April 2014

April 22, 2014

Last week the legislature's Committee on Health Care Financing held a public hearing on the issues stemming from the problems with the enrollment and eligibility systems built for the Health Connector and MassHealth.

The testimony from the administrative was offered by Secretaries John Polanowicz (Health and Human Services) and Glen Shor, (Administration and Finance); the Connector Website czar (formal title: Special Assistant to the Governor for Project Delivery) Sarah Iselin; Health Connector Executive Director Jean Yang; and MassHealth Director Kristin Thorn.

The hearing was covered by the State House New Service (link to their story from the Springfield Republican's mass.live site), and the AP (their story on Boston.com). For the record (as they say), here's the prepared testimony from each of the officials (all pdf):

1. Joint Testimony of Secretary John Polanowicz, Executive Office of Health and Human Services and Secretary Glen Shor, Executive Office for Administration and Finance

Highlight: In Massachusetts, since the ACA took full effect in January, over 230,000 more people have signed up for subsidized coverage. Working in concert with our partner agencies like the Health Connector and with thefederal Centers for Medicare and Medicaid Services, MassHealth stepped in to create our current transitional coverage solution for residents who applied for assistance with health coverage but whose applications have not yet been able to beprocessed.  We have extended this Transitional Coverage program to nearly 160,00 people.
As we continue to work toward a long-term solution that moves these individuals intotheir final ACA-compliant coverage, these 160,000 individuals can visit the doctor, gneeded prescriptions and know that they are covered in the event of a serious illness or accident.  Another 85,000 people have newly enrolled in permanent MassHealth coverage and likewise have full access to needed care.
Separately, people insured through Commonwealth Care prior to January 1 have hatheir coverage protected.  Approximately 110,000 Commonwealth Care members moved to permanent MassHealth coverage, and the Health Connector continues to keep Commonwealth Care open for the remainder under waiver extension authority secured by MassHealth.  Moreover, about 30,000 people have purchased unsubsidized, ACA-compliant plans through our Health Connector.  The Health Connector is also offering dental policies for the first time, with over 2,500 plans purchased to date by individual shoppers.
 

2. Testimony of Sarah Iselin, Special Assistant to the Governor for Project Delivery

Highlight: By the end of this week, Optum will finish an exhaustive assessment of the two long-term options we have been talking about with all of you, the Health Connector Board, CMS and the public for some time now: The first being to partner with a new vendor to rebuild key components of our system; or, option two, to leverage functionality – in whole or in part – of another state’s Exchange or the federal Exchange.
Optum’s deep dive into these two options will use specific evaluation criteria including: risks, costs, timeline, consumer experience, member management tools, state and federal-specific requirements and relative size and complexity of the options. Weighing the pros and cons associated with each will allow us to settle on a plan that ensures we can transition people into permanent ACA-compliant coverage as soon as possible and stand up a functional HIX by the fall, in time for the next ACA open enrollment period on November 15.  
... My colleagues and I will be traveling to Washington, D.C. in two weeks to discuss our assessment of our two long-term options. We will incorporate the feedback we receive into the path forward recommendations that will be presented to the Connector Board of Directors at the next meeting, May 8.

3. Testimony of Jean Yang, Executive Director of the Massachusetts Health Connector

Highlight: Another big topic that was discussed last time was people’s frustration with our call center, where wait time was long and people couldn’t reliably get the help they needed. To tackle the issue, we nearly quadrupled the number of customer service representatives answering phones for the Health Connector – starting with 65 customer service representatives on October 1, and reaching 239 by March 31. During Open Enrollment, we received more than half a million calls to our call center, and on March 31st alone we received more than 10,000 calls. Even with unprecedented volume, we were able to dramatically improve our wait time, from a peak average of 16 minutes in November to less than two minutes in March. To strengthen our service quality, we also increased call center staff retraining and developed better access to systems that allow call center staff to check enrollment and application status more easily.

 

4. Testimony of Kristin Thorn, Director of Massachusetts Medicaid

HPC Planned Actvities for 2014
April 21, 2014

The Health Policy Commission (HPC) board met on Wednesday, April 16 to cover a wide range of issues that included an update on patient-centered medical home standards, planning around behavioral health integration, cost and market impact reviews, and Phase 2 for the Community Hospital Acceleration, Revitalization, & Transformation (CHART) Investment Program. Slides from the meeting can be found here. Keep reading for all the details.


Executive Director David Seltz first gave his report on upcoming Committee and Board meetings and an overview of the 2014 expected activities at the HPC (slides 5-6).  Next Commissioner Carole Allen, Chair of the Care Delivery and Payment System Transformation (CDPST) Committee, provided an update on the development of the Patient-Centered Medical Home (PCMH) Certification Program. After releasing proposed PCMH certification criteria, the CDPST Committee held a listening session on March 18, 2014 and accepted written comments during a public comment period from March 5 – April 4, 2014.  Almost 40 organizations provided written feedback on the criteria (all written comments can be downloaded here).  Feedback from the public comment period and listening session included suggestions for program design, measurement and validation, payer engagement and stakeholder involvement (slides 9-10). As next steps, the CDPST Committee will revise the criteria for PCMH certification based on feedback and public comment and propose measures and validation tools for criteria for public comment and stakeholder engagement (slide 13).

Next up was an update from the Quality Improvement and Patient Protection (QIPP) Committee. Commissioner Marylou Sudders, QIPP Committee Chair, reported on a joint meeting of the QIPP and CDPST Committees that took place on April 9, 2014 to further discuss behavioral health integration and inform the HPC’s behavioral health agenda. During the meeting the Committees heard presentations from Judith Steinberg and Alexander Blount of UMass Medical School and Nancy Paull, CEO of Stanley Street Treatment and Resources (SSTAR), a nonprofit health care and social service organization (slide 15). The UMass Medical School presentation focused on national, regional and state-based behavioral health integration efforts, including the MA behavioral health integration landscape, as well as the different approaches and elements in existing behavioral health models. Nancy Paull’s presentation provided an overview of SSTAR’s comprehensive efforts to integrate primary care and behavioral health. The Committees are digesting this information, along with reviewing behavioral health integration efforts from the CHART Investment Program, PCMH program, Division of Insurance mental health parity oversight activities, and other state agency efforts, in order to articulate the behavioral health integration agenda for the HPC (slide 16).

Commissioner David Cutler, Chair of the Cost Trends and Market Performance (CTMP) Committee, then introduced the next Committee update.  Karen Tseng, Policy Director for Market Performance, provided an overview of the material change notices the HPC has received to date – with the highest frequency as physician group affiliation or acquisition, acute hospital acquisition and clinical affiliation – and a description of notices pending the HPC’s decision of whether to conduct a full cost and market impact review (CMIR) (slides 19-20). Tseng then provided a comprehensive overview of the preliminary report on the CMIR for Lahey Health System’s proposed acquisition of Winchester Hospital (slides 22-65). In examining the potential impacts on cost, care delivery and access, the HPC concluded the following:

NHDD Speak Up Video

April 16, 2014

Today is National Healthcare Decisions Day, a day to encourage education and discussions about end-of-life care, health care proxies, living wills, and more. Learn more on the NHDD website . Many Massachusetts organizations are in this space, working to educate consumers about palliative care, hospice, proxies, and more. For good background on this issue, read the 2010 report of the state’s end-of-life commission. Efforts are being made to update the report and determine next steps that the state could take to advance knowledge among consumers and among health care providers about these important aspects of health care.

This topic is one of many that will be discussed during our upcoming second annual Patient and Family Advisory Councils Conference.  This conference brings together members of PFACs from across Massachusetts to share accomplishments and challenges and learn from one another. Learn more and register here.  

 

Deb Wachenheim

 

Advocates of Barrier Free Care bill assemble at State House for picture
April 14, 2014

One of the things we hear over and over is that people cannot afford their co-pays and deductibles. Momentum is building on legislation (H. 3976) to eliminate co-pays for some very high value treatments.

Health Care For All activists and staff came together to lobby their state legislators on behalf of the “Barrier Free Care” Bill.  Fifteen activists plus HCFA staff members shared their stories and asked their legislators to work with committee members and leadership to make sure the bill gets passed.   

Angela Huntsberry of Dorchester has to ration test strips and re-use needles to stay on top of her diabetes.  This raises the likelihood that Angela, who has already lost two family members to diabetes-related complications, will suffer a catastrophic event that will create even more cost. Angela should be able to access the care she needs without having to choose between her medication and food. Angela related how when she lost her job, she went on MassHealth and had no copays for her diabetes medication and could afford to take the proper dosage on time. When she finally got a new job, she went onto her employer’s plan, but even with coverage, now had copays and wound up limiting her care.  Angela and others like her visited the offices of over 30 State Representatives and Senators to tell their stories and say why they support Barrier Free Care legislation.

The legislation would establish a commission to assess which chronic illness medications and procedures would qualify as “high value”-incredibly valuable to the patient with relatively low cost to the insurer-and, as a result, would be co-pay free.  The concept behind the legislation is known as Value Based Insurance Design and is founded on the premise that we get better health outcomes and reduce the cost of acute care by making sure that individuals with chronic illness can actually access what they need.

Then, on April 8th, Health Care For All participated in a legislative briefing at the State House hosted by the Prevention Caucus to answer specific questions. Senator Jehlen explains the benefits of Barrier Free CareSenator Pat Jehlen of Somerville, the bill’s Senate sponsor, outlined its components and effectively summarized the positive effects the bill would have.  Dr. Richard Lopez, the chief medical officer of Atrius Health, was on hand to further frame the problem of co-pays as a barrier to care while a representative from the Massachusetts Pharmacists Association also detailed the rationale behind the MPA’s support for the bill. Caucus co-chairs Senator Harriette Chandler and Representative (and Senator-elect) Jason Lewis spoke strongly in favor of the bill. Sen. Jehlen expressed her optimism about the bill’s future and encourage her fellow members to work for the bill’s passage this year.  

This bill has legs -- we are working hard to make sure that co-pays and deductibles are no longer barriers to necessary care that saves lives.

-Andy Gordon and Ari Fertig

Chart showing increase of 234,150 in state-subsidized health coverage as of 4-8-2014
April 10, 2014

The Board of the Health Connector met today to learn about progress in providing coverage, and to discuss next steps in repairing the flawed website and eligibility technology used to enroll people into ACA-compliant health coverage. Two big bottom lines came out of the meeting. First, an astonishing 234,150 more people are receiving subsidized coverage now compared to last December (see chart above for details). While not all of these people were previously uninsured, many? most? certainly were, leading to the conclusion that we have dramatically expanded health coverage in Massachusetts, despite the website woes. Second, coverage website czar Sarah Iselin and her team are honing in on a final recommendation for how to get to a functional enrollment system by this fall. They expect to present their recommendations at the next board meeting, on May 8. And we also learned that just like the federal exchange, Massachusetts had a big surge in calls and website visits on March 31, the last day of regular open enrollment (but if you're reading this, you surely know that there are many ways to still enroll, and that subsidized coverage is always available, right?)

You can review the main powerpoint presentation used for the meeting, as well as the latest Health Exchange Dashboard and Connector enrollment report online. Our full report just takes a click.

April 10, 2014

Oral Health Advocacy Task Force logoLoyal readers of the Healthy Blog know: oral health is health, and dental insurance is health insurance. Cuts to MassHealth adult dental benefits are bad for health, bad for employment, and bad for long-term state spending.

Yet in 2010, benefits in the MassHealth adult dental program were significantly cut. Currently, the only oral health services covered for adult MassHealth members are cleanings, extractions, and fillings. The result is damaging to health and quality of life in so many ways, as WGBH documented last year. Take Harriotte Hurie Ranvig, a MassHealth member who is 67, blind, and lives in Somerville:

Harriotte Hurie Ranvig has trouble chewing.

"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."

The House Ways & Means budget proposal was released yesterday. The language in Section 84 restricts MassHealth from providing any dental care services beyond those services covered in FY 2014. Here is the language:

SECTION 84. Notwithstanding section 53 of chapter 118E of the General Laws, the executive office of health and human services may determine the extent of which to include within its covered services for adults the federally optional dental services that were included in its state plan or demonstration program in effect on January 1, 2002, and the dental services that were covered for adults in the MassHealth basic program as of January 1, 2002; provided, however, that the level of covered services provided shall not exceed the level of services as provided in fiscal year 2014.

 

This proposal is our cue to dig in and continue to advocate for restoration of MassHealth adult dental benefits. And that’s exactly what is being done. Representative John Scibak is filing an amendment for full dental care, and we here at HCFA are helping to build support. Here’s what you can do to help today:

  • Call your Representative. Urge them to contact Representative Scibak’s office to sign on to his amendment for FULL restoration of MassHealth adult dental benefits. The amendment calls for an increase of $67.7 million for line item 4000-0700. The cosponsor deadline is Friday at noon, so please don’t delay!
  • Join us at the State House on April 16th. Advocates, providers, and consumers are coming together at 1:30 on April 16th to push for restoration of MassHealth adult dental benefits. It will be a brief but important event, followed by the opportunity to deliver the message that the time for restoration is now directly to legislators and staff. More information is online here.

Over 600,000 adults on MassHealth are counting on us to make sure they get the coverage they need to stay healthy.

     - Courtney Chelo

April 5, 2014

 

Colbert mourns the 7.1 million enrolled in exchange plans. Wait 'till he finds out total new coverage due to the ACA is as many as 26 million, and growing (source).

Click here to watch, or on the picture above.

April 3, 2014

The Blue Cross Foundation today issued an update to their essential chartpack, MassHealth: The Basics - Facts, Trends and National Context.

The charts are prepared by the Center for Health Law and Economics at the UMass Medical School, and put MassHealth, our Medicaid program, in the context of who gets helped, what it costs, and how people get coverage. The Foundation has been issuing these periodically since 2008, and they are the definitive source of background on MassHealth.The latest one includes charts showing that

  • MassHealth covers a third of all births in the state, and cares for more than half of people with disabilities, more than half of children of low-income families, and two-thirds of residents of nursing facilities;
  • nearly two-thirds of the program's spending is for the care of members with disabilities and for seniors.
  • the main driver of MassHealth spending growth in recent years has been the increase in MassHealth members, not the amount spent for each member. Per capita spending has grown by an average of just 1 percent per year in the past 5 years, much less than private insurance.
  • MassHealth has been providing more care in community-based settings and less in facilities and inpatient settings. Over the past six years, spending on nursing facility and hospital inpatient care declined slightly while a substantial portion of growth in spending was due to increased spending on community based long term support services.
  • Massachusetts is in the middle of the pack among states in the percent of residents covered by Medicaid.

But what caught this wonk's eye is the chart showing who gets which type of MassHealth and other subsidized coverage, based on age, family and disability status, and other factors. Because of the ACA, the state is able to dramatically simplify the various flavors of MassHealth coverage.

Here's the old version, pre 2014 (slide 6 from this presentation):

 

Susidized coverage chart before 2014

 

And here's the new version (slide 5), as of 2014 and the ACA:

 

The current version is much simpler for members to understand, for providers to work with, and for the state to administer. This is what progress looks like.

   -Brian Rosman