July 2016

July 26, 2016

In mid-June, MassHealth took another step towards payment and care delivery systems reforms with the release of their 1115 waiver proposal (background: section 1115 of the Social Security Act allows the federal government to authorize state demonstration projects to improve Medicaid). Through the 1115 waiver, MassHealth is requesting authority from the federal Centers for Medicare and Medicaid Services (CMS) to restructure MassHealth care delivery through implementation of Accountable Care Organizations (ACOs) and expand substance use disorders services. MassHealth is asking CMS for a $1.8 billion up-front investment over five years to support transition toward ACO models, including direct funding for community-based providers of behavioral health and long-term services, as well as funding for for safety net programs, including the Health Safety Net – this is important, as under the current waiver, a significant portion of Safety Net Care Pool funding is set to phase out by June 30, 2017.

The public comment period closed on July 17th, with many stakeholders weighing in. Health Care For All helped draft and submit several sets of comments on a range of issues covered in the waiver proposal, with common themes around ensuring access to care, member choice, consumer protections, and monitoring and oversight. One set of comments we organized included these 29 organizations:

Logos of groups commenting on 1115 Waiver

Use these links to read our submitted comments:

The next step is for MassHealth to submit their 1115 waiver proposal to CMS. CMS will send MassHealth a notice of receipt within 15 days of submission, and that notice initiates the start of a 30-day federal comment period.

 

 

July 25, 2016

It’s a horrible name, but a great program. And with HCFA’s support, the Massachusetts state legislature just saved its funding for this year.

“Detailing” is the term used to describe the marketing of prescription drugs to doctors, pressing them to prescribe specific drugs for their patients. Detailers are sales representatives who travel to physician practices to deliver sales pitches lauding the benefits of their drugs. Often, detailers provide a free meal and drug samples as an enticement for providers to listen to their spiel. Detailers only work for name brand drugs; there are no detailers for generic alternatives.

“Academic detailing” is just the opposite. Independent experts meet with doctors, and go over current scientific information on a class of drugs, informing doctors on all the research, and making unbiased recommendations based on comparative evidence, including cost-effectiveness. The result is better patient outcomes, and lower health care costs. One study from Harvard Medical School found that each dollar spent on academic detailing saved two dollars in prescription drug costs.

For several years, Massachusetts has operated an academic detailing program, operated by the Department of Public Health. For this coming fiscal year, the plan was to focus the $150,000 program on how to best prescribe pain killers, to avoid the over-prescribing of prescription opioids. But when the fiscal year 2017 budget was presented to Governor Baker, he vetoed the funding for the program.

Last week, the legislature overrode the veto, by a 122 to 31 vote in the House, and a 36 to 3 vote in the Senate. During the override debate, Senator Mark Montigny spoke out passionately in favor of the program:

“We're not only fighting the opiate crisis, we're also fighting price-gouging by the pharmaceutical companies. This is exactly what should be done. Instead of having folks running around offices selling things they aren't even qualified to sell half the time. I think this is a great program.”

HCFA continues to press for effective prescription drug policies that save money and improve care. In addition to support for academic detailing, our prescription drug policy agenda includes greater transparency around drug prices, and eliminating copays for cost-effective preventive care. We’re very pleased that the academic detailing program survived, and will continue to press for a consumer-focused policies in this area.

-Brian Rosman

July 20, 2016

The Oral Health Advocacy Taskforce (OHAT) has a new initiative: integrating oral health into the rest of the health care system. OHAT’s new Oral Health Integration Project (OHIP) kicked off this past May and has hit the ground running. Over the past couple of months, OHIP members and stakeholders have put their heads together to think about what oral health that is fully integrated with the rest of the health care system could look like.

There is currently a significant opportunity to elevate oral health in health care here in Massachusetts. As explained in previous blog posts, MassHealth is proposing substantial changes to its program with the renewal of its 1115 Demonstration Waiver, to be approved by the federal government. At stake is 1.8 billion dollars over five years to support MassHealth’s transition to Accountable Care Organizations (ACOs). ACOs are a new way to pay for and deliver care that works by bringing together providers to coordinate high quality health care – care that we believe should include oral health.

MassHealth’s released Waiver Proposal touches upon oral health in a few important ways, and briefly outlines the inclusion of oral health metrics in the ACO quality measure slate as well as contractual expectations for ACOs around oral health. OHIP is pleased to see that oral health is included in MassHealth’s future plans for restructuring and is urging MassHealth to expand its efforts in this area.

OHIP submitted formal comments to MassHealth pushing for more robust ACO standards that would facilitate increased integration of oral health. A summary is listed below:

  • ACOs need to have accountability for oral health and dental services, and dental services should be phased into ACO total cost of care
  • Dental providers should be allowed to join ACOs and take part in risk-sharing arrangements starting in the first year of ACO roll-out
  • ACO payment methodologies for dental and oral health services should incentivize high-value, evidence-based, preventative care
  • Delivery System Reform Incentive Payments (DSRIP) funds should be used to transition the delivery system to adequately address oral health
  • Oral health quality metrics can help tie oral health into overall health in ACOs and should be strengthened
  • Oral health should be integrated into all aspects of care coordination
  • Roll-out of dental services inclusion in ACOs should first consider piloting
  • ACO governance, quality, and clinical committees should have representation from oral health clinicians
  • There should be adequate consumer protections built-in throughout the ACO structure

Take a look at OHIP’s full set of comments here.

Kelly Vitzthum

July 19, 2016

Last Thursday, the Health Connector Board met to update their bylaws, award conditional Seal of Approval to health and dental plans, and review the Health Connector’s FY2016 final and FY2017 proposed administrative budgets. Materials from the meeting can be found here.

Executive Director’s Report

Health Connector Executive Director Louis Gutierrez provided updates on Connector activities.

  • July enrollment increased by 10,500 members
  • 7500 members were overcharged for their premiums; the Connector has worked with Dell to rectify the situation and ensure members receive refunds
  • Risk adjustment payment to carriers increased by $84 million, largely due to an increase in Qualified Health Plan (QHP) member months
  • The Health Connector is considering their options to the Small Business Health Options Program (SHOP) and employee choice program. The Health Connector cancelled the SHOP procurement after not receiving any good options.
  • Preparations for 2017 Open Enrollment are under way.

In response to the SHOP updates, Board members discussed and inquired as to whether implementing a SHOP system would be a waste of time and money and whether this feature of the ACA is able to be waived. Gutierrez responded that it is waivable under Section 1332 authority, but it would be very difficult to obtain approval. The Health Connector is considering a shared platform with other states such as Connecticut, Rhode Island and Washington DC as an alternative.  

Patricia Wada provided an update on the roadmap for IT systems upgrades. The next release in August will focus on repairs and user experience upgrades to prepare for 2017 Open Enrollment, allow for Spanish language notices, and plan management features. The HIX system is a joint effort between the Health Connector, MassHealth and Mass IT. One Board member questioned whether the IT system will be impacted by MassHealth’s delivery system redesign and implementation of Accountable Care Organizations (ACOs). Gutierrez responded that this is on their radar and they are planning very far ahead.

Update to Bylaws

Ed DeAngelo and Ashley Hague presented proposed updates to the Health Connector Board bylaws, which have not been updated since the Connector’s inception in 2006. Updates focused on the designation of the Secretary of Health and Human Services as the board chair, the allowance of Board members to be notified of scheduling matters via email, the shift of responsibility from Executive Director to a Health Connector employee to be responsible for meeting minutes, and the allowance of the election of a vice chair to occur any time during the final quarter of the year, depending on each monthly agenda were each enacted.

There were also a few contractual updates to the bylaws. This included the an update to the minimum dollar value (from $5,000 to $15,000) for contracts that do not require a formal vote, but do require a written notice to the Board 5 days before execution. The type of “contract” requiring Board vote was then specified as “any and all types” except for extensions, amendments and work orders that cost less than a quarter of the original contract, as long as the cost is noted in the most recent Board approved fiscal budget. The Board voted unanimously to approve the amended bylaws.

Conditional 2017 Seal of Approval

In response to the 2017 Seal of Approval RFR, there will be a 25% decrease in health plans offered through the Connector when compared to 2016. Unlike 2016, when only non-standardized Bronze plans were offered, the Health Connector created, two new Standardized Bronze plans - one MCC-compliant and the other  has-compatible. All carriers opted for the MCC-compliant Bronze  plan design. In addition, the second standardized Gold plan was also eliminated. In total, 10 medical carriers responded to the 2017SOA ,submitting 62 QHPs for both non-group and small group shelves.

Notably, one of the new goals of the SoA expressed by the Health Connector is  enhanced substance use disorders treatment 2017 ConnectorCare plans will offer enhanced access to Clinical Stabilization Services and reduce the cost burden for key MAT (medication-assisted treatment) and associated services.

Another change is the requirement for QHPs to include pediatric vision and dental services, as per the State’s updated Essential Health Benefits (EHB) requirement Requiring Pediatric dental EHB coverage would move the Health Connector into parity with the off-exchange market, increasing the accessibility of these services. While one carrier cited operational challenges as a barrier, most opted to include pediatric dental benefits into their plans. On the dental carrier side, there were not many changes to the requirements and offerings of Qualified Dental Plans (QDPs).

The Health Connector voted and approved the 2017 Conditional Seal of Approval for  recommended QHPs and QDPs from the following carriers:

  • Altus Dental
  • Blue Cross Blue Shield of MA
  • Boston Medical Center HealthNet Plan
  • CeltiCare Health
  • Delta Dental of MA
  • Fallon Health
  • Harvard Pilgrim Health Care
  • Health New England
  • Minuteman Health
  • Neighborhood Health Plan
  • Tufts Health Plan – Direct
  • Tufts Health Plan – Premier

Health Connector FY2016 & FY2017 Administrative Budgets

July 19, 2016

This blog post was originally published on Community Catalyst's blog Health Policy Hub

I recently attended Health Care for All’s (HCFA) 4th Annual Patient and Family Advisory Council (PFAC) Conference in Massachusetts, which was incredibly informative and inspiring. HCFA was a major force behind the passage of the 2008 law that required all Massachusetts hospitals to establish PFACs, and for the past eight years, has provided technical assistance, training and networking opportunities to strengthen patient and family engagement in hospitals.

So, what are PFACs and why do they matter? According to the Agency for Healthcare Research and Quality, PFACs are bodies made up of individuals who have received care at a hospital (or their representative family members) and are able to offer feedback and insights to inform and improve hospital care delivery, policies and operations to most effectively address patient and family needs and preferences. PFACs have the potential to help improve overall systems and processes of care, which can lead to better health outcomes for patients, as well as improve financial performance of health care organizations.  PFACs are a great example how to actively and meaningfully engage consumers in order to realign the health care system and place consumers at its center.

But establishing a PFAC is only the first step. Learning how to make it meaningful is an entirely other story. And that’s what the HCFA conference was all about. It began by offering a three-part vision of what constitutes authentic engagement: First, engagement is purposeful; second, engagement is effective; and, finally, engagement isequitable. The conference covered a lot of ground across these three themes, providing the nearly 300 participants with opportunities to discuss everything from building internal credibility for PFACs, to creating effective meeting agendas, to understanding why PFACs should care about and provide their perspectives around quality measures. Most importantly, the conference provided PFAC members from across the state with an opportunity to network with – and learn from -- one another.

One cross-cutting theme of the day was the importance of consumers being engaged at every level, and from beginning to end of all hospital processes. Examples abounded, including in sessions focused on engaging patients in research as partners rather than subjects, integrating patients into hospital committees, and identifying the PFAC’s role in shaping hospital community health assessments and activities in order to best address identified needs.

Another theme was the importance of recruiting a diverse PFAC membership that represents the patient population by race, ethnicity, language spoken, sexual orientation, gender, age, disability status, employment status and so forth. One PFAC’s approach to recruiting and retaining diverse members included developing a Diversity, Equity and Inclusion Council that supports other PFAC members in understanding how to be more inclusive of people from different racial and ethnic backgrounds. Another PFAC in the state is working to adapt educational materials for different age groups, particularly older adults, by ensuring materials are printed in large, bold text and colors that are easy to read. Several PFACs are changing their meeting times or incorporating virtual meetings and social media in order to accommodate members who are working parents or others who have difficulty getting to in-person meetings.

The conference helped me better understand some of the challenges and opportunities PFAC members face as they continue to develop and establish their roles within health care organizations here in Massachusetts. I also walked away from the conference with an increased appreciation of the role consumer health advocacy organizations like HCFA can play – through convenings, trainings and providing a space for PFAC members to connect – in supporting these councils so that their engagement is truly purposeful, effective and equitable.  

- Angela Jenkins, Project Manager at Community Catalyst 

July 12, 2016
New residents at BMC attend orientation, which includes a workshop on the social determinants of health. (Martha Bebinger/WBUR)
New residents at BMC attend orientation, which includes a workshop on the social determinants of health. (Martha Bebinger/WBUR)

Last week WBUR reported on an effort to improve doctor-patient relationships by training medical professionals in social determinants of health. These recognize that our health is largely determined by our access to social and economic opportunities, not direct medical care. Some of these factors include access to housing, nutritional food, education, and income supports, among many others. This piece highlights a program that is being implemented at Boston Medical Center, in which resident doctors are being trained to find out what kinds of barriers their patients may face when it comes to being healthy and staying healthy. In an effort to improve patient-centered care, similar trainings to the one at BMC are also being offered to doctors at various hospitals around the country, including Johns Hopkins in Maryland and at Dell Medical School in Texas.

Everyone in Massachusetts deserves the opportunity to lead a healthy life, and it is in our best interest for all doctors to be trained in how health may be affected by social factors. By looking at health from a more holistic perspective, health care professionals can aid in the transformation of the medical system and improve health outcomes. Health Care For All strongly supports the move to address social determinants of health. We believe that there is great value in this approach, as it helps to build patient-centered care and has the potential to positively impact our communities by promoting health equity. 

--Angela Swanson