August 2016

August 31, 2016

Globe letter - EpiPen pricingToday's Boston Globe's lead letter-to-the-editor is from Amy Whitcomb Slemmer, HCFA's Executive Director. The letter is call for action on high prescription drug prices, exemplified this week by the outrageous price increases Mylan is charging for their EpiPen injectible drug for allergic shock:

 

 

Re the Aug. 25 editorial “EpiPen maker sticks it to patients — again”: We agree. The price hikes of the EpiPen allergy-drug injector are “shameless” and “deceptive,” and another example of drugmakers pricing their products at whatever the market will bear.

Prescription drug prices are the fastest-growing cost in health care, placing life-saving therapies beyond the reach of consumers. Drugmaker Mylan’s initial response to the public’s EpiPen price hike outrage was to enhance its patient-assistance program, a marketing ploy that discounts the cost of EpiPens for individuals but does nothing to address the underlying cost gouging, or the resulting impact on insurance premiums.

We urge lawmakers and regulators to step in and shine a light on the true development and production costs of pharmaceuticals. This is a wake-up call. Let’s work together to place the EpiPen and other life-saving therapies back within the reach of the people who need them. Let’s stop underwriting exorbitant profits, drug marketing budgets, and lobbyists’ salaries.

Innovative new drugs and therapies will be worthless if no one can afford to buy and use them.

AMY WHITCOMB SLEMMER
Executive Director
Health Care For All
Boston

 

The public is demanding action on prescription drug prices. The Kaiser Health Tracking poll found overwhelming, bipartisan support for a variety of policy ideas to get tough on drug prices:

  • 86 percent support requiring drug companies to release information on how they set prices, including majorities of Democrats (90%), Republicans (82%), and independents (84%)
  • 83 percent support allowing the government to negotiate with drug companies to lower prices for people with Medicare, including majorities of Democrats (93%), Republicans (74%), and independents (83%)
  • 76 percent support limiting how much drug companies can charge for high-cost drugs for illnesses such as hepatitis or cancer, including majorities of Democrats (79%), Republicans (70%), and independents (77%)

HCFA has promoted a broad agenda to lower prescription drug prices, include price transparency legislation, restrictions on gifts and meals provided by drug marketing reps to doctors, support for "academic detailing," which provides objective, unbiased information to doctors to counter sales pitches from drug sellers, and reinstating the state ban on drug copay discount coupons, which, as mentioned in our letter, are ploys used to promote high-price drugs that end up costing consumers more in higher premiums.

We are planning to mount a major campaign for next year's legislative session to take strong action on prescription drugs. This year, Vermont passed major drug price transparency legislation, and bills are pending in other states as well. The tide on this issue is turning, growing larger and more urgent. Let us know if you would like to participate.

                                                                                                                                 -- Brian Rosman

 

August 17, 2016

HPC: Preventable Oral Health ED Visits Report

Reducing the number of preventable emergency department (ED) visits has been an important measure of health care quality. According to the U.S. Agency for Healthcare Research and Quality, avoidable ED visits are not only costly, but may indicate poor care management and/or inadequate access to care, among other system failures in inefficient health care delivery and prevention.

Thus ED visits for avoidable oral health conditions are a marker of serious deficiencies in our health care. The Health Policy Commission released a policy brief Monday describing the extent and significance of preventable dental visits in hospital emergency departments across the Commonwealth, following their initial findings back in April. The stark findings: In 2014, there were over 36,000 preventable oral health ED visits in Massachusetts, which cost the health care system between $14.8 million and $36 million. Around half of all preventable dental ED visits were paid for by MassHealth.

HPC Chart: Preventable Oral Health ED visits by age - 2014

When regular dental care is inaccessible and/or unaffordable, people tend to delay needed care, often exacerbating a problem until it becomes an acute issue. Aside from being significantly more expensive, emergency departments are also ill-equipped to adequately address underlying dental concerns. Along with establishing dedicated ED diversion programs for oral health conditions, the HPC suggested that access to care could be improved by authorizing mid-level dental providers to provide routine care. These providers, known as dental hygiene practitioners or dental therapists in other states, are akin to nurse practitioners in medicine and have been shown to be a safe and economically viable option to reduce ED utilization and improve access. The HPC also suggested that the state consider supporting teledentistry initiatives to expand the “geographical reach of existing dental providers.” Complementary to establishing mid-level dental providers, teledentistry uses portable equipment and remote telecommunication technologies to reach those who live in remote or dental provider shortage areas and deliver care directly in community settings and has been found to be effective in other states.

The report also focused on cuts to MassHealth dental care:

Policy shifts may have affected oral health access. On July 1, 2010, MassHealth reduced dental benefits for its members age 21 and over, eliminating coverage for endodontics (root canals), periodontics (care for gums, such as plaque removal from below gums), crowns, and denture coverage for roughly 700,000 adults. Some of these benefits have since been restored, including fillings (March 2014) and dentures (May 2015). One retrospective study found that dental-related ED visits and costs at Boston Medical Center increased following MassHealth dental cuts. Of particular note, these dental visits increased 2 percent in 2011 and 14 percent in 2012, suggesting that higher ED use may be due in part to the cumulative effects of forgone prevention.

The general lack of integration of oral health into the rest of health care is also a root cause of preventable ED visits and overall poor oral health outcomes. Health Care For All believes that access to affordable, quality dental care is an important part of overall primary care, and enthusiastically supports the HPC’s policy recommendations as important steps to improved oral health in the state.

                                                                                                                            -- Kelly Vitzthum

August 10, 2016

When high-value care is delivered effectively, everybody wins. Patients experience better health outcomes, payers save money in the long run, and providers are better able to care for their patients. But the system needs to help patients focus on high-value care.

At HCFA, we are committed to breaking down barriers to high-value care. Our "No Co-Pay bill" would eliminate cost-sharing for high-value preventive care, like asthma inhalers or hypertension drugs. The Health Connector's decision last month to eliminate copays for medication-assisted treatment for addiction reflected a similar approach.

Who benefits from clinical nuance? - patients, payers and providers

The University of Michigan-based Center for Value Based Insurance Design has released a very cool infographic on what they call "clinical nuance" - structuring insurance to promote high value care, and discourage waste and unnecessary, inefficient low-value services. An excerpt is above, but click here for the full infographic

                                                                                                                              -- Mike DiBello

August 10, 2016

Originally posted by the Center For Health Care Strategies (CHCS)

Achieving health equity is a growing priority among health care stakeholders. However, until recently, many efforts to achieve equity have been focused on increasing access rather than addressing specific inequities. This is particularly true in oral health, where major barriers to access such as limited insurance coverage and insufficient workforce capacity persist. As a result, the Center for Health Care Strategies (CHCS), with support from the DentaQuest Foundation, led the Advancing Oral Health Equity learning collaborative to help oral health stakeholder organizations examine the impact their programs have on oral health equity and develop targeted strategies for disparate populations.

Health Care for All (HCFA), a nonprofit advocacy organization focused on achieving high-quality, affordable, and accessible health care for all Massachusetts residents, was one of five organizations participating in the collaborative. By listening to community and stakeholder groups, as well as hearing stories through its Health Insurance HelpLine, HCFA has adopted an equity-based framework and approach throughout its work. It sees inequities in oral health care as a social justice issue, believing that the social determinants of health and the intersecting issues of racism and classism affect overall health and well-being. To learn more about HCFA’s approach, CHCS spoke to two members of HCFA’s oral health care team: Kate Frisher, oral health coalition coordinator, and Kelly Vitzthum, oral health policy analyst.

Q: What kinds of activities is HCFA doing to advance oral health equity?

A: We focus primarily on policy opportunities. One example is supporting legislation that would create a new type of mid-level dental provider, the dental hygiene practitioner, also known as a dental therapist. Dental hygiene practitioners can help fill gaps in access for communities that are most in need of dental services, including rural parts of Western Massachusetts, elderly communities, and low-income urban communities of color. We’re hopeful that this new model will become a reality in Massachusetts and will also work to ensure that mid-level providers will serve the people who need them most. It’s one thing to get a bill passed, but it’s not enough to just stop there.

Q: Which populations are you focusing your equity work on?

A: It’s really easy to just say, “We’re focusing on the Medicaid population,” and leave it at that without thinking about the sub-populations that exist within the broader set of Medicaid beneficiaries. We’re finding that the population with developmental disabilities as well as individuals who live in the rural areas of western Massachusetts are both having trouble with access to oral health care.  Even just saying that we’re “narrowing down” our focus to western Massachusetts is obviously a bit of an oxymoron because it’s a huge region.

We also know that not having culturally and linguistically competent care is a big barrier to access in some places. We were really surprised to find that although there appear to be enough dentists who speak Spanish, severely lacking are dentists who speak Portuguese, the third most common language in the state. Thus, we identified Portuguese speakers as a potentially underserved group.

Q: Are there any obstacles to your oral health equity work?

A: The biggest obstacle is the separation of oral health care from the rest of health care. A lot of the oral health disparities could be alleviated if oral health care were better integrated into the health care system. We’re pursuing structural-level changes in the way that oral health care is financed and delivered to try to “bring the mouth back into the body.”

We also see diversifying the workforce to better represent Massachusetts residents as critical, especially when you look at who is going into the dental profession. Establishing more pathways into the oral health professions through outreach to minority students, recruitment of minority faculty, and targeted financial incentives such as loan repayment programs will help.

Q: How does HCFA plan to advance oral health equity in Massachusetts going forward?

A: Through the learning collaborative, we’ve highlighted an ongoing priority: oral health surveillance. There aren’t many oral health care datasets available, so we have identified collecting those data as one of our top priorities. We are also making sure that oral health is being addressed within Massachusetts’ new accountable care organizations. Ensuring that these new delivery and financing models establish equitable ways of providing care is a critical part of the implementation process. This is in line with a broader attempt to increase the prominence of oral health at the systems level.

Progression toward oral health equity will happen with interventions that address specific barriers identified at the community level. Health Care for All’s strategies to improve oral health data collection, diversify the dental workforce and improve cultural competency will increase the availability of oral health care for those whom need it most in Massachusetts — and may serve as a promising path for other communities across the country.

--June Glover, Program Officer, CHCS and Teagan Kuruna, Communications Associate, CHCS

August 9, 2016

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

As states across the country look for ways to combat the ongoing opioid crisis, one overlooked issue is how we address the impact of this crisis on our communities’ youngest. Infants exposed to opioids in utero may experience a variety of potentially debilitating symptoms associated with opioid withdrawal, collectively known as Neonatal Abstinence Syndrome (NAS). As the opioid crisis and NAS receive greater attention, children’s advocates and public health professionals have pushed for more focused strategies and greater resources to assist. Efforts have focused not only on those infants specifically diagnosed with NAS, but also on additional substance-exposed newborns (SEN) who may experience problems related to other types of prenatal substance exposure.

At the federal level, the Protecting Our Infants Act of 2015, sponsored by Rep. Katherine Clark (D-MA) and Sen. Mitch McConnell (R-KY), helped bring greater attention to the issue, particularly the need to gather data to comprehensively assess the impact on infants and their families over time. Increasing awareness is an important first step in reversing the rise in newborns exposed to harmful substances. And while there are numerous efforts on the ground to combat the epidemic and support infants and their families in recovery, many are reliant on finite resources and have yet to be integrated into a system that will ensure their long-term sustainability.  

In Massachusetts, over the past year, Community Catalyst’s New England Alliance for Children’s Health (NEACH)convened a working group of practitioners, early childhood specialists, advocates and public health stakeholders to help the state take the next step to advance uniform policies across human and health services to support infants and their families. With the help of the Children’s Health Access Coalition (CHAC), the working group pushed the state to take more concrete steps to improve care for substance-exposed newborns. These efforts produced a resounding victory last month – the state’s FY 2017 budget included language establishing an inter-agency task force dedicated to addressing NAS and SEN. The relevant section declares that “all executive agencies work in coordination to address the needs of newborns, infants and young children impacted by exposure to substances.”

Importantly, the taskforce brings together state agency leaders who play an important role in the care of children and their parents. This list includes the Secretary of Health and Human Services, the Attorney General, the Commissioner of Children and Families, the Commissioner of Mental Health, the Commissioner of Public Health and the Executive Director of the Massachusetts Health Policy Commission. Additionally, an advisory council of experts and community leaders was formed from across the continuum of care for infants and parents experiencing the effects of substance use disorders. The establishment of this task force is a major step forward and presents a considerable opportunity for improving the care and outcomes for parents with substance use disorders and their children throughout the Commonwealth.

While the establishment of the task force is but one step in addressing a very large problem, it does make significant progress around coordination and communication among state agencies – one of the greatest barriers to establishing comprehensive systems of care on a state-wide basis. Due to the multiple issues involved, NAS and SEN necessitate the involvement and interaction of several agencies and departments. As states look to address NAS and SEN, the ability to coordinate effectively will be critical to ensuring the development and implementation of successful plans.

--Ben Koller, Program Associate, Community Catalyst Aliiance for Children's Health

August 1, 2016

The purpose of health insurance is twofold. First and foremost, it serves to protect a person’s health. Without coverage, people are more likely to delay getting needed care. But, almost as importantly, coverage ensures financial security. Even a routine procedure like an appendectomy could mean financial ruin for the uninsured. An important new study, The Effects of the Massachusetts Health Reform on Household Financial Distress, published in the American Economic Journal, sheds light on the economic impacts of the 2006 Massachusetts health reform. The conclusions suggest that the effects of sweeping health reform extend far beyond better health outcomes; expanding coverage may actually help to lift people out of the hole financially, ultimately driving opportunity for economic growth.

The study compared financial characteristics of people under age 65 in Massachusetts to other New England states, before and after full implementation of the Massachusetts health care law in 2008. The model took into account which subgroups were most heavily affected by the reform. Before the reform, from 1999-2005, Massachusetts followed the same financial trends as other New England states. After the expansion of coverage in 2008, Massachusetts suddenly deviated. The authors concluded that higher coverage rates directly and significantly contributed to the following outcomes through 2012:

  • improved credit scores,
  • reduced total debt,
  • reduced total amount and percent of debt past due, and
  • reduced probability of personal bankruptcy.

Just to be sure about health reform’s causal effect on improved financial well-being, the authors conducted an analysis of individuals over age 65 in Massachusetts, since this age group was essentially unaffected by the reform. Confirming the findings, seniors’ financial outcomes did not change relative to those who gained access to insurance under the reform.

The authors conclude:

Our analysis shows that health care legislation has implications that reach beyond health care providers and the uninsured, and extend into credit markets, benefiting not only uninsured households who gained coverage, but also creditors who served these households. Our finding that credit scores improved as a result of the reform indicate that the reform increased future access to credit for those individuals who gained coverage. These results show that health care reform legislation has pervasive effects not just on health and the use of health services, but across many measures of household well-being.


Chart adapted from paper, showing decline in Mass residents with over $10,000 in debts.

Particularly striking is the fact that these financial improvements took place in the midst of a serious economic recession. It prompts the question: did the 2006 health reform help mitigate some of the recession’s worst effects for the state of Massachusetts? Common sense economics says that if people have less bad debt, less likelihood of declaring bankruptcy, and better credit, they will have better economic opportunities. Greater numbers of economically healthy individuals means a more prosperous economy as a whole. A higher credit rating means better prospects of home ownership. Less unpaid debt means more money flowing through various sectors of the economy. Less personal bankruptcy means – well, let’s just say we know what happened in the 2008 financial collapse.

Again, Massachusetts leads the way in demonstrating the far-reaching beneficial impacts of universal healthcare. The nation should take note.

                                                                                                                                                                         -- Mike DiBello