September 2013

September 30, 2013

The Statewide Quality Advisory Committee (SQAC) met this morning.

The bulk of the meeting was focused on an evaluation of the 35 non-mandated measures approved in 2012 by the committee for inclusion in the Standard Quality Measure Set (SQMS). The Lewin Group was hired to evaluate the measures and determine if any of them that were seen as moderate recommendations should be moved to strong and vice-versa.

The evaluation recommended that 6 measures that had been judged as moderate be considered strong and that 8 measures that had been considered strong be moved to moderate. After much discussion, it was determined that going forward the committee should not determine if recommendations are strong or moderate but rather that once the committee decides a measure should be in the SQMS, it is in there. So as measures are evaluated for inclusion, they can be given a “score” based on the criteria set forth by the SQAC for evaluation (ease of measurement, reliability and validity, field implementation, and amenable to targeted improvement) and then the SQAC will determine if they are in or out of the SQMS. As was mentioned, the committee selected the 35 non-mandated measures in 2012 out of hundreds that were nominated, so why do further selection with a strong or moderate recommendation if it was already determined that they are important enough to have in the set.

The Lewin Group also evaluated the three measures that were submitted over the summer as part of an open and public process for individuals and organizations to nominate measures for consideration for the SQMS. This summer, only 3 measures were submitted, many fewer than in 2012. HCFA questioned the lack of nominated measures, and was told part of the reason was  a lack of public outreach by CHIA about the nomination period. We hope to see more publicity about this opportunity during future nominating periods. HCFA nominated two measures-patient confidence and shared decision-making. Both were evaluated and not recommended for inclusion in the measure set at this time but both were also seen as measures that should be reconsidered in the future as they become more widely implemented and studied.  After HCFA mentioned that shared decision-making is mentioned in Chapter 224 as part of the standards for both medical homes and Accountable Care Organizations , Iyah Romm did point out that the Health Policy Commission can consider measures beyond what is in the SQMS. The one measure that was nominated over the summer and was recommended for inclusion related to birth trauma.

The SQAC will meet again on October 21, 3-5pm, at CHIA, 2 Boylston Street, 5th floor.
-Deb Wachenheim

September 30, 2013

Understandably, there's lots media attention on October 1 as the D-Day for health reform. The health insurance marketplaces will be newly open in every state (of course, in  Massachusetts we've had our Health Connector since 2006),  and people can shop for both subsidized and unsubsidized coverage. But it's just the start of an open enrollment period that will continue through next March. Even if someone enrolls on October 1, coverage doesn't begin until January. Still, October 1 is a critical date.

For us in Massachusetts, though, October 1 is more of a milestone along an evolutionary path for health reform here.

If anyone needs specific information or personal assistance on how the ACA (Affordable Care Act / Obamacare) will impact them as Massachusetts residents, you can call the Health Care For All Helpline tollfree at 800-272-4232. For more information, or to send us questions by email, click here. In addition, you can call the Health Connector at 877-MA-ENROLL (1-877-623-6765), or go to their website at

No Wrong Door
On October 1, the Health Connector will unveil their new web site, and their new online eligibility portal will open for business. For people looking for unsubsidized coverage, the new streamlined system will take in all the information and allow you to pick a plan. For those who may be eligible for subsidies (generally earning under $46,000 for an individual, or $94,000 for a family of 4), a new online form will replace the current paper "Medical Benefit Request" for people applying for coverage starting in January. The same form and process will work for MassHealth, the new federal premium tax credits and subsidies, and the Health Safety Net program. The motto is, "No Wrong Door." But people needing current coverage should still use the current form.

As the new system comes online, additional functionality will be added over the next few weeks. We look forward to being among the early testers of the system to identify the any bugs and glitches that may pop up, and have seen a strong commitment by the Connector and the administration to receiving ongoing feedback from users. The staff working on the massive Health Insurance Exchange/Integrated Eligibility System (what the state calls "HIX/IES," pronounced "hixies") has been working overtime, and we appreciate all the efforts so far to bring us a 21st century eligibility system.

What's New
Come January, we'll see lots of changes. People buying individual coverage on their own will find new choices and options, including dental coverage. For small businesses, the Health Connector will provide tax credits and wellness discounts. People getting coverage through Commonwealth Care or the Medical Security Program will switch to either MassHealth or ConnectorCare, our state's name for the federal and state assistance with premiums and cost-sharing program. MassHealth's confusing array of different benefit plans will simplify somewhat, with fewer categories and more consistent benefits. And state taxpayers will get a big break as the federal government picks up more of the cost of coverage programs, particularly for children, legal immigrants, and low-income working families.

State officials held a press conference last week on all the changes, with good coverage by the Springfield Republican, and Worcester Telegram. There's lots more, summarized by EOHHS here.

Three and a half years ago we released this graphic, and used it with a series of posts on how the ACA will benefit the Bay State:
National H Reform is Good for MA (no dot org)With October 1 a day away, we're looking forward even more to January.
-Brian Rosman



September 28, 2013

With October 1 barreling down, we thought your ACA weekend would be livened by two valuable, and two enjoyable links, proving again that the internet is the most important use of time and waste of time in creation.

Before getting to the fun stuff, here's two serious listicles that you should see:

1. Top 10 Reasons Why the Affordable Care Act is Good for Massachusetts, from EOHHS.

2. 10 Things You Need to Know About Obamacare in Massachusetts, from the Patch, is a good list of the upcoming changes. We'll have more to say in a few days.

Now for the goodies:

1. Adorable Care Act

The Adorable Care Act tumblr is, well, adorable. Isn't it? It was created by a former Obama campaign staffer Salim Zymet, and there's a twitter, too.

2. The Collected Poems of the Affordable Care Act

Tim Murphy from Mother Jones (no, not our Tim Murphy) has "rearranged the most vivid and hyperbolic descriptions of the Affordable Care Act" into a series of short poems. Each line includes links to the source of the metaphor or simile. He writes, "Obamacare is fractal; it contains multitudes," and suggests reading them in your best Don Berwick voice (yes, our Don Berwick).


Obamacare is like a box of chocolates.

Obamacare is Waterloo.

Obamacare is the Iraq War,

or its domestic equivalent.

Obamacare will kill more people than 9/11.

Obamacare is the War of Yankee Aggression,

Obamacare is the hill to die on,

Obamacare is Gettysburg.

Obamacare is the Fourth of July.

Obamacare is Christmas,

like being forced to purchase a book of cowboy poetry,

or a Barry Manilow album.

Obamcare is like this health insurance/medical aid kind of thing,

like a military draft.

Obamacare is the best bill you could have passed.

Obamacare is here to stay.

Obamacare will survive.

Obamacare is the moon.

- Brian Rosman

September 26, 2013

[Today's guest blog is by Erica Brunner, former HCFA staffer and now a leader at NARAL Pro-Choice Massachusetts.]

In the past, laws like those that prevented unmarried women from accessing contraception were the main barrier women faced in controlling their health and bodies. However, in recent years the cost of contraception and office visits necessary to obtain a prescription have resulted in a financial burden that can be as high as $600 a month out-of-pocket—a barrier for many women to access basic reproductive health care.

Before the Affordable Care Act (ACA) passed in 2012, 52% of women reported delaying needed medical care because of the cost. Under health care reform, insurers are now required to cover physician-recommended preventative services, including contraception, without cost sharing. Since August 1, 2012, over 45 million women nationwide have taken advantage of free preventative services, such as well-woman visits, cancer screenings, and contraception.

Although many women have already reaped the benefits of this law, there are more benefits to come. The ACA won’t be in full effect until next year, and on October 1, 2013, the Health Insurance Marketplaces will be open nationwide, with all health plans required to cover some contraceptive options. The marketplace concept was modeled off of the Massachusetts exchange, our Health Connector. More than 225,000 Massachusetts residents have gained health insurance coverage through the Health Connector, allowing Massachusetts to have the lowest uninsured rate in the country.

The passage of the ACA is a huge step forward for women, but there is more to do! The ACA does not require insurance plans to offer all forms of contraception at no cost to consumers. Additionally, many plans do not cover long-acting reversible contraception, which are proven to be most effective at preventing pregnancy and can be more cost-effective for long term use.

Even though the ACA has paved the way for women to access basic health care regardless of their income, women need to be aware of these benefits and the specific contraception their insurance providers will cover with no cost sharing.  The National Women’s Law Center has created tool kit that provides women with information on how to ensure that they are getting the coverage and no-cost preventative services that the health care law allows them. You can find the tool kit on their website.

As Massachusetts moves forward with the implementation of payment reform, it will be critical to ensure that women continue to see increased access to all forms of contraception - which is why the NARAL-led Massachusetts Women's Health Policy Coalition is working with partners such as HCFA and the Administration to make this a reality in our state.
-Erica Brunner, NARAL Pro-Choice Massachusetts

September 26, 2013

Rapper Nas has spit a great rhyme in his song Make the World Go Round:

I'm a rare dude, I'm a wonder,
your best success is my worst blunder

Today, a post on Health Affairs blog, Plano, Texas Vs. Revere, Massachusetts: Sorting Through The Differing Causes And Durations Of Uninsurance made the same point in the realm of uninsurance rates. The worst in Massachusetts equals the best in Texas:

Plano, Texas is an affluent Dallas suburb ranked as the wealthiest American city with at least 250,000 residents.  Between 2007 and 2011, the median income in Plano was $83,901, well above the national figure of $52,762.  As corporate home to several Fortune 500 companies, Plano has a workforce that is largely white-collar, with most employed adults working in management and professional occupations.

If Plano is the prototypical white-collar town then Revere, Massachusetts may well be its blue-collar opposite.  A working-class suburb north of Boston, Revere has a workforce employed primarily in service and sales occupations.  Between 2007 and 2011 the median household income in Revere was $50,592, ranking in the bottom half of U.S. communities.  While 90 percent of Revere’s labor force is employed, one in six people there live below the poverty line.

Plano and Revere also offer an illustrative juxtaposition when it comes to health insurance coverage.  According to the 2009-2011 American Community Survey, the wealthiest area of Plano had the lowest uninsured rate in Texas — the state with the highest rate in the country (24 percent).  Revere had the opposite distinction:  its rate was highest in the only state with an uninsured rate below 5 percent.  Most striking is a statistic these two communities shared: between 2009 and 2011, both had an uninsured rate of 10 percent.

The best illustration of the vast gulf between the states comes from the fascinating map project produced by Civis, a data analytics firm that grew out of the backroom "analytics cave" of the 2012 Obama campaign.

The map displays the uninsured rate for each of the over 70,000 census tracts in the US. Here's the map of the greater Boston area:

Uninsurance rate by census tract in Boston regionAnd here's the section for the Dallas-Fort Worth region, including Plano:

Dallas - Forth Worth uninsured by census

HCFA will be using similar analytics to target Massachusetts uninsured people for our community education campaign on behalf of the Health Connector.

And speaking of Nas, wouldn't it be cool to see a freestyle battle between Governors Deval Patrick and Rick Perry?
- Brian Rosman

September 20, 2013

As our news is filled with more details about the Navy Yard shooter, Health Care For All is convening the first coalition conversations with our newest policy effort.  We are calling our new coalition MASH (Massachusetts Alliance to Support Heroes), which is being created to strengthen the supports for all military service members and their families.  We know that there are remarkable organizations spread all over the Commonwealth that vary in size from the Home Base program with the Red Sox and MGH to brand new Mom and Pop shops that have sprung up in cities and towns to provide comfort, or care to our service members and families.  We also know that Massachusetts has some wonderful support services and programs available for military and veterans but that they are not universally known or accessed. MASH will create a broad coalition table where smaller organizations can collaborate with bigger institutions.  Where we will learn from providers of a host of social and medical services and will eventually strengthen and improve our health care and social service supports for those who have served us.  We want Massachusetts to have the most efficient and effective system of care for the nearly 400,000 veterans who have served our nation and their loved ones. The first meeting of MASH reminded me that we have the leaders in place who can make this happen.  It redoubled my determination that when successful, MASH might be helpful to prevent a tragedy like the Navy Yard from happening in Massachusetts.  We will strengthen our reporting and care system so that anyone who seeks help and needs care from our system will not fall through the cracks. We will begin to fulfill the promise that Abraham Lincoln made in his 2nd inaugural address: “With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation’s wounds, to care for him who shall have borne the battle and for his widow, and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.” --Amy Whitcomb Slemmer

September 20, 2013

The MA Department of Public Health yesterday released its latest data on the rates of influenza vaccination among hospital personnel for the 2012/2013 flu season. Hospital personnel includes all staff (including per diem staff), students and volunteers. You can find the data on these DPH tables (pdf). The findings were presented and discussed yesterday at a meeting of DPH’s Healthcare-Associated Infections Technical Advisory Group (HAI TAG), on which HCFA has a seat.  The data include statewide aggregate numbers, numbers by region, hospital type, and size, and numbers for each hospital.

The data show a wide variation in terms of percentage of personnel vaccinated. While the median is 85% (meaning half of the hospitals reported that at least 85% of their personnel were vaccinated), the range goes from 47% to 99% of personnel vaccinated.

What drives the hospitals to the higher percentages? There are a number of factors, to be sure, but one that has seen success (not surprisingly) is when a hospital mandates that personnel get vaccinated. Of the 9 hospitals that reported vaccinations of at least 95% of their personnel, at least 6 of them mandate vaccination (according to attendees at yesterday’s HAI TAG meeting). The 9 hospitals at the top are: Anna Jacques Hospital, Boston Medical Center, Boston Children’s Hospital, Dana-Farber Cancer Institute, Kindred Boston, Leahy Clinic, Nantucket Cottage Hospital, Sturdy Memorial, and Tufts Medical Center.

As consumers, it is really hard to understand why anyone who works in a setting where you are caring for sick and vulnerable individuals would choose not to get vaccinated. You are protecting others from getting sick (or sicker) and you are protecting yourself from catching the flu from a patient. We have heard some of the arguments, for example that the vaccine does not always give 100% protection…. well, some protection seems a lot wiser than no protection!

If you are a patient, family member, or community member of one of the hospitals with a lower vaccination rate, speak up and ask that institution what it is doing to raise the rate. It would be fantastic to see more hospitals follow the lead of those that have mandated vaccination as a condition of employment.

Also discussed at yesterday’s meeting was the upcoming DPH report on healthcare-associated infection at hospitals. We posted a blog in June when DPH released 6 months’ worth of preliminary data. The next set of data should be released by the end of this month, according to DPH staff at the meeting. Keep an eye out for a blog post once the data is released.
-Deb Wachenheim

September 17, 2013

The Health Policy Commission (HPC) met on Wednesday, September 11th for its eighth full meeting. As noted by the HPC, the theme of this particular meeting was twofold, to highlight how far the Commission has come and discuss how far it has left to travel moving into 2014. This theme was evident in the topics on the agenda: the Community Hospital Acceleration, Revitalization, and Transformation (CHART) investment program (formerly the Distressed Hospital Fund), the Patient Centered Medical Home (PCMH) program, quality improvement and patient protection and cost trends and market performance.

The consolidated meeting presentation is here (pdf), and our full report is on the backside, so click on.

September 13, 2013

Next steps for Connector on ACA implementationYesterday, the Health Connector Board voted to award final Seal of Approval to Qualified Health Plans (QHPs) and Qualified Dental Plans (QDPs) to be sold on the Health Connector in 2014.  In addition, the Board discussed the Health Connector’s progress in implementing the new Affordable Care Act (ACA) eligibility system as well as their outreach and education efforts.

Materials from the meeting are here, and our full report is just a click away.

September 12, 2013

ConnectorCare Results slide

Today, the Health Connector Board voted to award Seals of Approval (SoA) for Qualified Health Plans (QHPs) to be sold on the Health Connector, for coverage effective beginning January 1, 2014 (details in Connector presentation, (pdf)).  Dental plans were also approved. These are the private insurance choices that will be available through the Health Connector starting in October. Coverage will start in January. (As always, we'll have full  details on the Board discussion in an upcoming blog post.)

Under the ACA, many of the lowest-income people in Massachusetts who are now part of the Commonwealth Care program will transition to MassHealth. Most of the rest will receive new federal tax credits and cost sharing assistance to purchase QHPs. Those who are below 300% of the federal poverty level will also get additional state assistance. This has been called the "QHP Wrap," in wonk circles, and will be called ConnectorCare in public.

The Health Connector's goal was to keep premiums from going up for these low-income people. Using dedicated funding in the state budget, and competitive rates negotiated with insurance carriers, the Health Connector was able to do just that.  Base enrollee premiums in ConnectorCare will mirror base enrollee premiums in today’s Commonwealth Care program.  And, the Health Connector was able to use funds to narrow the spread between the lowest and highest cost plans for premium payers.

Chart showing premiums for ConnectorCare in 2014We're particularly pleased that ConnectorCare enrollees at or below the poverty level will not pay a premium, no matter which plan they choose, just as they do today.  The Health Connector had previously considered charging this population small premiums.  Massachusetts Law Reform Institute and Health Care For All weighed in with why this would be a bad idea (see our fact sheet, pdf).

Today's premium affordability decision is a major victory for lower income Health Connector enrollees.  Thanks to all those involved who made sure coverage remains affordable for this population.
-Suzanne Curry

September 11, 2013

Today the Healthy Blog is inaugurating a new feature we're calling, Ari's Healthrageous Links. 

September 10, 2013

MITSS (Medically Induced Trauma Support Services) is seeking nominations for its annual HOPE Award (“Honoring Outstanding People Everywhere”).

The nominees should be individuals or organizations who exemplify the mission of MITSS—supporting healing and restoring hope to patients, families and clinicians impacted by adverse medical events. Nominations are being accepted through this Friday, September 13. Get more information on the MITSS website. The winner will be announced at the MITSS annual dinner on November 14.
-Deb Wachenheim