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 23, 2016

The legislature's Joint Committee on Health Care Financing held a session last week in Springfield, looking at the impact of skyrocketing prices of prescription drugs. 

Among those speaking was HCFA Executive Director, Amy Whitcomb Slemmer. She brought real-life examples of the how high drug costs are hurting people in Massachusetts:

  • Recently our HelpLine heard from a consumer named Jessica who sought our assistance in September. She called us because her mother has been prescribed a treatment for psoriasis – a chronic and sometimes painful skin condition, that costs her family $400 per month. Without some sort of subsidy or relief, each month Jessica’s family finds itself having to choose between her mother’s injection drug treatment and meeting their rent and food needs. 
  • In October we talked to Beatriz whose daughter’s college insurance plan did not cover the cost of an incredibly expensive drug that she relies on to stay well. Her daughter was struggling with what to do, and eventually dropped out of college, qualified for a different health plan which provided access to her needed medication, but cut her off from a college education.
  • We also heard from HelpLine caller Marisa, who has type 1 diabetes and is fortunate enough to have employer-sponsored health insurance. Marisa struggles to meet the out of pocket costs of paying for frequent co-pays and meeting her deductible as she keeps herself equipped with the appropriate medication and diabetes supplies. One of the ways Marisa chose to cut costs was to cut way back on food, which not only saved her money, but created a drop in her blood sugar. During a doctor’s visit, she was warned about the potential irreversible harm she might cause herself, so she has left her own apartment, and moved back in with family in order to save money and afford the medicine and health supplies she needs.

We called on the legislature to take strong action to reduce the high cost of prescription drugs. One proposal we supported is pending legislation to provide transparency for prescription drug costs. This concept was also endorsed by the Health Policy Commission, which focused on prescription drug cost transparency in its Cost Trends Report recommendations last week (see slide 36 in this presentation for details).

Following the hearing, Slemmer was interviewed by Springfield's Channel 22 about the issue. Click on the graphic below to see the full video interview:

HCFA ED Amy Whitcomb Slemmer interviewed about prescription drug costs by Springfield's channel 22


             -- Brian Rosman

HCFA Volunteers assist several hundered people with enrollment in Framingham
January 21, 2016

Nearly 300 individuals gathered at Fuller Middle School in Framingham this past Saturday, January 16th, seeking health care coverage enrollment and navigation assistance, as well as other health services. Health Care For All’s ‘Grand Enrollment Event’ featured more than 70 HCFA staff and volunteers, including Spanish and Portuguese-speaking health insurance Navigators and Certified Application Counselors. Volunteers helped 154 individuals, 107 of whom were uninsured upon arriving to the event, to enroll in health care coverage.

Volunteers helping people enroll in health coverage

86% of event attendees self-reported as Portuguese-speaking, while only 10% reported speaking English.

“Massachusetts has the nation’s highest rate of health insurance, with over 97 percent of the population covered; however there are areas in the Commonwealth where many remain uninsured. Framingham, for example, has a significant number of uninsured residents, and we know that many uninsured residents speak a language other than English. Today, we are here to help people navigate the enrollment process in English, Spanish and Portuguese,” said Amy Whitcomb Slemmer, Executive Director of Health Care For All.

State Senator Karen Spilka at HCFA enrollment event in Framingham

State Senator Karen Spilka (above), as well as State Representatives Chris Walsh and Carmine Gentile welcomed the group. Also attending were Louis Gutierrez, Executive Director of Massachusetts Health Connector, and Michael Hugo, Chair of the Framingham Board of Health, as well as Edna Smith, chair of the Community Health Network of Greater Metrowest (CHNA 7).

The ‘Grand Enrollment Event’ was a part of a larger Open Enrollment effort conducted by the Health Connector and MassHealth, as well as numerous community organizations and health care providers statewide. Massachusetts residents have until January 31st to apply, enroll in a health plan, and pay their premium for coverage for 2016. Please call HCFA’s HelpLine at 800-272-4232 if you or someone you know needs help applying or renewing their health care coverage.

December 23, 2015

Last week Health Care For All submitted comprehensive recommendations to MassHealth regarding their development of Accountable Care Organizations (ACOs). ACOs represent a new way to pay for and organize health care delivery, by bringing together doctors, hospitals and other health care providers who work to give coordinated, high quality care to their patients. 

MassHealth is engaged in a process of consultation with health care stakeholders and the public to establish the contours of their ACO transition. You can read more about MassHealth's thinking on ACOs in this presentation. Here are two of their slides:

MassHealth ACO slides

We agree that MassHealth 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 and ensures coordination of care, improved communication, member support and empowerment, and ready access to health care providers, services and community-based resources and supports. The goal is not just better health care, but better health for the entire state.

There’s a lot of detail in our full recommendations (download the document here (warning: 29-page pdf)), along with examples from other states. Below is a much-abridged summary of our recommendations:

Member Protections

  • Monitor and track underutilization: ACOs should establish internal monitoring mechanisms for under-service to safeguard against potential incentives to deny or limit care, especially for members with high risk factors or multiple health conditions. MassHealth should monitor under-service by assessing claims data and health outcomes over time to identify patterns of variation.
  • Protect member choice of providers
    • Network adequacy: Members should have access to care across the continuum, which includes reasonable access to a sufficient number of primary and specialty care physicians, facilities, and other providers, as well as benefits delivered in a timely fashion within a reasonable distance. ACOs should have continuity of care provisions for contracting with providers outside of the ACO.
    • Attribution methodologies: Attribution methods should involve member choice to the maximum extent feasible. MassHealth should not establish a lock-in period forcing members to remain in their ACO for a particular period of time.
  • Ensure robust appeals and grievances procedures: ACO grievance and appeals processes should be easily accessible. MassHealth should establish a single source of information and accountability for under-service through an ombuds program model.

Member Engagement at Multiple Levels


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