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 2, 2015

The headline leads today's Globe's front page: Health care costs jump, a setback for Mass. There's no question that today's report from CHIA, with its topline finding of a 4.8% per capita growth in total health care spending in 2014, might lead to the perception that our progress in controlling health care cost growth has hit a bump. Certainly 4.8% exceeds the state's goal of holding spending growth to 3.6% or less. But digging into the report, there's a complex mix of good and bad news, and the report defies simplistic conclusions. So here are a few of our takeaways:

Components of rate of increase leading to composite rate of 4.8%

Racial and ethnic disparities in reported patient experience

  1. MassHealth (Medicaid) spending growth drove the all of the excess spending. MassHealth spending grew by 19%, compared to much lower growth rates in other forms of coverage. Commercial insurance spending grew by only 2.9%, Medicare grew by 2.1%, other public coverage grew by 2.0%, and insurance overhead grew by 1.7%. Except for the MassHealth spending (more on that below), 2014 should be counted as another success story in the state's efforts to control health care spending.
  2. The MassHealth backstory is almost all due to (a) the breakdown last year in the state's implementation of the ACA, and (b) the expected shift into MassHealth of people formerly covered by the Connector. As the Connector's online eligibility system failed, state officials (appropriately) kept people in coverage by shifting people who applied into stopgap, unmanaged MassHealth coverage. Many of these people were formerly in the Connector's Commonwealth Care plan, which was being phased out. Meanwhile, CommCare enrollment (in member-months over the year) decreased by 55% for the whole year as people shifted to MassHealth. By the end of the year, CommCare was gone. Bottom line: while MassHealth enrollment soared 23% during the year, spending grew by only 19%. 
    (and note that the federal government picked up 75% of the cost of the newly eligible, with the federal share increasing over time.
  3. The report highlights ongoing racial/ethnic disparities in care. In every category - access, provider communication, integration, and so on - quality was rated lower by Blacks, Hispanics and Asians compared to Whites in the survey. We have long called for an Office of Health Equity in state government and this report drives home the need for more attention to this issue.
  4. Growth in the cost of prescription drugs is the looming health cost issue in Massachusetts. Commercial plans had a whopping 13% increase in pharmacy spending. This is roughly double national projections of 6.8% spending growth for prescription drugs. HCFA has a broad agenda to control drug costs, including more transparency around drug pricing, objective information for doctors to counter marketing claims, and eliminating cost-sharing for cost-effective preventive drugs. And this afternoon, Senate President Stanley Rosenberg raised the issue of the state using bulk purchasing to negotiate larger discounts from drug companies. Lowering the cost for prescriptions is the imperative for state health policy in 2015.
  5. Cost shifting to patients continues. The number of Bay Staters in high deductible plans increased, and overall cost sharing (deductibles and copayments) increased 4.9% for people in commercial insurance plans. This trend, too, is problematic as insurance becomes less a collective sharing of the cost among everyone with coverage, healthy or sick.

There's lots more of good wonk in the report, on adoption of alternative payment systems, growth in employers self-insuring, and more. Go read it.

                     -- Brian Rosman

(UPDATE: mistaken statsitic on Medicaid spending growth removed)


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