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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

June 14, 2016

On Thursday, the Connector Board met to discuss Health Connector open enrollment operational readiness, outreach and messaging efforts, and the Student Health Insurance Program. Materials from the meeting are posted here

Executive Director’s Report
First, Louis Gutierrez, the Executive Director of the Health Connector, shared some updates:

  • Massachusetts received approval from CMS to maintain small-group rating practices.
  • The Health Connector plans to transition the market-wide risk adjustment program they had been administering to CMS beginning in 2018 (for plan year 2017).
  • The Health Connector is entering into a contract with Dell (which will be acquired by Japanese firm NTT) to modernize their customer relations management system.
  • The Health Connector is looking at metrics to evaluate the impact of their upcoming outreach efforts to reach the uninsured.
  • Health Connector enrollment as of June 1, 2016:
    • Total non-group medical: 223,778
    • Unsubsidized and APTC: 52,503
    • ConnectorCare: 171,275
    • Non-group dental: 59,471
    • Small group medical : 5,922
    • Small group dental: 831

2017 Open Enrollment Preparations 
Based on Department of Revenue tax-filing data,  the remaining uninsured people in the state (approximately 3.6%, or 240,000 residents)  are almost evenly divided between chronically uninsured and temporarily uninsured; evidence shows that Hispanics are the most likely population to remain chronically uninsured, both in Massachusetts and nationally. Connector Board and staff members spent a good portion of the meeting discussing how to best target the remaining uninsured.

In preparation for the next open enrollment period, which begins in November, the Connector Board approved a contract with Dell, who provides customer service for the Connector, to re-launch temporary walk-in centers throughout the Commonwealth for the 2017 open enrollment period. These walk-in centers complement the permanent walk-in centers in place in Boston, Worcester, and Springfield. During the 2016 open enrollment period, the “pop-up” walk-in centers – co-located with community health centers – served 15,000 consumers, helping with issues that only customer service can address, such as billing and payment.

The Connector Board also approved outreach and marketing contracts with Weber Shandwick and Archipelago Strategies Group, to conduct outreach and media campaigns to better reach the remaining uninsured.  Weber Shandwick will conduct general outreach and marketing, while Archipelago will focus on ethnic outreach and media. 

Student Health Insurance Program
Lastly, the Board discussed the Student Health Insurance program (SHIP). Since 1989, all students in the Commonwealth have been required to have health insurance, and each school is required to offer a SHIP. Students are able to waive the coverage if they have comparable coverage elsewhere, such as a parents’ employer plan or, since the passage of the ACA, MassHealth. Since the passage of the ACA, fewer students have been enrolling in SHIPs, in large part likely due to newly-gained access to MassHealth. In an effort to keep premiums in SHIP plans reasonable, and retain access to MassHealth, the Commonwealth has begun a pilot program to enroll MassHealth students into Premium Assistance. Like other MassHealth Premium Assistance programs, students enroll in their private plan (in the case, the school’s SHIP), and MassHealth helps them pay for their premiums and cost-sharing. MassHealth plans to roll this out to all full-time college students receiving MassHealth coverage in coming months and years.

The next Connector Board meeting is scheduled for Thursday, July 14th from 2-4pm at 1 Ashburton Place, 21st floor, Boston. 

- Sara O’Brien

May 6, 2016

Closing the SNAP Gap is a top priority for the Healthy Food, Healthy Homes, Healthy Children (HHH) Coalition and Health Care For All and we were thrilled to see Children’s HealthWatch’s letter to the editor in the Boston Globe on the importance a combined MassHealth/Supplemental Nutrition Assistance Program (SNAP) application.

What is the SNAP Gap? The difference between 1.356 million MassHealth enrollees who are likely SNAP eligible and the 785,000 MassHealth enrollees actually receiving SNAP.1 Or, to put it another way: Roughly 570,000 MassHealth enrollees who are likely eligible for, but not receiving SNAP benefits.

 

Common app needed for MassHealth and SNAP

MAY 06, 2016

We are glad to see the Globe acknowledge the need to better coordinate health care (“A necessary prescription for MassHealth,” April 29). Hopefully, accountable care will lead to both healthier patients and cost savings. We recommend an additional prescription.

Permitting low income families to file for both Mass-Health and the federally-funded nutrition (SNAP) benefits simultaneously is key. A common application would reduce administrative red tape for families and improve the health of young children. Children’s HealthWatch research shows that young children enrolled in MassHealth who received SNAP were more likely to be food-secure and in better health than children eligible for, but not receiving, SNAP.

Many families eligible for one public assistance benefit are often eligible for others as well. A comparison of SNAP and MassHealth data by the Mass Law Reform Institute suggests a “SNAP Gap” of roughly 600,000 very low-income MassHealth recipients eligible for SNAP but not enrolled. This is due, in part, to difficulties navigating multiple government agencies. Families often submit duplicate documentation to access a disjointed patchwork of programs. Massachusetts should seize the opportunity and offer families a common application portal.

Dr. Megan Sandel

Richard Sheward

Children’s HealthWatch, Boston

 

Massachusetts is a national leader in health services and access to care, but staying well requires more than health insurance. SNAP significantly decreases families’ food insecurity which is an established health hazard that can lead to poor health and hoptilizations.2 Research shows that SNAP improves health outcomes and reduces health costs.3

SNAP is a 100% federally funded benefit. Over 500,000 Massachusetts residents are eligible for but not receiving SNAP. MA is leaving federal dollars on the table that could be feeding low income Massachusetts residents and improving their health.

Under the leadership of Representative Livingstone, and advocacy from the Massachusetts Law Reform Institute and HHH Coalition, the House budget included   an amendment to study the feasibility of creating this combined application. We will work through the Senate budget process to further push this important effort forward.

 

1 October 2015: EOHHS reported 1.8 million Masshealth enrollees, DTA reported 785K SNAP enrollees. Of the 1.8M Masshealth enrollees, 200,000 were “temporarily enrolled.”  MLRI evaluated Masshealth and SNAP participation data for October 2015. MLRI determined the “likely SNAP eligible” by counting Masshealth enrollees under 200% FPL in Masshealth Standard, CarePlus, and Commonhealth, and excluding temporarily enrolled, long term care and immigrant ineligibles.

2 Children’s Health Watch, The SNAP Vaccine: Boosting Children’s Health, February 2012, pp.1-2

3 Gunderson, Craig and Ziliak, James P., Food Insecurity and Health Outcomes, Health Affairs, 34, no. 11 (2015), pp.1830-9.

February 16, 2016

Last week, the board of the Massachusetts Health Connector met to discuss results from the 2016 open enrollment period and voted to release the proposed 2017 Affordability Schedule for public comment. Materials from the meeting can be found here.        

The meeting started with a warm send-off for Dolores Mitchell, who is retiring from a long career in public service. Mitchell ran the Group Insurance Commission (GIC) for nearly 30 years and served as a Connector Board member since its inception in 2006. Throughout her career, she has been leader in advancing access to affordable health care in the Commonwealth.

Health Connector Deputy Executive Director Ashley Hague and Chief Operating Officer Vicki Coates shared highlights from the 2016 Open Enrollment period, which ran from November 1, 2015-January 31, 2016. They started by looking at how the Health Connector made enrollment a smoother process by using direct mailing campaigns, logging additional call center hours, and setting up four additional walk-in centers across the state, among other efforts.

2016 Open Enrollment Update

September 28, 2015

The recent Blue Cross Blue Shield of Massachusetts Foundation “State of Health Coverage for the Elderly in Massachusetts: Affordability, Access and Satisfaction” event included a productive discussion about the current state of health care affordability and accessibility for seniors in Massachusetts.

Nancy Turnbull, professor at the Harvard T.H. Chan School of Public Health and a Health Connector Board member, gave a presentation describing how supplemental coverage often is needed to cover benefit gaps and high cost-sharing in Medicare. She also pointed out that many Massachusetts seniors are not eligible for, or – if eligible – are not aware of, programs intended to help them overcome these deficiencies.

One finding of a survey of over 500 Massachusetts seniors conducted by Robert J. Blendon (also a faculty member at the Harvard T.H. Chan School of Public Health) is that 18% of Massachusetts seniors in poorer health have had to resort to not filling a prescription due to the cost of prescription drugs.

A panel comprised of representatives from Blue Cross Blue Shield, the SHINE Program, Centers for Medicare & Medicaid Services and Mass Senior Action Council, as well as Nancy Turnbull and Bob Blendon, discussed the survey findings and current efforts to address the gap in health coverage for seniors. The Mass Senior Action Council is leading a legislative advocacy effort to help close coverage gaps for seniors. Let’s keep this vital conversation going!

  -- Wayne Jones (*Updated 9/30/15)

September 17, 2015

Yesterday, the U.S. Census Bureau, as part of its annual report on income, poverty and health insurance, announced that the percentage of people without health insurance fell rom 13.3% in 2013 to 10.4% in 2014.  This means a reduction of the number of people without insurance from 41.8 million to 33 million.

The report notes that between 2008 and 2013, the uninsured rate was relatively stable; but in 2014, the uninsured rate sharply decreased. This decrease occurred during the first year that key coverage provisions of the Affordable Care Act (ACA) were in effect, and it was most dramatic in states that took up Medicaid expansion. Between 2013 and 2014, individual direct-purchase of health insurance, Medicaid and Medicare saw the greatest enrollment increases. According to the report, even "national leader" Massachusetts saw a decrease in the uninsured rate in 2014.

The next open enrollment period for the ACA’s health insurance marketplaces (the Health Connector in Massachusetts) runs from November 1, 2015 though January 31, 2016, providing a new opportunity for the millions of Americans who still lack health insurance to shop for a plan -- and for those who have insurance to review their options and re-enroll.

To learn more about the health care gains made by Massachusetts residents, as revealed by the census report, read this fact sheet created by the Massachusetts Budget and Policy Center.

September 14, 2015

On Thursday, September 10, the Health Connector  Board discussed  readiness for Open Enrollment (OE) 2016,  including outreach efforts, and to deliver the final award of the 2016 Seal of Approval.  Materials from the meeting are posted here

Chief Operating Officer Vicki Coates provided consumer experience updates.  Coates first noted that total Non-Group Medical Enrollment stands at 175,605 members, a 1.2% increase from last month.  Non-Group Dental enrollment is 45,240 members, a 0.8% increase from last month.  Non-Group Enrollment for ConnectorCare is 129,657 members, an increase of 1.4% from last month.  Coates then said that the call center continues to hold the gains made in the last several months, with a lower call abandonment rate and average speed to answer than February and March.  Issue resolution has increased by 5% after holding steady for a few months and there are significantly fewer people reporting that they called more than three times without resolution.  First contact resolution, Coates reported, has increased 4.1% since May.  Overall satisfaction has increased 7% from July to August as lower wait times have resulted in higher satisfaction levels.  Coates also re-iterated that staffing is on track to match the anticipated increase in call volume associated with OE and staff are being trained to support customers’ shopping needs.

2016 Open Enrollment Readiness Update

During Open Enrollment, which runs from November 1, 2015-January 31, 2016, individuals in the non-group market can enroll in or switch plans for any reason without needing a qualifying event.  Currently, the Connector is in the final stages of determining eligibility and renewals for the upcoming OE.  118,000 households that applied for help paying for coverage and are eligible for a Qualified Health Plan (QHP) received eligibility notices.  The notice, it was noted in the meeting, is very “high level” and does not include information on the amount of tax credits an individual is expected to receive.  However, consumers will receive notices of their tax credit values before November 1st.  Once members receive their eligibility notices, they have 30 days to take action to update and finalize their eligibility if they choose. 

2016 Open Enrollment Outreach Update

The Connector performed a comprehensive consumer survey in July, surveying 1,086 residents representing those  currently enrolled in subsidized and unsubsidized health plans, dental plans, and a group of former enrollees.  The Connector also conducted several focus groups aimed at uninsured, current, and former members.  They held sessions in Lawrence, Lynn and Brockton, areas with high uninsurance rates, to learn about barriers to obtaining coverage and whether people felt comfortable using the Health Connector.

The survey found that, overall, the majority of insured respondents are satisfied with their experience as Health Connector members but room for improvement exists.  Dental plan enrollees were significantly less satisfied than health plan enrollees.  Additionally, satisfaction rates were skewed between lower-income subsidized members and upper income unsubsidized members - with lower income enrollees more likely to be satisfied. 

Uninsured respondents perceived that cost was the biggest barrier but insured members of similar income levels find their coverage to be generally affordable.  Uninsured individuals are more willing to risk not having coverage and show an inherent distrust in the health care system.  Individuals with families, however, were more interested in enrolling in health insurance.  Lastly, respondents emphasized that the process is still often confusing and expressed that having help with their application was useful.  To illustrate this point, the satisfaction rating of Navigators is relatively high compared to those of the Health Connector website or customer service. 

Survey and focus group data on plan selection and enrollment indicate that the top reasons people select the plan they enrolled in are to keep premiums low and have a plan that includes their doctor or provider.  More people report not understanding their benefits than understanding them.  Respondents noted that the enrollment process could be improved through better website design, better trained Customer Services Representatives (CSRs), simpler web navigation, and the ability for more plan comparisons. 

The top customer service issue appears to be linked to phone services, as shown by the number of respondents dissatisfied with long wait times and the fact that some CSRs appear to lack sufficient knowledge.  The Connector is addressing these problems by proactively hiring and training staff to add to the number of available CSRs during OE.  Fortunately, the Connector is emphasizing in-person assistance throughout the state through Navigators, Certified Application Counselors, Issuer Enrollment Assisters, Broker Enrollment Assisters, and new locations for support with trained CSRs.  Springfield, Fall River, Brockton, and Lowell will all be additional in-person centers staffed with trained Health Connector CSRs.  The permanent Boston and Worcester Centers will also have extended evening and weekend hours.

Final Award of 2016 Seal of Approval

September 11, 2015

On September 9th the Health Policy Commission (HPC) Board met primarily to discuss the release in early September of the Center for Health Information and Analysis (CHIA) Annual Report on the Performance of the Massachusetts Health Care System and the upcoming annual Health Care Cost Trends Hearing.  The full slide deck can be accessed here.

Executive Director’s Report

First, Executive Director David Seltz delivered a report to summarize recent activities at the HPC. He began with an update on Material Change Notices, noting that of the types of transactions documented from April 2013 to the present, the most frequent were physician group merger, acquisition, or network affiliation transactions at 26% (Slide 7).

Notices received since the last HPC meeting include an acquisition of Saint Francis Care, a hospital system in Hartford, CT, by Trinity Health Corporation, which owns Mercy Medical Center in Springfield, MA..  Additionally, the HPC received notice of a new clinical affiliation between Tufts Medical Center Parent (Tufts) and Cape Cod Hospital (CCH) under which Tufts physicians will provide substantially all pediatric services at CCH (Slide 8). 

The HPC elected not to proceed with Cost and Market Impact Reviews (CMIR) for the following:

  • Acquisition of Braintree Rehabilitation Hospital and New England Rehabilitation Hospital by HealthSouth Acquisition Holdings. Their analysis indicated there is limited scope for a CMIR due to the fact that the hospitals in question primarily serve Medicare patients.
  • Acquisition of Saint Francis Care by Trinity Health Corporation. The proposed transaction would have a limited impact on operations, prices, and contracting practices at Mercy Medical Center.  While the transaction may result in a small increase in referrals between MA and CT providers, their analysis did not find that such changes would likely have a negative effect on spending or on the competitive market. 
  • Affiliation between Tufts Medical Center Parent and Cape Cod Hospital. The analysis indicated that rates and referral patterns are unlikely to change as a result and, in fact, may improve quality, access, and the ability of CCH to provide consistent pediatric coverage (Slide 9). 

Seltz then gave an update on the HPC’s Registration of Provider Organizations Program, a project meant to create a database to capture ongoing changes in the provider market Thus far 59 provider organizations have completed the first part of initial registration and are expected to complete the second part this Fall. The registrants represent behavioral health, hospital systems, physician groups, and an “other” group solely including Quest Diagnostics (Slide 11).  The provider organizations must submit their part 2 materials to the HPC by October 30, 2015.  Provider organizations can now access the online submission platform and the HPC encourages providers to schedule one-on-one meetings with them.

Next Seltz turned to the HPC’s Community Hospital Acceleration, Revitalization, & Transformation (CHART) Investment Program, which is progressing with both Signature Healthcare and Berkshire Health Systems moving into the contracting and launch phases respectively.  At Northern Berkshire Neighborhood of Health, part of Berkshire Health Systems, the $4M project has now launched and is serving patients from Northern Berkshire County.  The project primarily aims to reduce 30-day readmissions by 20% and, secondly, reduce 30-day returns to the emergency department from any bed by 10%.  They hope to achieve these goals by utilizing a number of strategies like individual care plans, addressing underlying social issues, and investing in technology to support care coordination.  The project also hopes to integrate many services into the community (Slides 17-18).

Lastly, Seltz reported on an important amendment passed in the FY2016 budget that strengthens consumer protections for patients who face medical bills and who exercise their rights to pursue internal or external appeals of certain health insurance coverage decisions. The amendment prohibits health care providers and their agents from providing information about unpaid charges for health care services to a consumer reporting agency while an internal or external review is pending or for 30 days (increased from 15 days) following the resolution of the internal or external review. The amendment further prohibits health care providers and their agents, including any collection agency or debt collector from initiating debt collection activities relative to unpaid charges for health care services while an internal or external review is pending or for 30 days following the resolution of the internal or external review (Slide 20).

CHIA Annual Report

Executive Director of CHIA, Áron Boros, began by delivering the major finding of CHIA’s Annual Performance Report that total health care expenditures (THCE) per capita rose 4.8% from 2014, which amounts to $8,010 spending per person. The greatest source of the percentage change is reported to be MassHealth/Commonwealth Care spending. However, there was much debate among the Board members as to what this fact actually meant when examined more closely and its impact on the total spending change number. 

March 10, 2015

Health Care For All new logo - blue Massachusetts red Health Care For All text
September 19, 2014

It’s fall and that means it’s a season of change. Health Care For All is moving its office. After September 20th, you can find us at One Federal Street, Boston, 02110! 

We are also opening our celebration of the 30th Anniversary of Health Care For All. The anniversary has us reflect on some of the major victories that Health Care For All has won over the course of three decades. Again and again, the work of HCFA has led Massachusetts to lead the country in health care:

The universal coverage law in 1988 under Governor Dukakis. The expansions in Medicaid to form MassHealth, and new help for prescription drugs for seniors. Patient protections in managed care plans, and ending pre-existing conditions exclusions for groups and individual plans. More kids enrolled in coverage. Landmark health care reform under Governor Romney, providing a model for the Affordable Care Act signed by President Obama. The 2012 comprehensive payment and delivery system reform law, changing the focus of our system towards value and health.

We are proud of this week's census report that we still lead the nation in health coverage, including virtually universal coverage for children.

The policy victories have been coordinated with a best-in-the-nation HelpLine and outreach and education effort, integrated with our policy work.

We have come a long, long way in 30 years. But, there's still lots more to do.

To mark this occasion, and to mark our move, today we are unveiling a brand new logo.

Our new logo reflects the Massachusetts focus of the work we do to bring quality, affordable health care to all people in the Bay State. We are a truly statewide organization. We help answer questions from all corners of the Commonwealth on our HelpLine. This fall we will again knock on doors to reach out to hundreds of thousands of our neighbors to make sure they get covered.

Today, the 30 Winter Street team of Health Care For All, Health Law Advocates, and Community Catalyst are busy packing up to move to One Federal Street. Our phone numbers and emails will stay the same. And so will our determination to work for three more decades of health care advocacy, education and service for access to quality, affordable care - for all.

Cameras on the Kids Count Press Conference
July 24, 2014

This week, we were proud to participate in the release of the Kids Count report, placing Massachusetts at number one in the nation when it comes to overall child well-being. The Annie E. Casey Foundation report covers a wide spectrum of data when it considers children’s wellbeing, and of course access to health care is one of the main metrics in addition to early education, child poverty, and more. With just only about 1% of children uninsured, Massachusetts does extremely well on access to coverage.

The report says that “Children have a greater opportunity to thrive and succeed in Massachusetts than in any other state,” according to our friends at the Mass Budget and Policy Center. You can read MassBudget’s full report here.

But there is more work to do. One in seven -- seven -- children in Massachusetts live in poverty. That number is too high. Governor Patrick spoke passionately about the work that lies ahead. “The question before the Commonwealth, and the country, isn't what to do - we know what to do,” said Governor Patrick. “The question is whether we mean what we say, whether all means all - opportunity for all, equality for all, a fair chance for all.  If we mean it, then we have to do the things we know work." To see the Governor’s full remarks, watch his YouTube clip.

Our Executive Director, Amy Whitcomb Slemmer had this to say: "The Commonwealth's focus and forward-thinking financial investments are paying off for our children. Covering 99% of our children with health insurance as part of our commitment to providing comprehensive, affordable, accessible high quality care for all is unprecedented and unparalleled in the country.”

The facts are clear that despite our number 1 ranking, we are far from finished nationwide or at home. There is a national poverty gap that breaks along racial and ethnic lines. In America, 40 percent of black children and 34 percent of Hispanic children live in poverty while 14 percent of white children do.

In Massachusetts, despite having almost universal access to health care, there are other health concerns. For example, Massachusetts children are about as likely to abuse drugs and alcohol as kids anywhere else in the country. And we know that no issue is separate -- all the issues are interconnected. How well a child does in school often depends on his or her health, for example. 

As Amy Whitcomb Slemmer said: “The Kids Count report also highlights the work yet to do. We must close the gaps for non-English speaking children and for immigrant communities across the Commonwealth. We must uproot the entrenched causes of poverty that make being born in certain zip-codes a health hazard.  We must continue to push so that our world class health delivery system to which nearly every child in Massachusetts has access, translates into having the healthiest children in our nation."

The report garnered a lot of press coverage, and you can read just some of the coverage here. Again, Health Care For All is proud of Massachusetts’ number 1 status. It did not happen by accident. We got to where we are because of hard work, a commitment to universal health coverage, early education, and more. Now the work continues to make sure that we lift all children out of poverty to ensure that they lead the healthiest, happiest lives possible.

--Ari Fertig

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