

2. Implementation of the cost control and delivery system reforms. Last summer the legislature passed comprehensive legislation (Chapter 224) to control health care cost growth, and to reorient our health system to promote integrated, patient-centered care. With these changes, the system will focus more on keeping people healthy, saving money by reducing waste and preventing acute illness. In 2013, the implementation process begins, with new boards and agencies digging in and creating the regulations and guidelines as we move to accountable care. Our priorities include consumer protections, transparency, public health, and protecting vulnerable populations.

3. Roll-out of the integrated care plan for adults with disabilities. Beginning sometime this summer, MassHealth will begin enrolling over 100,000 adults with disabilities who are “dual-eligibles” – people enrolled in both MassHealth (Medicaid) and Medicare, into new managed care plans. These plans bring the promise of better integrated care and expanded benefits, if done right. But there is also the very real danger of inadequate coverage and barriers to receiving the long-term support services that people with disabilities depend on. HCFA is working closely with representatives of people with disabilities to make sure the plans meet all the needs of the people they serve.

4. Restore full dental benefits. For over 700,000 adults on MassHealth, the reduction in dental benefits imposed two years ago means they are at risk for severe problems with their teeth, impacting their ability to chew food, be social and be free of pain. For health experts, it also means they are at risk for many other health impacts, because good oral health is part of overall health. Lack of good dental care leads to expensive chronic diseases, like diabetes, heart disease, and stroke. HCFA will be working to make sure full dental care is available through MassHealth.

5. Remove Barriers To Cost-Effective Care. Copays and deductibles are increasingly a barrier to care — especially for low and moderate income and chronically ill patients who require multiple treatments and services to maintain optimal health and treat disease. Research shows that many chronically ill patients reduce their use of drugs and other treatments when faced with increased cost sharing, but increase their use of more expensive emergency room visits and inpatient hospital care. HCFA will be exploring ways to remove barriers for high-value, cost-effective treatments and drugs, in order to promote better overall health.

6. Adequate revenue for the state. Our health care system is faced every year with sharp budget cuts, because our state’s tax base is not adequate for all we need for strong, healthy communities. HCFA will be joining with many other groups to work for sufficient revenue, raised in a way that protects low- and middle-income families and seniors from big increases.

We have a number of other issues we will be actively working on, including health care quality, mental health, prescription drug marketing, and a number of private insurance issues.

It’s a big agenda for 2013, and we welcome your input and participation. To support this work in 2013, please make an end of the year gift to HCFA today.

December 28, 2012

Giving to HCFA has never been so easy The season of giving is almost over and there are only a few days left to donate to HCFA in 2012. 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 Individual Giving & Events Manager

December 28, 2012

Earlier this year, HCFA conducted a needs assessment, commissioned by the Health Connector, among Spanish- and Portuguese-speaking small businesses about how they provide or don’t provide health coverage to their employees. The survey is a part of the work we’re doing with the Health Connector as we reach out to Spanish- and Portuguese-speaking small businesses across Massachusetts to make sure they know about the affordable health care options that are available to employers, employees and others. Now, based on the results we got from talking with hundreds of small businesses, we’re ready to enter the next phase: reaching out to thousands of businesses and individuals across the state to enroll even more people in affordable and quality health care plans.

Connector Explains Some Options

Last week, leaders in the Portuguese- and Spanish-speaking community gathered at HCFA to learn about affordable health care options and to hear details of the outreach campaign set to launch early next year. With the Health Connector and our partners at Health Law Advocates, we trained these leaders on coverage options available to employers, employees, individuals and families. The training set up the stage for our next effort at the grassroots level, in partnership with ten regional organizations that will help us make a big difference in underserved communities. We are thrilled to have on board the following respected partners in the Portuguese- and Spanish-speaking communities:

- Massachusetts Alliance of Portuguese Speakers (MAPS)
- New Bedford Immigrants’ Assistance Center, Inc
- Avivamento Mundial-Revival Church for the Nations
- Brazilian Center
- Brazilian Women’s Group
- Massachusetts Latino Chamber of Commerce (MLCC)
- Center for Women and Enterprise (CWE)
- North Shore Latino Business Association (NSLBA)
- Hispanic American Chamber of Commerce (HACC)

We’re also reaching out in ethnic media outlets all across Massachusetts to send the message out that our HelpLine can answer their questions about coverage. We can help you navigate the complicated health care system and find the right program not just for you and your family, but also for your employees and your costumers.

HCFA HLA and Connector

We’re kicking-off this campaign on January 11, 12pm-2pm in Lawrence.

Save the date and join us for our Small Business and Consumer Outreach Campaign Launch. Here are the details:

WHEN: January 11th, noon- 2PM
WHERE: Lawrence, Massachusetts
Clemente Abascal Community Room
Sovereign Santander Bank
296 Essex St., 2nd Floor, Lawrence, MA 01840
WHAT: Health Care For All and the Massachusetts Health Connector launch an affordable health care education campaign for Spanish- and Portuguese-speaking small businesses and individuals.

--Maria Gonzalez

December 20, 2012

The Informed Medical Decisions Foundation has created a worksheet titled “I Wish I Had Asked That” (PDF) for patients to use during medical appointments when they are faced with making decisions among treatment or testing options.  This is a very useful tool for engaging the patient and provider in a conversation about health concerns and next steps. We encourage patients and family members to use them during appointments and we encourage medical providers to make these available to patients, especially when they are facing a decision about their care.

--Deb Wachenheim

December 19, 2012

Yesterday the Health Policy Commission (HPC) held its second meeting. While its initial meeting was all about the promise of health care cost control and quality improvement, at this meeting the enormity of the work ahead for them became apparent. Chapter 224, the health delivery system reform and cost containment law, heaped loads of responsibility on this new entity. With just one staffer (David Seltz, unanimously approved as Executive Director) and early deadlines, the work begins in earnest. Materials from the meeting may be viewed here, and our detailed report is just a click away.

December 14, 2012

The reshuffle of Gov. Patrick’s top cabinet officials has brought another committed and skilled person into a leadership position. We are pleased to hear that Jean Yang, currently the Connector’s Chief Financial Officer, will take the helm as the agency’s Executive Director upon Glen Shor’s move to Secretary of Administration & Finance.

Jean has been a driving force in maintaining affordable coverage for Commonwealth Care enrollees during bleak state fiscal climates and has helped move Connector programs forward through a changing health policy environment. We know the Connector will continue to thrive under her leadership and look forward to working with Jean in her new role. Congratulations, Jean!
-Suzanne Curry

December 14, 2012

Amy Whitcomb Slemmer, our Executive Director, is in Africa visiting hospitals in Tanzania and Uganda to learn about the health care systems in these countries. You can read her first dispatch here. Below is her latest update:

Kasese, Uganda

It is after 9pm and we are about to collapse at the Rwenzori Garden Hotel in Kasese, Uganda. It has been a long and incredibly educational day - also a tad overwhelming. We learned about the children's program at Bishop Masereka Christian Foundation which sponsors 450 children, mostly girls who have been orphaned to HIV/AIDS, violence, or armed conflict or disease. It is an eye opening experience to hear from some of the graduates of this program whose school fees were sponsored by the foundation. It is also hard to get our heads around schools requiring fees, and kicking kids out when they can't pay. Equally challenging, from what we understood today, are the students whose fees may be paid for, but who can't afford the books, or other school supplies.

I hope to write more about this program in the future, but will spend some time trying to understand family structures that include children as young as 10 years old being the heads of household. It was quite a day. If you want many more photos, and more detailed information, I recommend Sara Irwin's blog. We have been together this whole trip, and she was greeted as an oddity in Tanzania - where they are surprised to see a woman clergy member, and she is greeted as a rock star in Uganda because she is a priest whose parish includes a Ugandan congregation in Medford. It is a treat to get to know her better.

Bishop Shaw with Dr Daniel

Bishop Shaw with Dr. Daniel, the only physician at a health clinic that serves 22,000 patients a year.

We have been told that this is the best doctor in all of Africa, and we watched him with patients today. He has a marvelous bedside manner. He is also leaving in August 2013 after more than 6 years to take up a residency in plastic and reconstructive surgery. He wants to return to his native country Congo to repair wounds and amputations from the armed conflict currently under way. We were walking the property of the new hospital to be.


This is Ann who runs the Children's Project for Bishop Masereka's Christian Foundation. She does more with limited funds than anyone else we have run into thus far. She also has a giant heart, and an aura about her that seems saintly. She told us remarkable stories about tracking down girls who had left school and keeping in touch with them until they returned to their classes. More remarkably, we heard from some of her success stories, who talked about what a hard time they had given Ann and how they know owe her their lives.....when asked whether she has children of her own, Ann said, "yes, the program children are mine." and then Bishop Masereka piped up to tell us that Ann actually has 7 children...all orphans who she met through the program. The most recent child is a baby girl Ann found in a ditch right outside the health clinic when the child was about a day old. She is now a healthy one year old...We are pretty sure Ann has wings.

With Awe and Wonder - and about to step out under the gorgeous stars - with NO light pollution (which we were surrounded by in Korogwe, Tanzania)


December 14, 2012

Proposed Structure

Remember a year ago when we asked the question, "To BHP or not to BHP?" Well at the Dec. 13 Connector Board meeting, we learned the answer to that question. No BHP. Instead, we'll have a wrap.

The core of the Connector Board discussion revolved around two big questions:

  • Should the Commonwealth maintain its individual mandate policy in addition to the federal mandate required in the Affordable Care Act (ACA)?
  • Given there is no federal guidance on the Basic Health Plan (BHP), what can the state do to ensure continuity and affordability of coverage for low-income residents who are not eligible for MassHealth?

Materials from the meeting are posted here, and our full report is below the fold.

December 14, 2012

Outsiders can often see you with better perspective than people close to you. At least smart outsiders who know what they're talking about.

That's often the feeling I get when I read coverage of Massachusetts health developments from out-of-state sources.

Today's exhibit is a well done article in the LA Times by Noam Levey. The online headline is "A shift in how healthcare is paid for," with this kicker:

In Massachusetts, thousands of physicians receive more pay if their patients stay healthy and avoid costly medical care. It could become a national template.

The story has good detail and analysis about the shift to global payments already occurring in the market here:

This simple shift in how healthcare is paid for — long seen as key to taming costs — has been occurring in pockets of the country. But nowhere is it happening more systematically than in Massachusetts, the state that blazed a trail in 2006 by guaranteeing its residents health insurance. Now Massachusetts, a model for President Obama's 2010 national healthcare law, may offer another template for national leaders looking to control health spending.

"There have been few greater periods of change in American medical history … and this is the epicenter," said Dr. Kevin Tabb, a former chief medical officer at Stanford Hospital and Clinics in Northern California who now heads Beth Israel Deaconess Medical Center, one of Boston's leading hospitals. "It is striking how different Massachusetts is from the rest of the nation."

In the last three years, commercial insurers in the state have moved nearly 1 million patients into health plans that reward doctors and hospitals that control costs while improving quality.

About 180,000 Massachusetts seniors are on track to get care from physicians paid this way by Medicare through a new initiative included in the national health law. And this summer, state lawmakers passed legislation aimed at moving 1.7 million government employees and Medicaid recipients into similar health plans.

Within a few years, close to half of the state's 6.5 million residents could be in a health plan that pays for medical care in a fundamentally different way.

The article discusses the experience of the Blue Cross "Alternative Quality Contract," and looks at the experience through the eyes of physicians and patients. All in all, this is as good a summary of where things are today as we've seen.
 -Brian Rosman


December 13, 2012

Secretary Bigby

Tonight news broke that Governor Patrick's Secretary of Health and Human Service, Dr. JudyAnn Bigby, is leaving the Patrick administration. Dr. Bigby signed up the very first day (here's our post from December, 2006), and we thank her profoundly for her service.

She leaves two historic, transformative legacies, and dozens of major achievements. Legacy one is the successful implementation of chapter 58, which was just underway when she took office. She led the Patrick administration's quick reversal of some of the harshest inherited Romney policies, and worked to make implementation succeed. She made sure that the focus never left Medicaid while attention was lavished on Commonwealth Care and the Connector. The result is an unprecedented coverage rate in Massachusetts - some 98% overall, with over 99% of kids covered. This legacy has national implications, as our success led directly to the ACA, bring coverage to some 30 million uninsured Americans.

Her second legacy is leading the charge for comprehensive delivery system reform. Her experience as a primary care doctor for rich and poor led to understand how patient-centered, coordinated care can both lower costs and improve health. She convinced the Governor after many, many meetings that it is possible for Massachusetts to crack the code of health costs. And now after overseeing the painful process that led to the passage of chapter 224, we are on the road to what may again be nationally important progress towards a health care system that rewards value and quality, rather than volume and quantity.

As Secretary, she and her staff were more open to advocate input than any Secretary in memory. She met with us in her first weeks (see our report), and the lines of communication were always open.

Her replacement will reportedly be St. Elizabeth's hospital president John Polanowicz (2011 Globe story). We look forward to working closely with Polanowicz.

Also reported today is the promotion of Health Connector Executive Director Glen Shor to be the Secretary of Administration and Finance. We're pleased that Glen will just slide over a seat at the Connector Board meetings, and will also play a key role in the Health Policy Commission. Glen has been an outstanding leader for the Connector. When he was appointed, we said he was a "gifted and skilled leader;" after watching him lead the Connector for two and a half years, that judgement is confirmed. We know we will continue to work closely together in his new role. Congratulations, Glen.

December 13, 2012

HELP semaphore

Today the US Senate majority Democrats announced their committee assignments for the next Congress. While lots of attention was heaped on the appointment of Massachusetts Senator Elizabeth Warren to the Banking Committee, we were thrilled to learn that she also was named to the Senate Health, Education, Labor and Pensions Committee, usually called the HELP Committee.

The Committee works on a wide variety of health issues, with Medicare and Medicaid being the notable exclusions. They oversee public health and health insurance issues. Their jurisdiction includes most of the agencies and programs of the Department of Health and Human Services, including the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, the Administration on Aging, the Substance Abuse and Mental Health Services Administration, and the Agency for Healthcare Research and Quality.

Of course, Senator Edward Kennedy was a long-time HELP Committee member, chair in 2001 and 2007-2009, and chair of its predecessor committee, Labor and Human Resources from 1987 to 1995. We look forward to working closely with Senator Warren as she fills his shoes and begins her health-related work as she takes office in January.
-Brian Rosman

December 11, 2012

Amy Whitcomb Slemmer, our Executive Director, is in Africa visiting hospitals in Tanzania and Uganda to learn about the health care systems in these countries. To the extent she can (internet is spotty) she is sending us updates and dispatches. Below is her first:

Friday, 5:30 am
Korogwe, Tanzania

Hospital Exterior

Yesterday we visited SAMDDH, a very large hospital with more than 300 beds and were there during visiting hours, so it was bustling.  There are seven doctors, only half of whom are there full time, and a large nursing and support staff who take extraordinary interest and care of their charges.  We saw the TB and HIV clinic where rapid testing is done, and the wards where those who are ill are cared for.  The only air conditioning in the sprawling complex is in the testing laboratory, which is sparsely appointed, and the building with the two operating rooms, which to my untrained eye appeared to have very modest technology.  This is one of the best hospitals in the region, and even though it is only supposed to treat people from a specific catchment area, patients come from well beyond those boarders to be cared for at this facility.

About two-thirds of the beds in the maternity ward were full with women in various stages of labor and delivery.  Those who had recently delivered were resting with their newborns and those who were in labor kept to themselves, and it was challenging as visiting westerners not to offer comfort.  Men are not allowed in these rooms.

The hospital campus includes a nursing school and we were shown around by the head teacher who is also a nurse.  We visited classrooms and their dorms, and there appeared to be a difference between the male dorms (LOUD music and clothes strewn about their rooms) and the female dorms (no noise, beds made), but otherwise they are in classes together.  One class was learning about blood typing. Nurse

While this is a remarkably well-appointed and successful hospital in this region, to Western eyes the facility was making do with very old or modest equipment.

The single fact that has brought me up short is that the hospital runs out of water - regularly.  When this happens surgeries are suspended, patients have limited access to water in the wards, I don't know how people take their pills, particularly those on advanced regimens that require very large pills.  Imagine a hospital without water!

More to follow.

--Amy Whitcomb Slemmer