"Health Care For All" in lights on a bridge

A Healthy Blog

Massachusetts health care – wonky with a dose of reality

March 3, 2016

Dentists to be trained on opioid abuse care

Highlighting the undeniable connection of dental services and medical care, three major dental schools in Massachusetts launched an initiative to combat the opioid crisis by teaching dental students skills in pain management and use of prescription pain killers. Notably, the program also trains and encourages dentists to collaborate with other health professionals in identifying and treating addiction. Governor Baker announced the agreement:

Dentists prescribe about 8% of opioids, the third-highest profession to do so. Because of this, dentists and oral health professionals are in a unique position to help combat opioid addiction. Not only do dentists regularly encounter patients experiencing pain, they are also unique in the amount of time they spend with each patient – on average, one hour compared to the primary care physician’s ten or twenty minutes. Dentists and other oral health providers are primed to play a strong role in prevention as well as education on a number of medical issues.

As the opioid crisis shows, greater integration of dental services into medical care and vice versa can yield powerful results, but training doctors and dentists individually to identify and address opioid addiction is not enough. Medical and dental providers must be regularly engaging and interacting to coordinate patient health, and every practice (both medical and dental) should have facilitated referral networks so that patients can access the care they need. This should also include inter-operational electronic health record (EHR) systems so that all providers can access a patient’s health history. What would it look like, for example, if a dentist identified a patient as being vulnerable to opioid addiction and was then able to relay that information to their primary care physician?

With regards to the opioid crisis, coordinated care means providers are more likely to avoid over-prescription and can readily assess behavioral risks based on a patient’s health history. This program is a strong step towards integrated health. Health Care For All applauds initiatives like this and we hope to see more collaborative, cross-professional thinking in the future.

                                    --Kate Frisher & Sara O'Brien

March 1, 2016

AAFP endorses oral health integration

At Health Care For All, we believe that oral health is integral to overall health. This belief is gaining more and more traction as mainstream organizations begin embracing it. Late last year, it gained even more support as the American Academy of Family Physicians (AAFP) endorsed a medical-dental integration framework.

The model, known as the Oral Health Delivery Framework, outlines the importance of including preventive oral health care as a component of routine medical care and reviews the social and economic consequences of poor oral health. The report also details five actionable steps that primary care providers can take to protect and promote oral health, including:

  • Performing basic oral health risk assessments for patients;
  • Training and educating other primary care providers on how to identify oral health conditions and the importance of oral health;
  • Offering preventive interventions like fluoride varnish or dietary counseling;
  • Having structured referral networks between dentistry and primary care;
  • Leveraging health information technology to facilitate oral health risk assessments.

Primary care providers, including family physicians, are positioned to play a strong role in promoting good oral health. As the oral health delivery framework explains, providers can make it a priority by screening for oral health behaviors and risk factors. We’ve seen similar initiatives with mental health, and now nearly every primary care visit includes a short survey and screening for depression. Oral health should be treated with equal importance.

Yet it is not enough to simply screen for poor oral health – providers must have an established mechanism for connecting patients with the appropriate care, too. Whether this comes in the form of co-located practices, structured referral networks, or another method, providers must be able to effectively help patients establish a dental home. Primary care providers can also play a strong role in patient education. In Boston Children’s Hospital’s primary care clinic, for example, every visit includes oral health education from a nurse practitioner or physician’s assistant during the intake procedure.  

This endorsement comes at a pivotal time for Massachusetts. As the state transitions to new payment and delivery models known as Accountable Care Organizations (ACOs), providers will be held accountable for improving patient health through coordinated care delivery. This moment represents a critical opportunity to elevate oral health as a priority for residents of the Commonwealth and to advocate for the integration and inclusion of dental care into new models. As more and more organizations like the AAFP recognize the importance of oral health and support for medical-dental integration grows, it proves: it’s time to put the mouth back in the body.

                                  -- Kate Frisher

February 29, 2016

Crowds gather at the State House for Elder Leap Day 2-29-16

Today, Health Care For All was delighted to join hundreds of seniors, advocates, and caregivers at the Grand Staircase in the State House to advocate for services that keep seniors healthy and living at home. Mass Home Care organized and AARP Massachusetts State Director Mike Festa emceed the event. Over a dozen senior and disability organizations sponsored the event.

According to Mass Home Care, the elderly population in Massachusetts will increase 40% by the year 2035, with nearly 40% of elder needing long term services for more than two years in their lifetime. Today’s lobby day was an amazing showing of energy around policies that will ensure seniors of today and tomorrow have the resources and community supports they need, including home care, adequate housing and transportation.

Issues highlighted include:

  • Eligibility and funding for home care services
  • Proposed passive enrollment into Senior Care Options
  • Supporting caregivers
  • Expanding MassHealth eligibility for seniors
  • Fair pay for home care workers and personal care attendants
  • Opposing EOHHS authority to restructure MassHealth benefits
  • Protecting the Community Choices program
  • MassHealth estate recovery

Mass Home Care has a good rundown of some of the issues raised. HCFA supports these efforts to help older Massachusetts residents remain independent and living with dignity in their homes and communities.

     - Suzanne Curry

February 28, 2016

S. 2138 - An Act to protect Confidential Healthcare

Last week, the Massachusetts Senate advanced S. 2138, An Act to protect access to confidential health care, a key priority for Health Care For All. The bill would fix a crucial barrier to accessing health care by ensuring that when multiple people are on the same insurance plan, confidential health care information is not shared with anyone other than the patient.

Health insurers routinely send out explanation of benefits (EOB) forms detailing the type and cost of medical services received to the primary subscriber of a health insurance plan, not the individual patient who accessed services. Sensitive health information may be disclosed in these forms, violating the basic right to privacy for anyone enrolled as a dependent on another’s policy, such as a young adult, minor, or spouse. S. 2318 would address this problem by allowing patients to choose where and how they receive explanation of benefits (EOB) forms.

During the Senate session, Senate Ways and Means Chair Karen Spilka, the bill’s lead sponsor in the Senate, spoke passionately in support of the bill’s passage. She explained that patient confidentiality is a fundamental element of the patient-provider relationship and is essential in helping patients feel comfortable accessing care and sharing information with their health care providers. Out of fear that a parent or spouse may see an EOB, young adults or survivors of domestic violence may not seek needed treatment at all, she said.  While some health plans already take steps to ensure confidentiality, this bill would ensure that all health plans do so and in turn would help many individuals across the Commonwealth.

Senator Eldridge, Chair of the Joint Committee on Financial Services, which had previously given the bill a favorable report, also spoke in support of the bill. He reminded his fellow Senators of the compelling testimony from a number of young people at the bill’s public hearing. He described the bill as an important way to work towards continuing to improve our health care system, as keeping health care information confidential is extremely important to every patient in Massachusetts.

The bill was then advanced on a unanimous voice vote and ordered to a third reading, and will likely taken up for a final vote next week.  We thank both Senator Spilka and Senator Eldridge for their leadership in ensuring critical confidentiality protections for patients in Massachusetts and urge the full Senate to pass this legislation next week.

      -- Alyssa Vangeli & Jessica Imbro

February 21, 2016

The remaining uninsured in MassachusettsLast week, the Blue Cross Blue Shield of Massachusetts Foundation and the University of Massachusetts Medical School released a report entitled “The Remaining Uninsured in MA: Experiences of Individuals Living without Health Insurance Coverage” (read the report here). Massachusetts continues to have the lowest uninsured rate in the nation, with some 97% of residents covered. However, about 200,000 people of diverse age, race and employment status remain uninsured. The goal of this study was to figure out the reasons why people remained uninsured and help inform policy suggestions which would help them receive coverage in the future.

The report authors spoke to a sample of uninsured people from seven counties in the state and developed the following key findings;

First, health care costs continue to be prohibitive. One of the most cited reasons that people gave for being uninsured was the cost. Some people weren’t eligible for their employer’s insurance, and other were not eligible for subsidies. Some 58% of respondents said they had had coverage at some point in their adult lives, but changing circumstances had dissuaded them from applying. Some said that they let their coverage lapse because they said they didn’t use it enough to justify the cost, while others simply became ineligible for employer-provided insurance. One respondent said that the cost of the penalty was less than the cost of insurance itself, and so they decided to simply pay the fine.

Another key point here is that a vast majority (73%) of the people surveyed said that they considered themselves to be in very good health, despite that slightly more than one third has one or more chronic conditions. Still, it would seem that some people were willing to hedge their bets by remaining uninsured, counting on good health to compensate for their lack of insurance.

Some other important aspects were related to communication; the process of applying was widely reported to be confusing and complex, and would be greatly simplified by having personal assistance, in people’s primary language. Having access to this would be even better if it is available in convenient location such as “health clinics, hospitals, nonprofit organizations, unemployment offices, and local businesses” that have evening and weekend operating hours, additional appointment times and more staff to assist.

Some respondents also reported losing their health insurance through state programs like MassHealth because they did not realize they needed to take any action to renew their membership. In this area, better communication with enrollees is necessary.

Secondly, the value of health insurance was lost on no one. Almost every person contacted indicated that they wanted health insurance coverage, and certainly understood the value of it to their overall wellbeing. Most people indicated that that the insurance provided a sense of security and that the lack on insurance was reflected in the way that people interacted with their care. People without insurance said that being uninsured limits “when they can get care, where they can get care, and what type of care they receive. Nearly a third said they were unable to get care when they needed it and that not having insurance limited their access to specialty care, routine tests, and preventive screenings”. Almost one third said that they were unable to get care when they needed it. While some people reported that they didn’t use it enough to justify the costs, the lack of insurance meant either not receiving or putting off necessary and preventative care.

The study notes that community health services such as free clinics and community health centers provide necessary access points for uninsured, especially undocumented, people in the Commonwealth. Additionally, the report supports the value of enrollment events and in-person assistance to help insure people and recommends possibly working with unemployment offices to help those who are looking for insurance outside of the open enrollment period.

The report closes with a note that lowering Massachusetts’ already low uninsured rate will be difficult, but that by learning from the experiences of those people, we can do what is possible to get the number down to 0% uninsured.

                  -Sara O’Brien

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

February 2, 2016

ACO

Health Care For All submitted detailed comments last week to the Health Policy Commission on their proposed certification standards for ACOs. In our introduction to our comments (submitted in conjunction with Health Law Advocates), we wrote that

The Health Policy Commission has an opportunity to promote approaches to payment reform that fundamentally transform the way care is delivered. ACOs should deliver high quality, high value care that treats the individual as a whole person. ACOs should ensure coordination of care, improved communication, member support and empowerment, and ready access to health care providers, services and community-based resources and supports.

You can read a detailed summary of our comments, as well as download our complete submission, here.

January 31, 2016

Headline: Patient Confidentiality Bill Moving Through Statehouse

In a step towards victory for patient privacy, the Massachusetts legislature’s Joint Committees on Financial Services and Health Care Financing reported favorably on one of HCFA’s legislative priorities, “An Act to protect access to confidential healthcare.”  The new bill, S. 2081, sponsored by Senator Karen Spilka and Representative Kate Hogan, is now before the Senate Ways and Means Committee.

Health insurers routinely send out an Explanation of Benefits (EOB), detailing the type and cost of medical services received, to the primary subscriber each time an enrollee on the plan accesses care. Sensitive health information is frequently disclosed in an EOB, violating the basic right to privacy for anyone enrolled as a dependent on another's health plan, such as a young adult, minor, or spouse. Young adults and minors are particularly likely to not seek care for sensitive services when worried that their parents will find out.

The bill would remove a crucial barrier to accessing health care by ensuring that when multiple people are on the same insurance plan, confidential health care information is not shared with anyone other than the patient.

The bill's legislative progress was covered by the AP, and appeared at a number of state news sites:

Sen. Jamie Eldridge, co-chairman of the committee, says the bill is particularly important given that more young people are obtaining health insurance through their parents under President Obama’s health care law.

The Acton Democrat says the state must be vigilant in making sure that all patients’ health information remains confidential.

Democratic Sen. Karen Spilka says victims of abuse and minors are often reluctant to seek certain types of treatment, fearing that their abuser or parent will learn details.

Last July, the committee heard testimony in support of the bill from patients, health care providers, and members of the HCFA-led Protecting Access to Confidential Health Care (PATCH) Alliance.

If your Senator is on the Senate Ways and Means Committee (see list here), please contact them in support of the bill.

  -- Jessica Imbro

January 29, 2016

Baker admin files FY 2017 budget

On Wednesday, Governor Baker released his proposed state budget for fiscal year 2017, which begins on July 1, 2016. While the budget provides for an approximate 5% growth rate for MassHealth spending, administration officials had projected that total MassHealth expenditures would rise around 8% next year, due to increases in the caseload and medical inflation. As a result, the budget calls for spending cuts in a number of areas, and freezes in many reimbursement rates.

The cuts were covered in an article by the Springfield Republican State House reporter Shira Schoenberg: Gov. Charlie Baker's budget finds ways to trim MassHealth spending:

Some advocates worry that proposed changes could limit access to some benefits.

One change is MassHealth is moving more people away from fee-for-service plans toward managed care organizations, where a provider group is paid one fee to coordinate all of a patient's health care. The state will eliminate some benefits from fee-for-service plans and keep those benefits in managed care plans, as an incentive to switch. These benefits include physical, occupational and speech therapy, chiropractic benefits and vision. ...

But the health care advocacy group Health Care for All opposes the changes. Restricting benefits in fee-for-service plans "unnecessarily restricts member choice and may impose barriers to accessing certain benefits and providers," said Health Care for All Executive Director Amy Whitcomb Slemmer. Locking members into one plan for a year, she said, "can have a negative impact on access to care and reduce flexibility to find a network that meets the members' individual needs."

In another area, the state has a Health Safety Net plan that reimburses hospitals and community health center for caring for uninsured or underinsured residents – generally, people who do not qualify for other plans, such as illegal immigrants and people waiting for employer-sponsored care. The state wants to lower eligibility from individuals earning four times the federal poverty level ($47,000 for an individual) to three times the poverty level ($35,400), according to Health Care for All.

"It will get a very fair look, because I think our goals are the same." - Sen. Jim Welch

"This would hurt their ability to get the health care they need and stay healthy," said Health Care for All research director Brian Rosman.

Health Care For All's Executive Director, Amy Whitcomb Slemmer, issued the following statement in response to the Governor's proposed budget:

"Health Care For All appreciates Governor Baker's budget proposal that preserves and invests in many critical health-related programs.

"We especially applaud the decision to maintain dental benefits for adults in MassHealth. Having access to good oral health care is critical for vulnerable populations in order to prevent health complications.
 
"We are also pleased that the Governor proposes to keep MassHealth payment rates steady, and even increase some rates for behavioral health and substance abuse services under the MassHealth program. We know that paying fair rates to providers will encourage more to accept MassHealth coverage, increasing access to needed care for patients seeking diagnosis and treatment.
 
"However, we strongly disagree with the proposal to lock MassHealth members into a specific managed care plan for 12 months. This can have a negative impact on access to care and reduce flexibility to find the network that meets the members' individual needs.
 
"We oppose his proposal to restrict benefits for some in MassHealth in order to push members into managed care plans. This unnecessarily restricts member choice and may impose barriers to accessing certain benefits and providers.
 
"We are also deeply concerned about proposed cuts in eligibility for the Health Safety Net program. This increases the risk of medical debt for low- and moderate-income residents who are uninsured or underinsured.
 
"We are encouraged by the Governor's focus on solutions to family homelessness and support his call to raise the Earned Income Tax Credit (EITC) to 50%. This credit provides a valuable increase in a family's income that has been shown to have multiple beneficial impacts, particularly for children. Research has shown that the EITC can be linked to improved child health, better academic performance, and higher income levels as adults.
 
"We look forward to working with the Baker Administration and the legislature to advance policies and regulations that aim at improving health care access and health outcomes for all Massachusetts residents."
The budget next will be considered by the House Ways and Means Committee, and then the full House, followed by the Senate,with their action expected in the spring and early summer.
 
January 27, 2016

The Massachusetts House of Representatives today took a major step to address health disparities by passing legislation creating an Office of Health Equity. The bill passed by an overwhelming 152 to 4 vote.

The bill (H. 3969) has been a long-time priority for Health Care For All. It creates an Office of Health Equity within the Executive Office of Health and Human Services (EOHHS), charged with creating an annual plan for the elimination of health disparities in Massachusetts and working with other state agencies, including agencies dealing with housing, transportation, public safety and labor, on disparities reduction initiatives to address the social factors that influence health inequities.

Bill co-sponsor Representative Jeffrey Sánchez spoke passionately in support of the bill on the House floor:

Today is a really big day. It's another chapter in our road to health reform. Minorities have a disproportionate burden of death and disabilities Seventy-five percent of spending are on chronic diseases. The are conditions that are preventable and disproportionately affect people of color. African American and Latino citizens have a higher mortality rate and worse health outcomes. ... The benefits of a dedicated office of health equity are clear. It will improve the communication and the coordination and duplication across state agencies to make sure that we're using our scarce dollars to make a better impact and to make sure we leverage cross sector experience and foster mutual understanding and also to serve as a single point of access for partners outside of state government. We have to make sure disparities don't continue to broaden.

Also speaking was the bill's other co-sponsor, Representive Byron Rushing:

When we look at statistics like black residents having a higher death rate from asthma than other groups, when we look at statistics such as black and Hispanic babies have a 3 times and 2 times higher respectively infant mortality, we are not talking about other parts of this country. We are talking about Massachusetts from Boston to Pittsfield. We are talking about our own population.... This is complicated. It will not be solved overnight but it will never be solved if we are not consistently paying attention to it, and that's where this piece of legislation comes in. By establishing this office under the governor, we will now have a place that will be consistently looking at a strategy that will involve much more than only the medical establishment in looking to end these disparities. We will have an office that will be consistently working on this work and reporting on all of this progress so that we will be able to be involved in an educated set of policies and suggestions for future changes.

Over a decade ago, HCFA convened the "Disparities Action Network," which brought together dozens of groups in support of the bill. The group continues to advocate on disparities issues, and was active today expressing strong support for the bill to the House members.

The bill now goes to the state Senate.

              -- Brian Rosman

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