August 2014

August 19, 2014

DPH Slide - Serious Reportable Events in Massachusetts 2013

The MA Department of Public Health last week released its most recent set of data on Serious Reportable Events (sometimes called “never events”).

The list of 29 Serious Reportable Events (SREs) is developed by the National Quality Forum (NQF) and periodically changed/updated.  The list includes items such as wrong patient surgery and wrong site surgery, serious medication errors, falls, and pressure ulcers, and more. In 2012, NQF changed the definitions of some of the SREs and also added some new SREs, which may have resulted in increased numbers reported for those areas. For example, the definitions of serious medication errors and falls were changed to include those that resulted in serious injury or death while previously the definition had been disability or death.

In 2013, DPH introduced a new electronic reporting system in order to facilitate the reporting of SREs, which also may have led to an increase in numbers. The data that DPH released this week covers the years 2011, 2012, and 2013 and includes numbers for how many of each type of SRE occurred in each hospital in each of those years.

You can find the reports for acute care and non-acute care hospitals on the DPH website. Each year, the greatest numbers of reported events were serious falls and pressure ulcers. At last week’s Public Health Council meeting, DPH staff gave an overview of the reports and also discussed many of their efforts to streamline the reporting process and more closely analyze the data (also see this Boston Globe article about the reports).

  -Deb Wachenheim

August 14, 2014

Connector Summary of Dual Track Implementation 8-14-14

As announced earlier this month, Massachusetts is moving forward with a state-based system for its health insurance eligibility and enrollment system and consumer-facing website. Today’s Connector Board meeting focused on the progress made in building this new system and the Connector and MassHealth’s plans for coverage transitions and outreach and enrollment leading up to the next open enrollment period. The Connector Board also voted on the repeal of some obsolete employer-related regulations.

The Connector ran through a live demonstration of the work-in-progress website, showing that it is capable of processing an application form and responding with the proper eligibility decision. Still, there’s lots more to do, including get the word out to almost half a million residents about the need to renew their coverage.

Materials from the meeting can be found on the Connector’s website, under About – Leadership – Board Meetings. The key presentations are the update on the web site and eligibility system, and a deck on the outreach and communications strategy.  Our detailed report takes just a click.

August 8, 2014

This great news just in from the state. We're very pleased, because it means Massachusetts can proceed with its own affordability assistance and other state programs that will meet the needs of our consumers:

Commonwealth of Massachusetts
Press Release

Decision means Massachusetts will remain a State-based Marketplace, FFM no longer needed as a contingency plan

BOSTON – Friday, August 8, 2014 – Maydad Cohen, Special Assistant to the Governor for Project Delivery, today announced that the Patrick Administration has decided, with support from the Centers for Medicare and Medicaid Services (CMS), to use hCentive the state’s Health Insurance Exchange (HIX).

By proving hCentive’s IT readiness for Fall 2014 Open Enrollment, the Commonwealth can remain a state-based Marketplace, stop its contingency planning to join the Federally Facilitated Marketplace (FFM) and focus exclusively on expanding access to affordable, quality health insurance through hCentive.

“This decision means that the unique policies and programs that make us a national leader on access and affordability will continue and it provides the market the certainty it needs about our path forward,” said Cohen. “Our team, Connector, MassHealth, ITD, Optum, hCentive and Dell, moved mountains to get here and CMS has been an indispensable partner. I am grateful for all of the hard work but know some of the biggest lifts – especially around consumer outreach and member transition – are in front of us. We will need the coalition of insurers, providers and consumer advocates who helped us come this far to continue contributing their best thinking and efforts to the project.”

The Commonwealth front-loaded core technology into early releases of the hCentive software in order to demonstrate key functionality to CMS and to be in a position to conduct rigorous system testing in advance of go-live on November 15, 2014. As a result, the state is poised to offer consumers a streamlined, single-point-of-entry shopping experience this fall and a solution that meets – and in some instances exceeds – current FFM Exchange capabilities.

Unlike the FFM, hCentive now supports State Wrap, the unique Massachusetts program that offers additional state premium assistance to help make health insurance more affordable for thousands of residents. The State Wrap program is one of the main drivers behind the Commonwealth’s nation-leading 97% rate of insurance.

Additionally, hCentive has automated its interface with Dell, the Health Connector’s billing and enrollment vendor responsible for conducting transactions between insurers and consumers. Health plans and consumer advocates cited this connection and State Wrap as their top concerns with migrating to the FFM. The project’s IT team needed to create and implement new systems to modify the hCentive software to support these Massachusetts-specific consumer affordability and back-office functions.

“Today is an important milestone for the Massachusetts Connector and we are pleased to continue to work with them to ensure that consumers have access to affordable, quality health care,” said Andrew Dreyfus, Blue Cross Blue Shield of Massachusetts President and CEO.

“We are pleased with today's decision as we have believed that a state-based solution offers the best approach for Massachusetts residents given the unique offerings to supplement coverage, such as the State Wrap, that are available only in our state and would not be possible through the FFM,” said Lora Pellegrini, President & CEO of the Massachusetts Association of Health Plans. “We appreciate the collaborative and transparent process the Administration and Connector have undertaken with us and we commend them for the significant progress that has enabled the Commonwealth to reach today's decision.”

"Health Care For All thanks and congratulates the leaders and team members whose hard work we celebrate today including Sarah Iselin, Maydad Cohen, Kristin Thorn and Jean Yang who have worked tirelessly to preserve the Massachusetts state-based Exchange,” said Amy Whitcomb Slemmer, Executive Director of Health Care for All, “We are excited to be working on a single track. Reports of hCentive’s capabilities are very encouraging and it will be a pleasure to turn our attention to making sure that the upcoming Open Enrollment period is a success.”

Following the Administration’s May 5, 2014 dual track plan announcement, the Health Connector began to hold twice-weekly briefings with executive and IT health plan leadership. The group has met 48 times since May, increasing collaboration and giving insurers a direct sightline into dual track implementation and immediate access to leadership from the Commonwealth and project vendors Optum, hCentive and Dell.

People currently in extended or temporary coverage through the Health Connector and MassHealth, along with those in Qualified Health Plans through the Health Connector, will need to complete new applications this fall in order to transition into ACA plans starting in 2015. In order to prepare for the significant task of reaching hundreds of thousands of people these consumers, Cohen will use the insurer meeting model for consumer advocates and state and vendor leadership. Now that the project has moved to a single track, consumer outreach and member transition will take center stage as the Health Connector and MassHealth seek to implement successful strategies to encourage existing members to submit new applications and attract the remaining uninsured to sign-up during the upcoming Open Enrollment period.

August 6, 2014

The guest post below is by Melissa Shannon, Director of Government Relations & Public Affairs at the Commonwealth Care Alliance (CCA). CCA is a consumer-governed health care organization (founded by HCFA and other groups) that serves the "dually eligibile" - people enrolled in both Medicare and Medicaid. CCA covers seniors enrolled in the state's Senior Care Options (SCO) program, and people with disabilities in the One Care program. CCA focuses on people with complex medical needs, and provides enhanced primary care and care coordination through multi-disciplinary clinical teams including physicians, nurses, and behavioral health and geriatric specialists. For more commentary from Commonwealth Care Alliance, visit their blog, Dually Noted.


Shortly after we launched our One Care program last fall, we found that we wouldn’t hear from some members for a time and wouldn’t know why—only later to discover that they had been spending time in the criminal justice system, either awaiting trial or serving time.

Sadly, this isn’t too surprising: MassHealth estimates that roughly 70% of the One Care population (under 65 years old, disabled and eligible for Medicaid and Medicare) has a mental health condition, while one half of the jailed population in the United States has a mental health problem, according to the Bureau of Justice statistics. It’s logical to assume that there is significant overlap between these two groups, and that a portion of the One Care population has – or will – spend time in the criminal justice system.

Problems with continuity of care
We realized early on that many of our One Care members experienced lapses in coverage because they were in and out of the criminal justice system. That’s because of a longstanding federal law that terminates Medicaid and Medicare coverage for anyone who is incarcerated. Over time, we will be able to better quantify how many of our members have experienced these lapses in coverage and for how long, but presently this poses a significant question for us: how do we ensure continuity of care for our members in the criminal justice system?

Interestingly, as we’ve started to get our arms around these continuity of care challenges, we’ve noticed a surge in interest among policymakers and healthcare leaders on the subject. Health Affairs, for example, devoted most of their March 2014 edition to the intersection of Medicaid eligibility and incarceration. This increased interest stems partly from the Affordable Care Act, which expanded Medicaid to cover many more childless adults, resulting in more people in the criminal justice system being Medicaid-eligible.

County sheriffs call for change
Many have advocated for changes to the federal policy regarding continuity of care for the incarcerated, including county sheriffs’ offices, who, historically, have found themselves stuck with the (substantial) bills for inmates’ hospitalizations. To the sheriffs’ credit, they are not just concerned with unpaid hospital bills. They know the needs of their population well and want to see their inmates reconnected with their health insurance upon release, so they can receive the care and medications they need to stay healthy and on the right side of the law. (Sheriff Peter Koutoujian of Middlesex County is a leader on this issue here in Massachusetts.)

Enter Massachusetts State Senator Pat Jehlen (D-Somerville) and State Representative David Viera (R-Falmouth), who adopted the sheriffs’ cause and advocated successfully to have language included in the 2015 state budget to require that Massachusetts Medicaid benefits (MassHealth) be merely suspended when someone is incarcerated and immediately reactivated upon their release. This should be a big step forward in ensuring that recently released inmates are reconnected with the insurance for which they are eligible.

Though this may seem like a small change, it will have a significant impact on some of the most daunting issues facing our One Care members—like getting proper treatment for substance abuse and mental health treatment.

How will it work for One Care Members and others enrolled in managed care?
We at Commonwealth Care Alliance are interested in not only seeing members reconnected with their health care providers but also with their individual care plans. We know that having an active insurance card is not the same as receiving the care you need, particularly for the most vulnerable.  We also know that continuity of care is especially critical for the mentally ill and other vulnerable populations.

While it’s great to see this legislation pass, questions remain. MassHealth has until December 31 to submit an implementation plan for the new law to the legislature.