July 2013

July 30, 2013

This morning WGBH radio ran a story on the continued impact of the MassHealth adult dental cuts that were initiated in July 2010. Three years after most dental benefits were eliminated, we’ll see some progress. Fillings will be restored for all teeth, a change passed in the Fiscal Year 2014 budget that is likely to go into effect on January 1, 2014. As the story points out, this is great, but many individuals are still left without access to the basic services that they need to maintain their health. The story looks at two MassHealth recipients who's health is at risk due to limited dental benefits. Harriotte Hurie Ranvig is 67, blind, and lives in Somerville:

"I cannot chew on the right side of my mouth," she said. "Because there’s extracted teeth on the top and bottom on the right side in the molar area. So the teeth will not strike on that side. If I eat a carrot or something that’s big and hard, it slides in the grove between the teeth, and that’s not chewing!" ... "Dental health is an integral part in any human’s health," she said. "They’re not just little rocks in our mouth. They’re critical."

Joanne Jijon is 62 and lives in Worcester:

"My teeth have literally fallen apart, crumbled," Jijon said. ... Her teeth are in really bad shape. She’s missing several, and many of the remaining ones are misshapen and grey. She says at times they ache. "My teeth just gradually decayed," Jijon said. "Decay all the way to the point right into the gums. The whole tooth gone, except for like little pieces that might be stuck in the gum. My teeth are too bad to fix, so I have to get them all pulled now." MassHealth covers extractions, but not dentures, and Jijon says she can’t afford to pay for dentures herself. I asked her what she’ll do about food. "I’ll have to do what I have to do without teeth," she said.

Head over to WGBH to read the transcript or listen to the piece. -Courtney Chelo

July 28, 2013

Community Hospital Acceleration, Revitalization, and Transformation (CHART) grant program

The Health Policy Commission met on Thursday July 25th for its seventh full meeting. The Commission is moving ahead with important work set to occur in the fall, which will include awarding grants to support hospital investment and conducting the annual Cost Trends hearing. Read on for a full report of the meeting’s happenings.

July 24, 2013

The Health Policy Commission’s (HPC) Quality Improvement and Patient Protection Committee convened yesterday. The meeting focused on a discussion of the Office of Patient Protection’s (OPP) internal and external review procedures, and culminated in a lively listening session advising OPP on how to make these processes more accessible to patients and consumers.

Jenifer Bosco, director of OPP, presented a comprehensive overview of OPP’s roles and responsibilities, and then focused on OPP’s jurisdiction over the internal and external review processes for fully-insured health plans in the state. (The appeals processes for self-insured plans are governed by federal law and therefore outside of OPP’s jurisdiction).

Carriers are required to submit annual reports to OPP detailing grievances filed by beneficiaries.  The data collected so far for calendar year 2012 shows that over 12,780 decisions were appealed internally to carriers in Massachusetts, with 45% of these claims resolved in favor of the patient. External reviews administered by OPP amounted to a much smaller figure, around 287, with just over a third resolved in favor of the patient.  Given the number of internal appeal denials and the low number of external appeals filed, it seems that patients may not fully understand their rights to an external appeal. HPC Executive Director, David Seltz, noted the importance of increasing awareness of external review rights, and highlighted the role that community organizations can play in this process.

Several positive changes to the review processes will be forthcoming through ACA implementation. This includes a shortening of the external review process from 60 days to 45; reimbursement of a patient’s $25 external review fee if the carrier’s denial is overturned; and enactment of a $75 limit on external review fees per year, regardless of how many decisions a patient appeals. Additionally, under the ACA, an expedited external and internal review can now be filed concurrently, whereas previously an expedited external review could only be requested after an internal appeal was denied.

Mental health and substance use disorder treatment claims are the single largest category of external reviews filed with OPP, a fact reflected in the comments provided during the listening session.  OPP heard from David Matteodo of the Massachusetts Association of Behavioral Health Plans, Clare McGorrian of Health Law Advocates, Elena Eisman of the Massachusetts Psychological Association, and Susan Fendell of the Mental Health Legal Advisors Committee, who all offered valuable input regarding improvement of the review procedures for patients.  Recommendations included strengthening the certification criteria for reviewers; improving clarity and transparency for carrier notices; increasing protections to ensure continuity of care; making the process more accessible for non-English speakers; and simplifying the process so that more patients can navigate it on their own.

OPP is accepting written comments addressing the internal and external review process until July 31, 2013. For details on how to submit comments, see the listening session notice.
 -Claudia Kraft

July 23, 2013

We want to keep you up-to-date on all the great outreach work that HCFA has been doing. If you hadn’t already heard, we are proud to partner with The Massachusetts Executive Office of Health and Human Services and 10 local community organizations to launch a major public outreach campaign targeted to individuals and families in the Spanish- and Portuguese-speaking communities to explain the benefits coming to Massachusetts through the Affordable Care Act.

This initiative includes public events, focused ethnic media outreach, an advertising campaign, and distribution of educational materials to individuals and families statewide. These efforts will direct consumers to the Massachusetts Consumer Assistance Program (our HelpLine at 1-800-272-4232). We kicked off this campaign in Lawrence the other week with our partners.

HCFA, Seceretary Polanowicz and our partners Health Care For All, Seceretary Polanowicz and our partner organizations

As regular readers of our blog know, thanks to the Affordable Care Act, there will be new, affordable insurance options available for those still without insurance in Massachusetts. All insurance plans will have to show the costs and what it is covered in simple language with no fine print. Help is available in several languages online, by phone and in person for consumers to find the plan that best fits their needs. And we are busy getting the word out to implement the Affordable Care Act, especially in ethnic media around the state. Here’s just a few of the great articles from the launch in Portuguese and Spanish:

El Mundo: Compaña con Medios Latinos: Seguro Médico Para Todos

El Planeta: Nueva compaña de Health Care For All informará en español sobre los beneficios que traerá a Mass. la Reforma de Salud (See Page 8)

A Semana: Health Care For All lança nova companha educativa (Also see Page 8)

The ethnic media campaign is featured by two consumers who will benefit directly from some of the provisions included in the Affordable Care Act. From January 1st 2014, National health reform will help consumers - in between the 300% and 400% percent of the Federal Poverty Level who currently don't have access to subsidized programs in Massachusetts - pay for health insurance. An estimated of 50,000 people who are in that situation in the state will benefit from these tax credits.

"My family and I are having a hard time paying for health insurance. My wife and I both work and do not qualify for Commonwealth Care because our joint salary barely surpasses the income limits for the current state program. We are making a big effort to pay the monthly premiums and deductibles on the private plan that we decided to acquire," said Dionis Mezquita, a Lawrence resident who will benefit from tax credits through the Affordable Care Act. "It is great news for us to know that we will finally be able to access to some help to afford the health insurance we need."

Dionis Mezquita, consumer, speaks at the launch in Lawrence Dionis Mezquita speaks at the launch in Lawrence

We were also so pleased to launch the campaign alongside Secretary of Health and Human Services John Polanowicz. “By working with Health Care For All and our regional partners, we can ensure that individuals and business in every community have access to the information they need about new health benefits under the ACA," he said.

Amy Whitcomb Slemmer and Secretary John Polanowicz Amy and Secretary of Health and Human Services John Polanowicz

Stay tuned for more updates!

July 22, 2013

ProPublica is a non-profit news group dedicated to public interest investigative journalism. Their reporters matched for the first time federal data on payments from drug companies to prescribers and records on drugs prescribed by doctors to their Medicare patients. Until now, this has been secret information, known to the drug industry, but not the public. The report exposed some troubling drugmaker marketing strategies. ProPublica looked into why expensive name brand drugs are prescribed so often when significantly cheaper generics are proven to be just as effective. By examining the payment data disclosed by these drugmakers and comparing it to Medicare prescription records, ProPublica discovered something disconcerting. Top prescribers of these expensive name-brand drugs were given a financial incentive to do so by the drugmakers. Bystolic, a blood pressure medication made by Forest Laboratories was one of the prescriptions studied. At least 17 of the top 20 Bystolic prescribers in Medicare's prescription drug program in 2010 have been paid by Forest to deliver promotional talks. In 2012, they together received $284,700 for speeches and more than $20,000 in meals.” The report also identified drugmakers Novartis, Johnson&Johnson, Pfizer, and GlaxoSmithKline as engaging in a similar financially driven industry relationship with their drugs’ top prescribers.

  • 9/10 top prescribers of the Alzheimer's drug, Exelon, received money from the drugmaker Novartis.
  • 8/10 top prescribers of the painkiller, Nucynta, were speakers paid by the drugmaker, Johnson & Johnson.
  • 6/ 10 top prescribers of the antidepressant, Pristiq, were speakers paid by the drugmaker Pfizer.
  • 7/10 top prescribers of the asthma drug, Advair Diskus, were speakers paid by the drugmaker, GlaxoSmithKline.

This issue affects everyone, not only those prescribed the name brand drug. Taxpayers subsidize the cost of the Medicare prescription drug program, and last year alone, taxpayers spent $62 billion dollars in subsidies. “Each of the top 20 prescribers of Bystolic wrote at least 530 prescriptions in Part D in 2010”. The name brand drug Bystolic retails for $80, while a generic prescription only costs $10. If one is not superior to the other, physician prescription of the name brand seems a complete waste of patient and taxpayer money. If you don’t approve of drugmakers’ wallets influencing the prescription pad, you may be interested in some legislation we are pushing. Direct payment to prescribers through speaking fees is not the only method of bribery that is going on. As we have reported in past blog posts, the pharmaceutical industry has long been providing more than a convincing pitch about why their drugs are best. Sales reps tend to not only give out free samples of the drug but often wine and dine physicians, providing them with far more than information. The academic detailing program approved in the budget, and another HFCA bill, An Act to Define Modest Meals and refreshments in Prescriber Education Settings (H.2018) / An Act to Prevent Undue Influence on Prescriber Behavior (S.1051) (learn more here)  would establish concrete guidelines on how much could be spent on physicians and where these drug pitches could take place. It would also prohibit pharmaceutical  reps from purchasing alcoholic beverages for physicians during presentations that are, after all, supposedly educational in nature. We strongly support these bills and hope you will too! Thanks to ProPublica for providing tangible information that supports our stance on the issue. To look into whether your healthcare provider has received money from a drugmaker click here. -Zoe Burns  

July 17, 2013

Health care providers, take note: a new study published in Health Affairs reports that patients who are “activated” recount greater satisfaction in their healthcare encounters. Patient activation refers to how empowered a patient feels in managing his or her own health. The article, “When Seeing the Same Physician, Highly Activated Patients Have Better Care Experiences than Less Activated Patients,” details how patient activation promotes heightened patient satisfaction. Previously, some theorized that improvements in patient experience arise because activated patients are more adept at seeking out those providers who provide the most patient-centric care. The study’s findings, however, indicate that experiences are more positive because patient engagement actually improves the quality of the patient-provider transaction. A novel and important insight from the study is that activated patients had better experiences when compared to less activated patients with the same provider. This tells us that we’re not seeing selection bias, but real effects resulting from improved patient-provider interactions. How does activation promote better experiences? Research shows that activated patients see themselves as occupying a critical role in the patient-provider relationship, and view the interaction as one between partners working together to manage the patient’s care. Less activated patients assume a more passive role. Highly-activated patients are, in turn, more successful at eliciting the kind of interaction and care that they feel they need. This makes the patient’s clinical experience more positive. Health care providers should therefore pursue strategies to activate patients.  Provider reimbursement is increasingly being tied to patient satisfaction measures, and public reporting of patient experience ratings is becoming more common. Many of the factors that influence how patients report their healthcare experiences—characteristics such as race, income, and age—cannot be changed. Patient engagement, however, is a variable that the provider can actually influence. So, how can we promote patient engagement? Clearly, patients and providers must each do their part to further the patient’s engagement. Just as important is the environment of our care delivery system. To truly encourage patient activation, we must structure our health care payment system so that it furthers these interactions. For instance, providers should be reimbursed for providing services such as counseling to motivate behavioral change, which has been shown to activate patients. Patient engagement has already been shown to increase care quality and reduce costs. (Check out February’s edition of Health Affairs, which was dedicated to this issue). This study adds to those positive findings and further strengthens the case for why patient activation should be promoted whenever possible. To see some of the study’s highlights, take a look at the Commonwealth Fund’s summary of the findings. -Claudia Kraft

July 16, 2013

Last Thursday, the Connector Board reviewed the agency’s FY2013 and FY2014 administrative budgets, looked back at FY2013 accomplishments and ahead to FY2014 goals, and announced the Navigator program grant awards.  Materials from the meeting can be found here. 

Before delving into details, Jean Yang started the meeting with program enrollment.  As of July 1st, 207,584 residents are enrolled in Commonwealth Care (an increase over June) and 39,575 are enrolled in Commonwealth Choice (a decrease from June).  

July 10, 2013

Health Care For All has been asked to help review some health insurance materials! We would like your help to make sure the materials are easy to read and understand.

Two people from the Center for Health Literacy will come to interview men and women over the age of 18 who agree to help and have not completed high school. If you agree to help, it will not affect your health insurance or benefits in any way.

Each interview will take about 45 minutes and will happen on July 23rd. We will pay you $50 for your time after the interview.

If you want to help and are available July 23rd, please contact me, Kate Bicego, at 617-275-2912 or reply to kbicego@hcfama.org.

-Kate Bicego

July 3, 2013

As we noted on Monday, the budget just sent to Governor Patrick includes provisions repealing the Massachusetts Employer Fair Share statute. We were not supportive of the repeal, but understood the logic: since the federal ACA employer requirements were taking effect in January, it was OK to lose the state structure for just 6 months.

Then yesterday, the Obama administration announced that it would not enforce the federal employer fair share provisions for 2014.

Ruh-roh.

This changes everything. Because these provisions are sections of a budget bill, the Governor has the opportunity to treat each section individually - sign, veto, or return with an amendment. If the Governor signs those provisions into law, the state will have no effective employer responsibility requirement for at least 18 months.

We call on the Governor to either veto the repeal section, or return the provision with an amendment preserving the principle of fairness and responsibility for employer-provided health insurance. The Massachusetts fair share program should remain in force until the federal program kicks in.

Shared responsibility was the bedrock principle of chapter 58, and key to its success. It should not be thrown away. Here are some of our reasons:

  1. Effectiveness - If it's not broke, don't fix it.
    The current system has worked well, increasing employer offer rates. So while we can't know for sure to what extent the fair share system contributed to this, it has worked well. We should maintain our existing system .
  2. Conceptual - Meaningful Shared Responsibility
    The fair share provisions grew out of a shared value that all sectors should make a contribution to improving our health care coverage. Employers should have their obligations, as well as individuals and government and providers and insurers, all who play a role. Shared responsibility built the broad political support for the law.
  3. Fairness - Employers who don't cover their workers have an unfair advantage, and should contribute to the cost of health care
    An employer that doesn't cover their workers has an unfair cost advantage against a competitor who does. Unchecked, this could lead to a race to the bottom. Thus its fair to ask non-offering employers to pay something. In the Massachusetts context, employers who cover their workers also pay extra in their premiums to fund the Health Safety Net (HSN) program. In effect, they are subsidizing their less responsible competitors. The Fair Share assessment was set at $295  per worker to approximate the offering employer's contribution to the cost of the HSN cost per worker. Eliminating the fair share system would be unfair to the vast majority of employers to who do cover their workers.
  4. Political - Honor the agreement
    The bill that became chapter 58 was stuck for months in conference between the House bill, which had a very extensive pay-or-play requirement, and the Senate bill, which did not. The Fair Share compromise was a business community proposal that broke the logjam, and the interested groups - business, consumers/ACT!, health care providers and insurers, and the legislature agreed to the deal. Reneging now on the deal should require the consent of all parties to the original compromise.

Keeping the Massachusetts employer responsibility law will also provided much needed support for the approach of the ACA. The attacks that have intensified after yesterday's decision can be refuted by our ongoing successful implementation.

Governor Patrick has until next Wednesday to make a decision on this. We will work aggressively with the legislature to uphold his decision, should it be favorable. Massachusetts should hold strong in its commitment to shared responsibility.
 -Brian Rosman

 

July 2, 2013

Today the House and Senate sent to the Governor the FY 2014 budget (giant pdf), which  was filed by the joint conference committee late last night. Any minute now, we'll get a detailed report from our friends at the Mass Budget and Policy Center, and we'll post a link and any updates as they do their analysis. (Update: their analysis is here) But we were smiling when we turned first to the Medicaid line items. Smiling, of course, because the final budget includes $17.2 million to restore coverage for dental fillings for adults in the MassHealth program. These funds should allow the MassHealth dental benefit to include fillings beginning the first of the year. We will continue to work for full restoration of all dental benefits. But this is another step towards recognizing that oral health is integral to overall health, and an effective MassHealth program must cover good dental care. The budget also included funding for the academic detailing program, which provides objective information to physicians and other prescribers about the effective use of prescription drugs, as opposed to the biased sales pitches doctors hear from drug marketers. We need to look closer at the Medicaid and health reform line items, but we were pleased that the conferees went a bit higher than the House/Senate split-the-difference funding level for the MassHealth operations line item, which is critical for meeting the needs of MassHealth members, and for the costs to implement the ACA. We were very concerned, however, to see that the budget set a funding level for medical care for people newly eligible under the ACA that was lower than either the House or Senate figure. This will probably mean that several MassHealth initiatives intended to reduce gaps in coverage and assure broad coverage as part of the ACA will not be funded. We also have not looked closely enough at the DPH line items, but it appears in many cases that the budget tries to nudge up DPH funding for many vital services. (UPDATE: more details are available at the Mass Public Health Association blog post, FY14 Conference Budget Includes Victories for Public Health.) We were dismayed at the cut in tobacco control funding, and echo MPHA's comments:

Smoking Prevention and Cessation Services are cut by $180,000 from FY13, or about 5% of funding. After years of dramatic cuts to tobacco funding and in a year when a hike in the cigarette tax promises to bring in millions more in tobacco revenue, this cut is particularly troubling.

The budget is another step in moving away from our chapter 58 statutory structure to the ACA. The Commonwealth Care program is funded for just 6 months, as the program ends on January 1. One important milestone in the budget is the repeal of the employer fair share requirement, effective today. Because the federal ACA employer requirements do not start until January, this leaves a 6-month window with no mandate on employers to provide health insurance. Given the continued strong support by employers of health coverage in Massachusetts, we do not expect any real drop in coverage rates. We will closely monitor our helpline callers, which will let us detect any abrupt changes in employer coverage. -Brian Rosman