October 2016

October 31, 2016

MassHealth cardMost MassHealth members have the option of either enrolling in a health plan (a Managed Care Organization or MCO) or the Primary Care Clinician Plan (PCCP). In efforts to move more members to managed care, MassHealth proposed in its 1115 waiver proposal to cut chiropractic services, eyeglasses, hearing aids, orthotics and potentially other benefits in the PCC Plan, while maintaining these benefits for members enrolled in MCOs.

Health Care For All, along with partner organizations, such as Disability Advocates Advancing our Healthcare Rights (DAAHR), the Massachusetts Law Reform Institute, and the ACT!! Coalition, as well as several provider groups, persistently opposed the proposed benefit cuts. We argued that the benefit cuts would impose barriers to care for low-income individuals and families, and violate federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) standards for MassHealth members under age 21.

In response, MassHealth first modified their proposal to maintain the full package of benefits for children and youth under age 21, while moving forward with the benefit reductions for adult PCC Plan members. However, at their public meeting in October, MassHealth announced their decision to drop the PCC Plan benefit cuts altogether.

We commend MassHealth for making the right decision, and thank our advocacy partners for making this issue a priority.

The next hurdle is cost-sharing. MassHealth is moving forward with their request to charge higher copays to members enrolled in the PCC Plan as compared to those enrolled in MCOs or a new Accountable Care Organization (ACO) option. MassHealth also seeks to apply copays to additional services (currently MassHealth members only pay for prescription drugs), including use of the emergency room for non-emergent conditions. These cost-sharing policies are slated to go into effect in 2018, after a public process.

For low-income people using MassHealth to stay healthy, even modest copays can be barrier to getting the care they need. In the long run, this can make overall care more costly. We urge MassHealth to carefully consider the impact on health and the cost-effectiveness of adding more copays.

                                                                                                                                -- Suzanne Curry

 

October 28, 2016

Health Care For All is among more than 200 health and social service organizations and leaders who signed on to a letter yesterday requesting the reauthorization of the Prevention & Wellness Trust Fund (PWTF) before the funding expires in June of 2017. 

The PWTF was established by the legislature in 2012 as a part of Chapter 224 with the aim of reducing health care costs by investing in prevention for chronic conditions like diabetes and asthma. Services supported by this Fund are available to nearly one million Massachusetts residents in all areas of the state through nine community partnerships that help keep people safe and healthy.

The letter outlines the impact chronic illnesses have on individuals and how these conditions contribute to shorter lives, lower quality of life, reduced workplace activity, and, for children, missed school days. With rates of preventable chronic conditions skyrocketing, especially among individuals from lower-income communities, it is essential that we invest in these initiatives to ensure health care equity in Massachusetts. In fact, Representative Jeffrey Sánchez, House chair of the Joint Committee on Health Care Financing, said that "prevention at the community level is fundamental” to achieving equitable health outcomes.

HCFA believes that the integrated approach offered by the Prevention & Wellness Trust Fund is a key to addressing the underlying causes of poor health and is a complement to the ongoing transformation of the health care system. We urge  the legislature to reauthorize the funding next year so that all residents of Massachusetts have a equitable opportunities for good health.

 

--Angela Swanson

 

October 11, 2016

Policy Forum on Oral Health Integration

Last Thursday the Massachusetts Health Policy Forum hosted a forum entitled “Integrating Oral Health into ACOs.” This event brought together researchers and stakeholders to discuss the importance of oral health integration.

The context is the state’s proposal to set up ACO’s – Accountable Care Organizations – for our MassHealth program. ACOs are structured to provide more coordinated care, and the state is planning to better integrate behavioral health and long-term care services into the plans. At issue is how best to integrate oral health as well.

The morning started with a brief presentation by Dennis Heaphy, an analyst at the Disability Policy Consortium and a leader in Disability Advocates Advancing our Healthcare Rights, the leading health disability advocacy organization in Massachusetts. He spoke on the critical role good oral health and dental care has played in his own life.

The research panel presented with compelling evidence supporting coordination between oral health and overall health services and how that could fit into ACOs.  The first speaker was Yara Halasa, a dentist and PhD candidate from Brandeis’ Heller School. She provided a summary of her paper, demonstrating that including oral health care into the ACO model foster comprehensive and better quality care. She brought attention to the fact that 29% of adults in Massachusetts rated their oral health status as poor to fair. Yet, oral health is closely linked to overall health, with poor oral health leading to issues with diabetes and respiratory or cardiovascular conditions. She ended her discussion with a number of policy recommendations on how to best get to achieve integrated oral health. See her presentation here.

Chief Economist and Vice President of the Health Policy Institute and member of the American Dental Association, Marko Vujicic said that IT challenges are the top barrier for oral health integration. There are numerous benefits to oral health integration, particularly for diabetics and pregnant women. He also reported that $153 million could be saved if dentists were included in the general medical screening process.

Oregon CCOs integrate oral health

While Massachusetts prides itself on being number one in all things healthcare related, Oregon is leading the country in integrated care through ACOs. Representing the Oregon Health & Science University, Dr. Eli Schwarz discussed the successes that Oregon is having with integrating oral health in its ACO model, known as CCOs (see his presentation here). The program has reduced ED visits and hospital admissions for congestive heart failure and pulmonary disease, and increased used of effective dental sealants. It is estimated that the government will have saved $1.7 billion over the waiver period though better care.

The session ended with a panel of stakeholders, who discussed the importance of oral health integration, perceived barriers to integration and how to tackle those challenges. Members of this panel included the moderator Michael Monopoli of the DentaQuest Foundation, State Senator Harriette Chandler, MassHealth dental director Dr. Donna Jones, HCFA’s Brian Rosman, Dr. Hugh Silk, a primary care physician and instructor at UMass Medical School, and Dr. Raymond Martin, president of the Massachusetts Dental Society.

Senator Chandler, who co-chairs the legislature’s oral health caucus, passionately remarked that the state of Massachusetts is a “long way” from providing what we do for oral health than what we do for physical insurance, and pledged to continue working for full integration.

-- Chelsea Canedy and Angela Swanson