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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

December 10, 2013

The Massachusetts Prevention and Wellness Trust's Vision is that all Massachusetts residents live in communities that promote health and have seamless access to all community and clinical services needed to prevent and control chronic diseases.

The Robert Wood Johnson Foundation released a report today about the Massachusetts Prevention and Wellness Trust, passed in 2012 as a part of our payment and delivery system reform law. The Prevention Trust, the first of its kind in the nation, sets aside $60 million for community-based public health prevention and wellness programs. The aim of the trust is to fund local efforts to keep people healthier, which will reduce overall health costs.

The report was prepared by the Institute on Urban Health Research and Practice, Bouve College of Health Sciences, at Northeastern University. Former DPH Commissioner John Auerbach heads the institute, and led the work on the report.

Prevention Trust Infographic goalsRWJF also posted today a great discussion with John Auerbach and Cheryl Bartlett which explains how it works, how it came about and how Massachusetts is leading the way in innovation and public health. There's also a nicely done infographic (excerpts above) summarizing the findings.

State House Rally for the Prevention Trust Fund, organized by HCFA and Greater Boston Interfaith Organization November 2011 State House rally for the Prevention Trust Fund, organized by HCFA and the Greater Boston Interfaith Organization.

Health Care For All and our Campaign for Better Care coalition, allying with the Mass Public Health Association and the Prevention in Payment Reform coalition as well as the Greater Boston Interfaith Organization, pushed to include the Prevention Trust into the cost control law.  The cause was only successful because of the hard work of Representatives Jason Lewis and Senator Harriette Chandler, who led the Prevention for Health Caucus and pushed aggressively for the provision in the bill.

What we heard from the legislature was that everybody supported the idea of a trust, but nobody wanted to fund it.  We proposed the assessment on insurers which was included in the final law. Given the strong interest among all insurers to promote prevention activities that lower health care costs, we thought it made sense to align their interests with the public interest.

Very soon DPH will announce the preliminary funding awards from the program. We're looking forward already to the effort for renewal of the Trust, which was established as a 4-year pilot project.
-Brian Rosman

December 10, 2013

Trust Fund Spending chart

Wonks, start your salivating. This is the real thing. How good is this?:

As noted above, some budgeted funds segregate revenue for a particular purpose, but in most cases this is revenue that would otherwise go into the General Fund. Off-budget funds typically collect revenue from special fees or targeted assessments, and in some cases also receive operating transfers from the General Fund. While these funds are sometimes used to pay for program costs, such as use of the Commonwealth Care Trust Fund for the costs of Commonwealth Care discussed below, they generally do not fund regular operating expenses. Off-budget trust funds may also be used in cases where revenue and the spending it supports do not fit into the annual budget time frame.

Blue Cross Blue Shield Foundation has published its latest budget brief, The Role Of Trust Funds In Masshealth And Health Reform Spending: A Primer (pdf). The short paper is part of series coming from the Mass Budget and Policy Center, Mass Law Reform Institute, and the Foundation's Mass Medicaid Policy Institute.

This paper is useful summary of what has been insider budget trivia, but is actually critical to understanding how Massachusetts pays for health programs. The use of trust funds changes every year, and we hope this paper becomes an annual exercise. -Brian Rosman

December 6, 2013

The Department of Public Health recently issued draft regulations for implementing the section of Chapter 224 that requires the provision of information to appropriate patients about options for palliative care and end-of-life care (in October we blogged about the draft regulations.  The public hearing on the draft regulations was held on November 21 and written testimony was also submitted. You can find all of the written testimony on the DPH website. Some of the points that were raised by a number of those providing testimony include:

  • Distinguishing between palliative care and hospice care and helping to clarify the difference to patients and families. There is much confusion about the two, and there is a lack of understanding in particular about palliative care, which often should start much earlier than hospice and should also often be offered to patients with serious illnesses, including some patients with chronic conditions, and not just to those with terminal illnesses. For example, read this NY Times article about palliative care from earlier this week. There is also a helpful chart in the testimony provided by the Home Care Association.
  • Expanding the definition of appropriate patient to include not just those who would be eligible for hospice care but, for example, those who may be eligible for palliative care due to a serious illness or debilitating chronic condition.
  • Allowing for the information to be provided to family members/caregivers when appropriate (eg. if the patient has dementia).
  • The importance of providing training and education to providers who will be giving this information to patients.
  • The importance of recognizing the need to be sensitive to cultural differences in terms of how the information is communicated.
  • Encouraging hospitals to work with their Patient and Family Advisory Councils (see our information at www.hcfama.org/pfac) as they seek to educate their patient community about palliative care and end-of-life care options and as they train their providers in this area.

We will keep you posted on when the regulations are finalized. -Deb Wachenheim

December 4, 2013
CHIA graph showing health coverage remaining at around 97% in Massachusetts in 2012 Source: Center for Health Information and Analysis, Massachusetts Health Insurance Coverage, 2012 Estimate (Dec. 2, 2013)

On Monday, CHIA released their estimate of insurance coverage in Massachusetts (pdf) for 2012.

The good news conclusion? Insurance coverage remains high in Massachusetts, with approximately 96.2% - 97% of all residents covered. Less than four percent of residents are uninsured. Essentially, the 2012 coverage level was unchanged from the 2011 figure of 96.9%.

Because the state did not conduct its own survey like usual, the estimate is based on an analysis of several national surveys that include break-outs for Massachusetts. We were disappointed that CHIA decided to forgo its survey for 2012, and pleased that they will resume their survey for 2013.

Along with the survey, we urge CHIA to resume releasing a report similar to the "Key Indicators" that its predecessor agency used to produce regularly. That report included a hard count of the number of insured residents, by source of insurance, that was a more accurate aggregate coverage total than survey estimates.

This week's report also mentions other research CHIA is currently funding. Their employer survey is returning, and they have commissioned three research studies on uninsurance and underinsurance in Massachusetts. One, with HCFA participation is looking at potential barriers to access for Hispanics who are uninsured and newly insured. The others will explore utilization and outcomes for members in high deductible health plans and consumer perceptions of affordability.

We were also puzzled by the fact that CHIA decided to silently slip-stream this report, with no public announcement to its email list, twitter followers or the press. This led a long-time opponent of health reform to accuse "Massachusetts' Liberals Bury Bad News about Rising Uninsured Rate on Thanksgiving Weekend." But unless one is rooting for more people without coverage, the report itself is all good news, from our point of view.
-Brian Rosman

December 4, 2013

“I’m from Health Care For All and I’m not selling anything.” We’ve lost count of how many times we’ve used this line to start a conversation about the Affordable Care Act. We often find ourselves exclaiming to people outside of work: ”Did you know that more people will get help paying for health insurance or that more people now qualify for Mass Health because of the ACA?” Since October, HCFA has been working with the Massachusetts Health Connector and various community based organizations around Massachusetts to spread the word about the ACA. Our outreach and organizing team has trained canvassers and accompanied them to knock on doors to explain how the ACA will affect people here in Massachusetts.

Alex Weiner going door-to-door Alex Weiner going door-to-door

Our experiences from training canvassers and accompanying them door to door have been so positive that we thought we’d share our reflections with you. It turns out people really appreciate the information we’re giving them and want to know what the ACA is, how it affects them, and what their health insurance options are.

We met one woman, for example, a few weeks ago whose boyfriend had his leg amputated and was in the hospital again for a second leg amputation. She had numerous questions about her coverage and we were able to follow-up with her to answer her questions.

We are just starting this effort – we kicked off the canvassing effort in late October by knocking on doors in Lynn. As we go along we will periodically share our “notes from the field” with you so you can get a sense of where we are at in our campaign to knock on 40,000 doors by March 31st.

So far, we’ve knocked on 6,000 doors and have spoken with people from all walks of life – from fisherman in Gloucester and people from Moldova living in Greenfield. Once people realize they can trust us and that we’re only there to make sure they have the necessary information to navigate the system, they share their healthcare stories and experiences with us.

Here are just some of the Community Based Organizations we’re partnering with:

Pittsfield - Berkshire Community Action Council
Fitchburg - Cleghorn Neighborhood Center
Framingham - Latino Health Insurance Program
Worcester - Oak Hill Community Development Corporation
Florence - Casa Latina
Greenfield - Community Action!
Lynn – Lynn Economic Opportunity
Worcester – Centro Las Americas
Gloucester and Plymouth – Fishing Partnership

Our job, in partnership with the Health Connector, is to reach out to individuals in those regions which are not covered by health care “navigators,” to let them know about their options under the ACA. This means, for example, that we have not been going (and do not plan to go) door-to-door in Boston, but we will be going door-to-door across the state in other communities. The communities we are visiting represent a real cross-section of the state. We are focusing our efforts on people most likely to need help paying for health insurance.

Stay tuned for more updates from the field.

--Alex Weiner and Amanda McIntosh

December 3, 2013
Today is Giving Tuesday, an opportunity to step back from the barrage of Black Friday and Cyber Monday and reconsider how we can help those in need. We at HCFA, with the generosity of our supporters, are able to help individuals and families from across Massachusetts connect to the health coverage they need. Our donors make a difference. On this Giving Tuesday, please consider making a donation to Health Care For All in one of the many ways listed below. Thank you so much in advance! Your gift will have an immediate impact on our work. Sincerely, The Staff of Health Care For All To make a tax-deductible donation:

Click here to make an online donation • Mail a gift to: Health Care For All, 30 Winter Street, Boston, MA 02108 Attn:Development • Dial a pledge at 617-275-2926

Celebrate and Remember What 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 617-275-2926 to make a pledge! Online Giving Made Easy! Make a contribution to HCFA via Network for Good. Simply select Health Care For All as your charity of choice. Monthly Donations Support HCFA monthly by allocating an ongoing donation. Giving a specific amount each month has great impact on our work. Email freitas@hcfama.org to start the process today! Workplace Giving Join 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).  Thank you!

November 26, 2013

Thanksgiving is about being grateful. Here at Health Care For All, we see every day the impact Massachusetts health reform has on people all around us. We know it can work, because we've seen it work. That's why we're grateful for the ACA and national health reform.

Please share this graphic far and wide:

(and see this more detailed ACA Thanksgiving discussion guide by the Washington Post's Sarah Kliff)

Thanksgiving Infographic final

November 22, 2013

Hope you got your acronym cheat sheet handy.

The Health Policy Commission (HPC) met for its tenth full commission meeting on Wednesday November 20th.  Several important issues were discussed at the meeting, including the patient center medical home (PCMH) certification, the Registered Provider Organization (RPO) program, the Office of Patient Protection (OPP) regulations, and several updates on cost trends and market performance including Cost and Market Impact Reviews (CMIRs). Follow along with the presentation deck for the meeting, and click on for our full report.

November 20, 2013

Today marks one year since the inaugural meeting of the Health Policy Commission (see our report, Commence Cost Control), and at Wednesday's meeting, board members will reflect on their first year, and look forward to the second year.

Dr. Paul Hattis was appointed to represent expertise in health care consumer advocacy on the HPC board. Dr. Hattis is a long-time friend of HCFA, through his leadership in GBIO, including co-chairing their health care team. We invited Paul to write his own reflections on the role of HPC in our efforts to control costs and reform our health care system, and his role as the consumer voice in its governance.

Paul HattisAs the Health Policy Commission (HPC) completes its first year of existence, HCFA has invited me to share some thoughts about this past year as well as preview what lies ahead. So here goes:

Writing to the Health Care For All community, I feel a good deal of responsibility holding the Consumer Advocate seat—a position given to me by Attorney General Coakley.  I generally see my role as worrying about the “whole” in the sense of the overall direction of access, cost and quality challenges that confront us in Massachusetts. We are also all incredibly fortunate to have Nancy TurnbulI, who serves as the Consumer representative to the Health Connector board, to be vigilantly working on relevant access, cost and quality issues that intersect with that Board’s work.

With just one year in, I would say that the 2012 health care cost law (Chapter 224) has covered some significant ground in a short period of time. That said, though, this law doesn’t rely on quick fixes. It’s designed to be for the long-term and, as such, health care reform is a work in progress with many moving parts to be developed in the coming months and years.  The same is true for the HPC.  Containing the growth in health care spending is no easy task; the attendant issues are often complex and the details matter.  Fortunately, we have a very dedicated group of Commissioners chaired by Stuart Altman from Brandeis; and an incredible HPC staff led by David Seltz.  Over its first year of work, the HPC has tackled a complex variety of issues within its charge and we continue to add staff to help us fulfill our statutory responsibilities.

It is hard to briefly summarize the broad charge given to the HPC under the 2012 law.  Suffice it to say, the Legislature created our Board and asked us to use a combination of some regulatory authority, moral suasion,  and good critical thinking to help move the health care system and its actors towards higher-value.  Specifically, the HPC from my vantage point has been asked to frame, name, tame, acclaim, shame and blame our way to a more affordable and higher quality health care system.  When I teach students at Tufts Medical School about Chapter 224, and talk about the HPC’s role, I tell them:

We are trying to navigate our way to reducing the growth in health care spending using “GPS:”

G—Global Payment:  Promoting and evaluating the evolution of the health care payment system away from fee-for-service toward value-based payment that incentivizes less wasteful care and improved quality.   Payment system reforms should also help to create a framework for improved care integration among providers with a special focus on improving behavioral health care from an access, cost and quality perspective.

P—Prices and Provider Transformation:   It is important to recognize that there are higher-priced and lower-priced providers in our state, with the challenge that some amount of this price variation is unwarranted.   This reality suggests that there are important societal gains from helping to promote a payment system that pays fairly to all for high value care, and encourages  all providers to become more efficient.  Promoting high value care also necessitates our making smart investments in challenged community hospitals to help them transform and thrive for the long-term.  The HPC is also charged with completing Cost and Market Impact Reviews of transactions which may have significant cost, quality, access or market implications.  Prices also relate to the consumer side, where, in the non-urgent care context, a goal is to make price and quality information more transparent and readily available to consumers so that they can “choose wisely.”

S—Spending Target:  The HPC is responsible for overseeing the efforts of all stakeholders  to reduce the overall growth in health care spending by creating a per-person “cost growth target”  which is tied to the overall growth rate of the economy.

Five HPC subcommittees have been delegated an array of tasks for taking the first cut at these issues and others that fall under our broad charge.  After subcommittee processing and discussion, the full HPC Board is then referred relevant matters for its review, and as appropriate, can take official action on matters before it. (BTW:  For those interested, the subcommittees are often a great place to hear more detailed discussion about issues, and also afford opportunities for public comment; all of our meeting logistics are available at www.mass.gov/hpc or on Twitter via @Mass_HPC.)