December 2014

December 31, 2014

The Health Connector has just released a New Year's Eve update with information for the over 50,000 people who will be starting new coverage on January 1. Here's their release:

Commonwealth, Health Connector Prepared to Offer Coverage to More than 50,000 with Policies Starting January 1

 BOSTON – December 31, 2014 – More than 50,000 people will have new health insurance coverage starting Jan. 1 through the Massachusetts Health Connector, and the Commonwealth is prepared to ensure the transition goes as smoothly as possible for consumers obtaining their new coverage. Additionally, nearly 140,000 people have been enrolled in MassHealth since Nov. 15, 2014.

The health plan’s process of enrolling members into new coverage and delivering an ID card to a member can take 10-14 days, which means many of the people who paid their first month’s premium near the Dec. 28 deadline will not have identification cards in hand on Jan. 1. Their coverage takes effect on that date, however, and the Commonwealth is working with health plans, providers, pharmacies and community organizations to ensure members know they have coverage, and provide guidance on how to work with their health plan to obtain services before they get an ID card.

“In the first six weeks of Open Enrollment, nearly 140,000 people signed up for MassHealth, and more than 50,000 selected and paid for a Qualified Health Plan (QHP) through the Health Connector. That’s a very good start and brings us closer to our goal of seeing everyone in Massachusetts who needs insurance use the new system to access it,” said Maydad Cohen, Special Assistant to Governor Patrick. “We are going to spend the next week making sure that those who are in these QHP plans know the best way to access their coverage starting tomorrow, even if they don’t have an ID card yet.”


Within 24 hours of a member paying for a plan, the Health Connector sends enrollment information to the health plan. Health plans need up to five business days to process the enrollment information and get an ID card in the mail. This means for some members, it can take 10-14 days after making a payment for an ID card to arrive. In an effort to give consumers as much time as possible to pay for a plan, the Health Connector and health plans set a payment deadline of Dec. 28, which means many of those who paid in late December are confirmed to have coverage starting Jan. 1, but will not have an ID card this week.

“We are working very closely with carriers and providers to ensure everyone who has coverage starting Jan. 1 has access to their benefits,” said Jean Yang, the Executive Director of the Health Connector. “This is largely standard practice in the marketplace, and we want to make the extra effort to make sure members are aware of the forms and processes health plans have in place to support members’ ability to obtain services, even if they do not yet have an ID card.”

It is common practice for consumers to receive their ID cards after the starting date of coverage, and health plans have processes in place to support members before they have their ID cards. Because so many members are starting new coverage on Jan. 1, the Health Connector and the Commonwealth have taken a number of extra steps to ensure members are given as much information as possible, and are reassured they have health insurance starting Jan. 1. These steps include: 

·        An email to members confirming that they have coverage starting Jan. 1, even if they do not have an ID card;

·        A page on detailing for members their health plan’s process for accessing services without an ID card (that page can be accessed here);

·        A customer-service friendly list sent to each carrier from the Health Connector of members who paid near the deadline and may not be entered into a health plan’s system in time for Jan. 1, so health plans and their customer service centers have easily accessible information on new members; and

·        A Frequently Asked Questions tip sheet (attached to this email) that will be sent to pharmacies and other providers to offer information and direction to pharmacists and others who may be working with members that have not yet received their ID cards.


December 29, 2014

Health Care For All is important to me because of all we do to help individuals and families understand their health care options and get connected to the care they need. 

I travel across the state and have the joy of  helping people and hearing about their personal experiences with the health care system. These consumer stories help guide HCFA's advocacy efforts and improve the health care system for everyone.

I stand with HCFA in the belief that everyone has the right to high quality, affordable health care. If you stand with us, please show your support by donating today to Health Care For All. 

Thank you, 

Amilton Baptista
Senior Regional Canvassing Coordinator


Massachusetts is a national leader in health reform and our work is far from over.
Thousands of consumers rely on HCFA each year to get and stay connected to health care.
With so many changes coming to our health care system, we know that consumers will continue to need a strong advocate. 

Donate today to support our work, get your own HCFA sweatshirt and wear it proudly! 


HCFA Canvassers spread the word on health coverage 12-20-14 (Boston Globe photo)
December 20, 2014

Dozens of HCFA office staffers joined our canvassing teams on Saturday to knock on doors in Boston to get the word out about health care coverage options.

We've set a goal of meeting over 200,000 Bay Staters, and with the over 2000 doors we hit today, we're getting close to meeting our goal. We're working throughout the state, concentrating on low income and immigrant neighborhoods likely to have MassHealth or Health Connector coverage.

Our message was the need for everyone to check their coverage options, and renew their coverage if it's expiring. The Globe went with us, and here's excerpts from their report:

Days before the deadline to enroll for coverage beginning Jan. 1 through the Massachusetts Health Connector, volunteers and canvassers deployed in the South End today to knock on doors and tell residents about the agency’s open enrollment.

About 30 people gathered on the second floor of a South End dance studio this morning for breakfast and a crash course in canvassing, before departing in teams of two with a professional canvasser.

Amy Whitcomb Slemmer, executive director of Health Care for All, and Jean Yang, head of the Health Connnector, went door to door with one team.

“We want to make sure everyone has coverage, and the coverage they have is working for them,” Whitcomb Slemmer said....

“We want to make sure there is no gap in coverage,” said Maria Gonzalez, communications director with Health Care For All.

The South End has diversified over the past 15 years, she said, and canvassers were told to prepare to encounter a wide variety of languages. They carried brochures in eight different languages and door hangers in English, Spanish, and Portuguese. ...

The process, repeated thousands of times, goes as follows: knock on the door, ask people who answer about their insurance -- do they have it, what kind, are they satisfied with their coverage, and would they like assistance applying through the Connector if they aren’t insured -- and log the information in a phone app. ....

(Boston Globe photo by John Tlumacki)

       - Brian Rosman

Make Your Year-End Gift Today
December 19, 2014

Giving to Health Care For All has never been easier

Please make a tax-deductible donation today!

HCFA's Outreach Team Meeting People Throughout the StateHCFA is reaching out into communities across the state during the Commonwealth’s open enrollment period to make sure individuals and families have the information they need to get, and stay, connected to quality, affordable health care.

HCFA is more than halfway to its goal of knocking on 200,000 statewide!

Give to HCFA today and join the list of supporters that make our work possible.

December 17, 2014

Today the Health Policy Commission held a lengthy, end-of-year meeting (meeting slide deck here) summing up the year and discussing a wide variety of topics, including a year-end summary of the work of the Office of Patient Protection and updates on the medical home and ACO standard process. It was also announced that the first meeting of the "Essential Services Task Force," made up of state officials and charged with looking at the issues of hospital and service closures, will occur on December 18.  

The highlight was the release of select findings of its upcoming cost trends report, due to be released at its next meeting, on January 20. The Commission also issued a press statement with the key points of today's release. Here's their good news/bad news headline and subhead, which neatly ties up the findings released today:

Health Policy Commission Finds Health Care Cost Growth in Mass. is Slowing

Identifies further areas of opportunity for enhancing the transparency, quality, and affordability of health care system

The good news is that Massachusetts spending growth is the lowest in many years:

HPC spending trends 12-17-14

The presentation breaks down spending growth in 2013 by payer, like commercial insurers (growing at just 1.7% per person), and Medicare and Medicaid growth rates. For MassHealth, our Medicaid program, per-member spending by the managed care organizations went up 3.9%, while spending growth in the primary care clinician fee-for-service program grew by 2.6%.

The question, not answerable yet, is whether this trend is a temporary blip, or represents a fundamental change. Commission Chair Stuart Altman warned that he has seen costs go up and down in many cycles over the past.

The presentation also looked at the other side - the areas where needless spending continues. They looked at five areas where opportunities for progress should be addressed:

  • Variation in Cost of Common Treatments: For three common procedures (knee replacement, hip replacement, and angioplasty and stents), hospitals vary widely in health spending across an episode of care – driven by procedure price – without clear differences in quality. The HPC finds that opportunities exist to reduce spending by shifting site of care to lower cost settings such as community hospitals or lower cost specialty facilities, or by increasing efficiency and reducing price within existing settings.
  • Post-Acute Care: Wide variation exists in discharge practice patterns among Massachusetts hospitals, both in total discharge to post-acute care and the balance between home health and institutional settings (such as skilled nursing facilities). While the “right” levels of post acute care use are not clear, variation between Massachusetts and the U.S. – and between Massachusetts hospitals – shows need for focus on optimal care.
  • Wasteful Spending: Building upon its 2013 estimate that 21 to 39 percent of all health care spending could be considered wasteful, the HPC focused on opportunities in avoidable readmissions and avoidable emergency department visits as areas for improvement in care delivery. The HPC finds that almost half of Massachusetts ED visits were avoidable in 2012 and that Massachusetts has substantial opportunity to reduce unnecessary readmissions, where the state continues to fall short of national benchmarks.
  • High-Cost Patients: Because 5 percent of commercial patients account for 45 percent of commercial medical spending, the HPC conducted a first-of-its-kind cluster analysis of Massachusetts claims data, identifying segments of high-cost patients. The results reinforced a focus on behavioral health, and managing chronic conditions such as asthma.
  • Behavioral Health: The HPC continues to identify challenges in behavioral health that pervade the health care system, and identifies areas for improvement that include the advancement of integrated clinical models within patient-centered medical homes and accountable care organizations, the alignment of financial incentives to support these care models, and improved transparency through the collection and public reporting comprehensive data.

Lots and lots of great stuff here. If you have even a smidgen of health wonk in you, go look at the presentation.

   - Brian Rosman

December 14, 2014

Last Thursday’s Connector Board meeting began with a bittersweet farewell to outgoing Administration & Finance Secretary Glen Shor, who has been a leader in Massachusetts health reform implementation since 2007, holding multiple roles in Administration & Finance as well as Executive Director of the Health Connector, preceding Jean Yang.

Shor gave a moving goodbye speech, and recognized Jean Yang’s leadership of the Health Connector, particularly during the most recent difficult times; Yang received a standing ovation from the Board and audience alike.

After the heartfelt overtures, the Connector Board got down to business. With over 150,000 people already determined eligible for coverage for next year, the Connector is pleased with progress. They outlined a number of key improvements planned for next year, and detailed the extensive outreach campaign. We were particularly proud of the numerous shout-outs to Health Care For All from the Connector leadership for our outreach work.

HCFA outreach campaign highlighted by the Connector (12-11-14)

The Connector Board also voted to:

  • Extend a contract with Dell to complete integration with the hCentive eligibility and enrollment system, to ensure back-end functions such as sending financial and enrollment files to health insurance carriers are completed.
  • Extend the Commonwealth Care program through January 31, 2015 to align with the Commonwealth’s coverage transition plans.
  •  Release proposed state-based market-wide risk adjustment regulations, focusing on operational processes, for public comment.

For your reference, all the meeting materials are here, with the two key presentations updating board members on progress with the online enrollment system, and the outreach and education efforts. Our detailed report is on the flip.

December 9, 2014

Health Connector Board member Jon Gruber was on the DC hot seat today, testifying for hours at an it's-all-politics extravaganza. Even the staid The Hill newspaper said that it was a "circus-like affair." Committee Chair Darrell thought it worthwhile to channel Forest Gump ("Mr. Gruber, are you stupid"). Some even accused the Democrats of releasing the CIA torture report today to distract attention from the Gruber inquisition (examples).There's some good summaries and videos of the whole thing at The NY Times and a good report at The Atlantic.

But we want to highlight this video, where Congressman Gerry Connolly (D-VA) turns Gruber's attention to Massachusetts health reform. This doesn't make up for all the nonsense, but at least we got our due:


(And if you're still in an Obamacare video watching mood, this is more than worth it, too:)

             - Brian Rosman

December 9, 2014

Today the Massachusetts Blue Cross Blue Shield Foundation and its Mass Medicaid Policy Institute held a packed forum titled, MassHealth Matters: Priorities for the New Administration.

The focus of the event was the release of a report identifying five priority issues for improving MassHealth in the coming administration, followed by a panel discussion on the issues raised. We'll have a summary of the report up later, but we wanted to first highlight this amazing video below, and an infographic that illustrates the crucial role played by MassHealth.

Please watch this video (click here to watch), and meet some Bay Staters whose health depends on MassHealth. The video conveys more in 5 minutes than any policy paper. So please, watch this:

MassHealth Matters video

We helped the Foundation find one of the individuals featured in the video, and are pleased that we could assist with this.


MassHealth serves 1.7 million peopleThe full MassHealth infographic is also worth downloading and absorbing. The headline is, "MassHealth is important to the people of Massachusetts because it affects so many of us and has a large impact on our economy." The facts and figures are all there about the role MassHealth plays in the state economy, bringing in over 80% of the federal revenue received, and MassHealth's role in filling gaps in Medicare for 270,000 elders and people with disabilities. There's also a great panel showing the broad reach of MassHealth:

Click through for the whole thing.

And go watch the MassHealth video.

   - Brian Rosman



December 4, 2014

[UPDATED UPDATE: On December 17, the Connector and MassHealth reported that 202,156 people have now become eligible for ACA coverage in Massachsuetts #thatwasfast ]

Open enrollment dashboard excerpt 12-17-14

[UPDATE: On December 12, the Connector and MassHealth reported that 156,163 people have now become eligible for ACA coverage in Massachusetts:]



Pop the corks! Cue the balloon drop! Today's update from the Connector and MassHealth represents a major milestone: Massachusetts health reform eligibility determinations topped 100,000 people.

Connector dashboard report 12-4-14

The Connector marked the progress with a press release with lots and lots of numbers, many drawn from today's Daily Dashboard). Some excerpts: Passes 100,000 Mark

108,155 people determined eligible for ACA health insurance; Enrollment Fair in Springfield attracts more than 250, in-person help available on Dec. 9 in Boston

BOSTON – Thursday, December 4, 2014 – The new Massachusetts Health Insurance Exchange (“MA HIX”) website has successfully determined 108,155 individuals eligible for Affordable Care Act (ACA) health insurance. Less than three weeks into Open Enrollment 2015, 49,928 have been enrolled in MassHealth coverage and 58,227 have been found eligible for Health Connector-sponsored plans.

Of the 58,227 who qualify for Health Connector insurance, 29,439 have already shopped and selected their health plans while 2,043 have paid their first bill, less than three weeks in advance of the Dec. 23 deadline to take action for Jan. 1, 2015 coverage. ...

To reach these individuals, the Commonwealth and its partners have knocked on 55,918 doors, sent nearly 500,000 pieces of direct mail and placed 160,370 calls. Yesterday, the Health Connector and MassHealth held an Enrollment Fair in Springfield that attracted 250 people. Individuals and families received free in-person help completing applications and talked to insurers about their plans and networks. The next enrollment event is on Tuesday, Dec. 9, from noon to 8 p.m., at the Courtyard Marriott, 275 Tremont St., Boston. Along with providing application and coverage assistance, the event will include an appearance by Boston Bruin Patrice Bergeron from 2 to 4 p.m. ... has attracted a total of 732,371 unique visitors since Nov. 15, serving a high of 1,292 concurrent users with a page response time of less than half a second (382 milliseconds). An average of 623 front line staff have been available to assist consumers with questions about their applications across state and vendor call centers and application processing units.

       -  Brian Rosman

December 3, 2014

Zero Harm conference banner

The Betsy Lehman Center for Patient Safety and Medical Error Reduction held an event at the JFK Library and Museum on Tuesday both to mark the 20th anniversary of the death of Betsy Lehman due to a massive chemotherapy overdose and to introduce the newly constituted Betsy Lehman Center, which was moved from the Department of Public Health to the Center for Health Information and Analysis in 2012. The day started off with remarks from Betsy Lehman’s two daughters and a video which you can view on the meeting's website, All event materials are also on the website.

The event featured two panels of speakers. The morning panel included Eric Schneider from RAND Corp., Jill Rosenthal from the National Academy for State Health Policy, and Robert Blendon from Harvard. All three of them had been commissioned by the Center to do research on patient safety and they presented the research results. Dr. Schneider’s research looked at the state of patient safety in Massachusetts and opportunities for improvement. He said that most patient safety advances have taken place in the hospital setting and the leading areas of risk are infections, medication errors, surgical risks, falls and pressure ulcers. Among a list of risks related to organizational characteristics were a lack of a patient safety culture, a failure to provider patient-centered care and to engage patients and families, and a lack of a leadership focus on patient safety. The areas he listed or future work include coordination of care, decreasing diagnostic errors, and gathering data on safety in settings outside of the hospital.

Leading patient safety risks

Ms. Rosenthal talked about adverse event reporting systems across the country. She said that 26 states and the District of Columbia have adverse event reporting systems, a number that has not changed since 2007. It is hard to make comparisons across states because of differences in the systems and in what is reported and how it is reported. She suggested integrating patient safety efforts into delivery system reports and evaluating reporting systems.

Mr. Blendon gave an overview of the results of survey on the public’s view of medical error in MA. Some results include: ¼ of MA residents have been personally involved in a medical error in the past 5 years, the most common error was misdiagnosis, over half of those experiencing an error believe it was the result of a mistake made by an individual provider and not by the institution where they work, about half of those experiencing an error reported it to someone else (mostly to health care providers and in very few cases to a government agency), two-thirds of those who didn’t report an error said it was because they didn’t think it would do any good, and about one-third of residents say that medical errors are a serious problem. In response to the question of what should change in Massachusetts, Mr. Blendon said that he would want more information for consumers on what an injured patient should do, how a patient can report an injury and to whom, and what will happen after they make the report.

The afternoon panel featured representatives from various sectors of the health care system, including a patient who is a Patient and Family Advisory Council (PFAC) member at Baystate Medical Center and who sits on the hospital’s patient safety committee. Among this group, topics that came up included the need for better communication with patients and families, including shared decision-making and transparency of information, the need for improved communication between health care providers, the importance of a team-based approach in general and also in particular in the area of behavioral health care, and the importance of moving from a blame culture to one focused on changing systems to reduce errors.

In between the two panels, Senator Richard Moore was honored for his work in health care and patient safety and his leadership in establishing the Betsy Lehman Center. Barbara Fain, the executive director of the Center, closed out the day talking about some of the future roles the Center may take on, including being a convener of health care entities working together on improving patient safety, a place to aggregate and disseminate data, engaging the public in conversations and partnerships, and developing more comprehensive, coherent and transparent systems.

One topic that came up many times throughout the day was the importance of engaging patients and family members, and PFACs in particular came up multiple times. I reached out to some PFAC members who attended the event to get some of their thoughts, which are shared below:

December 1, 2014


Today is Giving Tuesday, a response to Black Friday and Cyber Monday. HCFA is able to do the work we do because of the generosity of our supporters. Gifts from individuals, families, and organizations allow HCFA to continue to assist all Massachusetts residents in receiving the health coverage they need. Giving to Health Care For All has never been so easy.

On this “Giving Tuesday,” please consider making a donation to Health Care For All in one of the following ways:

 To make a tax-deductible donation:

  • Click here to make an online donation
  • Mail a gift to: Health Care For All, One Federal Street, Boston, MA 02110  Attn: Development

Support HCFA through iGive.comYou can support Health Care For All this holiday season by shopping online at over 1,500 stores like Amazon, Crate&Barrel, and Toys R Us.  Join and select Health Care For All as your charity of choice and a percentage of your purchase will be donated to HCFA.

Monthly donation CalendarSupport HCFA monthly by allocating an ongoing donation. Giving a specific amount each month has great impact on our work. Email to start the process.


Workplace GivingJoin your employee giving program or encourage your company to become part of one. HCFA is a part of Community Works, the Commonwealth of Massachusetts Employees Charitable Campaign (COMECC # 111147) and the City of Boston Employees Charitable Campaign (COBECC # 2015).

Gifts of TributeWhat better way to celebrate family and friends than to give a gift to HCFA in their honor or memory? Click here to make a donation or call 617-275-2936 to make a pledge!

Thank you so much in advance! Your gift will have an immediate impact on our work.

--From all of us at Health Care For All

December 1, 2014

Weekly enrollment dashboard 12-1-14 - exceprt

Today the Health Connector and MassHealth released their second weekly enrollment dashboard, showing enrollment and eligibility numbers for the last week of November. An excerpt is copied above.  All of the daily and weekly dashboards are posted by the Connector each weekday afternoon, here.

The numbers show continued growth in people being found eligible for coverage. In the first week, almost 52,000 people were found eligible. For the second week, including Thanksgiving, another 30,800 people were found eligible. The total is now a bit below 83,000.

(By the way, outside observers are noticing that the Connector is releasing piles of detailed information on how open enrollment is going - more than any other state. Charles Gaba, the guru of Obamacare statistics, used our daily numbers to see the effect of Thanksgiving on enrollment, and commented on Friday that "Massachusetts continues to kick butt this time around in general, but I particularly like that they're providing a daily breakout of their enrollment data.")

The complex chart above shows both where the 82,767 people found eligible for coverage so far are coming from, and where they are going to. The colors (blue-pink-white-green) correspond to the program the people are currently in. The guide is on the right side. The bars on the left represent the program the people will be going to next year. The chart above just shows eligibility. The full dashboard also shows enrollment numbers, which requires picking a plan and then paying a premium. The enrollment numbers are substantially less, around 40,00, since the deadline for paying is still several weeks away.

The report also updates statistics on the outreach campaign. HCFA's door-to-door canvassing campaign has now reached 55,918 homes - a remarkable achievement. We continue to hear from many consumer grateful for the information about how to enroll and what they need to do to keep their coverage.

    - Brian Rosman