June 2015

June 29, 2015

Two consecutive Supreme Court decisions take an idea that was first implemented in Massachusetts and make it national law. So it's official: The Spirit of Massachusetts is the Spirit of America:

Mass license plate with "The Spirit of America" slogan




(Context 2:)


June 25, 2015

Today's 6-3 Supreme Court decision has Massachusetts health reform written all over it, right up front. After describing past failures to effectively reform health care coverage policy, Chief Justice Roberts turns to us, on pages 3-4 of the opinion:

Supreme Court ACA opinion mentions Massachusetts

We couldn't be prouder of the role Massachusetts has played in the formulation, passage and implementation of the ACA. We were the incubator of the ideas, the test bed for the policy, and, of course, our delegation, led by Senator Kennedy, was crucial in the law's passage. Now our success is pivotal to upholding the law, establishing it as part of the American landscape.

Today's court opinion leans heavily on the successful Massachusetts experience. As we are in the midst of implementing the next phase of health reform, exemplified by Chapter 224 from 2012, we're also encouraged by the ongoing role Massachusetts policy continues to play nationally.

     - Brian Rosman

June 22, 2015

Health Affairs Blog Post by Representative Jeffrey Sanchez

Writing in the blog of the leading national health policy journal Health Affairs, state Health Care Financing Committee co-chair Representative Jeffrey Sánchez provides a balanced summary of MassHealth's efforts to push delivery reform forward.

The post, titled Tackling Medicaid In Massachusetts, looks at both the progress we have made, and the serious challenges we have encountered.

After mentioning the success we have had at meeting the cost growth benchmark for 2013, Sánchez frames the issue with the context of the critical role MassHealth plays in the state's health care system:

Now we plan to address our Medicaid program, known as MassHealth. The MassHealth budget has reached 14 billion dollars, more than 30 percent of the state budget expenditures, and the program now serves one-quarter of the state population. MassHealth in its current form is financially unsustainable. If we are serious about improving the health of our residents and bending the cost growth curve, we need to address the state’s biggest provider of health care.

Massachusetts Governor Charlie Baker has announced his intentions to make significant changes to MassHealth within the coming year. He is conducting a series of community listening sessions to gather data on how the program operates and serves individuals. The legislature will certainly have an important role to play in any future reforms.

As House Chair of the Joint Committee on Health Care Financing, I am traveling around the state with my committee members and meeting with a variety of stakeholders to better understand the program and its impact. There is general agreement that the program needs to change, but the specific changes needed are up for debate. We need to go beyond just spending more money and truthfully evaluate the manner in which that money is spent and how it impacts patients.

Chair Sánchez then laments the low level of participation (just 3% of PCC practices) in the Primary Care Payment Reform Initiative, in part due to the lack of sufficient patient data being provided to providers. He's hopeful that the newer Delivery System Transformation Initiative will be able to support the investments necessary to prepare for the transition away from fee-for-service payments toward alternative payment arrangements that hold providers accountable for the quality and cost of care. The key is enhancing communication:

Massachusetts is on the right track with the design of our SIM Initiative, DSRIP/DSTI, and other Medicaid reforms. However, implementation of these policies has proved challenging. From our experience, real-time data and on-going communication between providers, payers, patients, and policymakers are essential for successful adoption of delivery and payment innovations.

Ultimately, Chair Sánchez sees Massachusetts' as again providing a model for the nation:

As a state, we are taking these early experiences to improve implementation of existing policies and inform next steps for Massachusetts health reform. Other states can learn from Massachusetts’ efforts and ensure that stakeholder engagement, data synthesis, and real creativity are incorporated into any health reform endeavor. The next challenge for all states will be to move from scalable pilot programs, to effective state-wide efforts, and ultimately, to national success.

We agree - and we're pleased that Rep. Sánchez emphasizes the value of stakeholder engagement as we move forward.

    - Brian Rosman



June 16, 2015

We've done a bunch of posts on the topic of the ACA is good for Massachusetts. The ACA does much more than just switch RomneyCare to ObamaCare. Under the ACA, we've been able to provide premium assistance for more people, allow children to remain on their parents' health coverage longer, eliminate limits on benefits, provide free preventive care, including contraception, in insurance plans, and improve drug coverage for seniors on Medicare. The ACA has improved care quality, funded community health centers, workforce development, community prevention and 52 patient-centered research projects (out of 400 nationally).

And dramatically improved the state budget.

Mass Budget report

The numbers are in a brief released today by the Mass Budget and Policy Center, blandly titled "New Federal Revenue Affects State Spending Trends" (pdf), but providing blockbuster information.

In 2015, spending on health care grew, both due to medical inflation and expanded coverage. The increased cost was around $1.17 billion. But the ACA provided much more new revenue to Massachusetts, some $1.02 billion, covering almost all of the new spending.

We actually saved money on MassHealth coverage: "[Due to the ACA], the state is seeing a net bottom line savings of $245 million as a result ($338 million in new federal revenue minus $93 million in new net costs associated with MassHealth coverage.)"

The study correctly identifies health spending growth as the most critical ongoing budget problem. The boost in federal funds doesn't affect long-term growth trends. We must continue to take steps to reduce health care cost growth.

But the ACA's increased federal revenue is good news for the state budget, and for everyone who cares about providing affordable health care to everyone who needs help.

   - Brian Rosman



June 12, 2015

Yesterday, the Connector Board met to:

  • Discuss the Connector’s progress in improving customer service, operations, and IT systems;
  • Approve Administration & Finance subcommittee members;
  • Discuss planning underway for the next open enrollment period;
  • Approve contracts with vendors for operations and media/messaging work;
  • Share updates on the 2015-2016 Student Health Insurance Plan procurement; and
  • Approve final repeal of Commonwealth Care regulations.

Materials from the meeting are posted here https://www.mahealthconnector.org/about/leadership/board-meetings. For the first time in a long while, the board meeting was covered in the Globe, WBUR and other outlets. But for the full story, our detailed report is just a click away:

June 11, 2015

President Obama spoke on Tuesday about health reform. In part, it probably was an attempt to get ahead of the upcoming Supreme Court decision, and in part an opportunity to reflect on the progress we've made and set the record straight.

If you have the time, and want to feel good about health reform, it's worth watching the whole thing; if you don't want to watch, we've posted some highlights below for you to read.:


It's also worth going to the special "Health Care in America" website set up by the White House to go along with the speech, at www.whitehouse.gov/health-care-in-america. The website includes a timeline of efforts to pass health reform, from Teddy (Roosevelt) to Teddy (Kennedy), which flows into a timeline of implementation of the ACA. There's also lots of real-life stories and videos of people who have benefited from the law, and some quizes, too.

But the most moving part of the site is a letter our Senator Kennedy wrote to the President, with instructions that it be delivered after he died:

Letter sent posthumously from Senator Kennedy to President Obama

Here are some highlights from the President's speech:

“The rugged individualism that defines America has always been bound by a set of shared values; an enduring sense that we are in this together. That America is not a place where we simply ignore the poor or turn away from the sick. It’s a place sustained by the idea that I am my brother’s keeper and I am my sister’s keeper. That we have an obligation to put ourselves in our neighbor’s shoes, and to see the common humanity in each other.

So after nearly a century of talk, after decades of trying, after a year of sustained debate, we finally made health care reform a reality for America. .

Five years in, what we’re talking about is no longer just a law. This isn’t about the Affordable Care Act. This isn’t about Obamacare. This isn’t about myths or rumors that won’t go away.

This is reality. This is health care in America.

Once you see millions of people having health care, once you see that all the bad things that were predicted didn't happen, you'd think that it'd be time to move on. It seems so cynical to want to take coverage away from millions of people, to take care away from the people who need it the most, to punish millions with higher costs of care and unravel what's now been woven into the fabric of America." .…

There are outcomes we can calculate – the number of newly insured families, the number of lives saved. And those numbers add up to success.

Then there are the outcomes that are harder to calculate – yes, in the tally of pain and tragedy and bankruptcies that have been averted, but also in the security of a parent who can afford to take her kid to the doctor. The dignity of a grandfather who can get the preventive care he needs. The freedom of an entrepreneur who can start a new venture. The joy of a wife who thought she’d never again take her husband’s hand and go for a walk in God’s creation.”


                            - Brian Rosman

June 10, 2015

MHQP home page image

MA Health Quality Partners (MHQP) today released its latest set of patient experience data for adult primary care and pediatric practices across Massachusetts. Visit healthcarecompassma.org to view data for your provider or others in your region of the state. You can compare up to three providers at a time. The data was gathered from patient experience surveys sent out in 2014. MHQP received 64,000 completed surveys (44,000 for adult primary care and 20,000 for pediatric care). Clinical quality measures are also reported on the website.

Adult primary care practices are rated on the following categories:

  • MD-patient communication
  • coordination of care,
  • how well MDs know their patients
  • how well MDs pay attention to the patient’s mental health
  • access to timely appointments
  • care and information
  • getting quality care from staff and
  • if the patient is willing to recommend this provider to others.

Pediatric practices are rated on the following categories:

  • communication
  • how well MDs know their patients
  • how well providers give advice about keeping your child safe and healthy
  • how well MDs pay attention to a child’s growth and development
  • access to timely appointments, care and information
  • getting quality care from staff, and
  • if the family is willing to recommend this provider to others.

Massachusetts is one of the few states that publicly reports statewide results of adult primary care patient experience surveys and is the only state publicly reporting pediatric patient experience survey data. This information is useful to consumers who may be looking for a new provider or who want to see how well their own provider measures up in comparison with others. If you have concerns about any of the areas covered in the survey, bring these up with your provider. The information is also useful to medical providers who can look at areas where they need to improve and determine how best to do so. Patients’ experience of care impacts their health and health care.

2015 patient experience surveys are currently out in the field. If you receive a survey, fill it out so that your experiences can inform others, including your provider.

     - Deb Wachenheim

Expensive prescription drugs
June 1, 2015

We need to do more to control prescription drug prices, says HCFA Executive Director Amy Whitcomb Slemmer in a letter published in today's Boston Globe:

What pharmaceutical companies pay their executives is generally their business. But the bonuses reported lately are so mind-boggling that it’s impossible to believe that the rest of us aren’t shouldering part of the burden through our skyrocketing deductibles, copays, and other out-of-pocket drug expenses (“Firms say top pay at Vertex is excessive,” Business, May 27).

In Massachusetts, we spend more than $4.5 billion annually on prescription drugs, and as consumer advocates we hear the increasingly common complaint that rising drug costs are jeopardizing patients’ care. So, are we getting a good deal, or are we getting ripped off?

We are excited about a legislative proposal aimed at shedding light on some of the mystery that currently shrouds drug pricing. The bill would require pharmaceutical companies to report their manufacturing, marketing, and research costs, and what they charge for the same medicine overseas.

The bill empowers the Health Policy Commission to determine whether a drug’s price is unreasonable, threatening our cost growth goal, in which case the commission could establish a maximum Massachusetts selling price.

We are determined to create the most effective consumer-centered health care system in the country, which means that prescriptions must be an affordable element of care.

Amy Whitcomb Slemmer
Executive Director, Health Care For All, Boston

The letter is in support of Senator Mark Montigny's bill, S. 1048, An Act to promote transparency and cost control of pharmaceutical drug prices, introduced this session with 16 cosponsors.The bill would start to open a window into the pricing of prescription drugs and finally give the state some tools to control price increases for the most egregious cases.

The bill is grabbing the attention of the industry. Boston law firm Foley Hoag, which represents pharma industry players, alerted clients.to the bill in its newsletter. National insider drug industry tip sheets also took notice, pointing out that the Massachusetts bill is similar to initiatives in other states. We're part of a growing movement.

Opposition to high drug prices continues to grow. Our Globe letter appeared the same day news broke of an unusual speech decrying drug price increases given by a prominent oncologist at a meeting of cancer specialists. While normally these meetings only discuss clinical issues, the drug cost issue was deemed too important to ignore. The Wall Street Journal has the story:

“These drugs cost too much,” Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering Cancer Center, said in a speech heard by thousands of doctors here for the annual meeting of the American Society of Clinical Oncology.

Dr. Saltz’s remarks focused mainly on an experimental melanoma treatment made by Bristol-Myers Squibb Co., but he also criticized pricing more widely. He cited statistics showing that the median monthly price for new cancer drugs in the U.S. had more than doubled in inflation-adjusted dollars from $4,716 in the period from 2000 through 2004 to roughly $9,900 from 2010 through 2014. Dr. Saltz cited studies showing that the price increases haven’t corresponded to increases in the drugs’ effectiveness. ....

It is unprecedented for plenary speeches, which typically address scientific and medical issues, to substantially take on the topic of drug costs, said Alan Venook, a professor of medicine at the University of California San Francisco who planned the meeting’s scientific session and invited Dr. Saltz to speak.

The prominent venue for the speech was also unusual because, like many medical meetings, ASCO is sponsored by pharmaceutical companies and often focuses on highlighting advancements in drug development, said Dr. Venook. He said discussing drug prices there is “uncomfortable” because it could be seen as “biting the hand that feeds you.”

Doctors are also reluctant to antagonize the drug industry because they need pharmaceutical firms to invest in developing new medicines for patients, he said.

We will continue to push aggressively for the state to take firm action to keep prescriptions affordable.

     - Brian Rosman