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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

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

May 23, 2015

The State Senate finished its work on the Fiscal Year 2016 budget early in the morning on Friday.  A number of HCFA's priorities were included in the final budget, including funding for early intervention, an earmark for the Office of Health Equity in EOHHS, and a restructuring of CHIA to allow for oversight of an independent agency. Other priorities of ours, such as reinstating full dental coverage for adults on MassHealth, were not approved by the Senate. A bright spot in the budget was some real progress on a number of public health initiatives, where HCFA collaborated with our partners at the Mass Public Health Association on several issues. We asked Rebekah Gewirtz, Executive Director of the MPHA, to let us know about their good news in a guest post:

Mass in Motion logoThe Massachusetts Public Health Association (MPHA) is thrilled to announce that because of statewide advocacy efforts on the ground and the tireless leadership of our senate champions, Mass in Motion once again received dedicated funding of $250,000 in this year’s Senate budget.  Last year was the first year funds were earmarked specifically for Mass in Motion in the state budget. We know the reason it continued is because senators understand how important funding is to promoting the health of all communities and particularly low income and communities of color, most impacted by chronic disease. 

In addition, for the first time, language to fund the Massachusetts Food Trust program, also known as Healthy Food Financing, was included in the Senate budget.  While we have work to do to achieve our goal of a $2.5 million state budget appropriation, this language affirms the importance of the program even in a year when there is a budget deficit.  Another key public health victory was passage of an increase in the Earned Income Tax Credit, which is proven to help lift low income, working families out of poverty and in turn, improve health outcomes.  Studies have linked increases in the EITC with positive outcomes for maternal child health including a marked decrease in low birth weight babies.  Another positive outcome from the Senate budget was a new excise tax on flavored cigars.  Products like candy flavored cigarettes and cigars are intended to hook kids and are aggressively marketed to a younger audience.  Some $4 million in revenue from this new excise tax would be directed to tobacco control and cessation programs. 

Overall, this was a difficult budget year.  Many programs were cut or underfunded.  MPHA has always supported progressive revenue measures to ensure we have adequate funds to support key public health programs like Mass in Motion and the Food Trust.  And also for those programs that protect essential public health services like those provided by the state laboratory at Hinton.  Lab funding was once again reduced this year, which concerns us greatly.  We need to continue to raise awareness about how the lab impacts our lives each and every day – from inspectors for the food we eat to air quality monitoring that protects the air we breathe. 

The victories we saw in the Senate budget do not conclude the budget process.  The budget now goes to conference committee where we need to work hard to preserve our hard fought victories.  For more information on how to get involved in your own community or with us in the State House, please see our website at www.mphaweb.orgAlso: please support our work by attending our upcoming spring awards breakfast.  At the breakfast we honor 4 public health heroes across the state who work arm in arm with MPHA and our allies at HCFA and elsewhere to fight for systems change to improve the health and wellbeing of all residents of the Commonwealth.  The breakfast is on June 5th from 8:30-10:30am in the State Room at 60 State Street.  For tickets also check out our website.  We’ll see you there!

    -  Rebekah Gewirtz

 

May 20, 2015

MACRMI logo

MACRMI (The Massachusetts Alliance for Communication and Resolution following Medical Injury) held its 3rd annual CARe Forum yesterday. MACRMI works to advance the development of Communication, Apology and Resolution (or CARe) programs in Massachusetts hospitals. These programs are intended to foster openness and transparency following the occurrence of a medical error or an unanticipated outcome. There are many resources on the MACRMI website.

Yesterday’s forum included updates on the CARe program in Massachusetts, which has so far been implemented at pilot sites at Beth Israel Deaconess Medical Center, Baystate Medical Center, and the affiliated hospitals of both institutions. Also Sturdy Memorial Hospital and Atrius Health have been added as pilot sites.

The highlight of the day was the afternoon panel which focused on a specific error that occurred at BIDMC. All parties involved spoke about the error and the CARe process that followed, including the patient, her attorney, the hospital’s attorney, staff from the patient safety division of the hospital, and the chief surgeon of the department within which the error occurred (though he was not directly involved in the incident). The patient and her attorney both spoke via pre-recorded videos. The patient (named Tricia) had been at BI for gallbladder surgery. A number of months later she noticed on a report from her time in the hospital that there had been an incidental finding of a mass on a CT scan relating to the gallbladder surgery. She was never notified of the mass and then through her own outreach found out that she had Stage 3 ovarian cancer.  As a result of this delayed diagnosis and the fact that she should have been notified about the finding months earlier, she found an attorney and they sent the hospital a pre-litigation letter.

The hospital reached out to see if the patient could come in and meet with them so they could hear more from her.  This meeting did occur and the patient and her husband both felt that they were listened to and heard. They also received an apology from the staff in attendance and the staff explained changes they made to protocols to prevent something similar happening to another patient. She continues to get treatment for the ovarian cancer at BI because she still trusts them and their care. Luckily, it was determined that the delay did not lead to a long-term impact on her care and she is currently cancer free. The hospital did offer compensation to her, and after discussing her options with her attorney she agreed to accept, thus avoiding a lengthy legal process.

This panel was an example of how the CARe process can work to bring the patient and the providers together as human beings to talk about what happened and apologize. The patient’s attorney, Jeff Catalano, was a leader in working with the medical society to pass legislation (within Chapter 224) to promote apology, disclosure and compensation and he has continued to educate other attorneys about CARe programs and the impact on patient safety and transparency.

This kind of program, as it spreads across more hospitals, will hopefully lead to more openness and discussions both among hospital staff and between staff and patients/families about errors and how to prevent their recurrence. As hospitals develop and implement the programs, it is vital that they engage patients and families in the process. Patient and Family Advisory Councils (PFACs) are ideal vehicles for bringing in the patient and family perspective to the development of the CARe program.  

      - Deb Wachenheim, HCFA's Patient/Family Organizer and Coalition Coordinator

MassHealth notice regarding new coverage of dentures
May 15, 2015

 

Today marks a milestone in the 5-year effort to restore full oral health and dental benefits for adults on the MassHealth program. Today, MassHealth is restoring coverage for dentures (here's the official notice), another step along the road we hope leads to full coverage of all dental care.

In 2010, the Governor eliminated almost all dental benefits for adults on the MassHealth program - over 700,000 people, including 120,000 very low-income seniors. The cut reversed a legislative directive to include all dental services for MassHealth members, included as part of the Romneycare law, chapter 58 in 2006.

Lack of access to comprehensive and consistent oral health care creates a serious burden for the most vulnerable residents of the Commonwealth and can lead to pain, suffering, and in the worse cases, death. Fortunately, dental disease is almost entirely preventable when people have access to prevention and treatment services.

Oral health is overall health. Dental decay is linked to many complex, costly health problems, such as heart disease, stroke, HIV/AIDS, and diabetes. Oral disease can cause needless pain and suffering, and may spread throughout the body. Oral disease negatively impacts the management of chronic diseases such as diabetes, heart disease, and HIV/AIDS in that if one is unable to chew, eat or have dental function, they may not be able to adhere to dietary or prescription regimens.

Our Helpline hears regularly from people impacted by the cuts. A Mattapan man, unemployed and with eight recent extractions, is unable to afford the dentures he needs. He can neither eat nor speak properly and he certainly cannot interview for jobs. A Springfield woman with diabetes and mental illness told us she had to have all of her teeth pulled. Her doctor warned that without dentures, which are not covered by MassHealth, she will only get sicker. Across the Commonwealth, residents’ health is deteriorating dangerously because of a lack of access to basic oral health care and treatment.

Over the past few years, the legislature has slowly restored some benfits, including fillings and cleanings. The budget for this fiscal year (which runs from last July 1 to June 30 of this year) included limited funds for full, but not parital dentures. But the limited amount forced MassHealth to delay implementation to today, just 45 days before the end of the fiscal year.

We continue to push for full restoration of all benefits. Senator Jason Lewis, Senate chair of the legislature's Public Health Committee, recognizes that without access to comprehensive care, patients are forced to turn to emergency rooms, clinics, and inpatient hospitalization for treatment, and the Commonwealth wastes millions in emergency oral health care treating diseases and infections that could have been prevented. He is sponsoring a budget amendment in the Senate (Amendment 896) that would add funding to restore all dental benefits for adults on MassHealth. The Senate is expected to vote on the amendment early next week.

A group of HCFA activists will be gathering at the State House on Tuesday evening to meet with their senators about the dental care amendment. Please contact your state senator to add your voice.

   - Brian Rosman

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