The Connector Board met today to discuss current and future priorities for Commonwealth Care and Commonwealth Choice, and engaged in a robust discussion on allowing individuals with unaffordable employer-sponsored insurance to join CommCare.

The Board also voted and approved a new contract with Health Management Systems which will conduct insurance investigations on CommCare applicants and enrollees. All Board members were present, except a very sick Celia Wcislo (feel better, Celia!).

You can find the materials from the meeting here. Click on the “more” below for the our detailed report on the meeting.
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From today’s Kaiser Health Policy Report via the Wall Street Journal:

The “boom” of walk-in health clinics at pharmacies, supermarkets and retailers “is showing signs of slowing.” As of May 1, there were 963 retail clinics in the U.S., compared with 125 three years ago. However, some retail clinic operators recently have closed 69 clinics in 15 states, and others, including CVS Caremark, have announced their intentions to scale back clinic expansion plans.

Tom Charland, owner of Merchant Medicine and a former vice president for strategy at CVS’ MinuteClinic, said, “We have seen fallout in this industry, on a smaller scale, that is not unlike the dot-com bubble,” adding, “The big mistake was for people to think they could reach break-even in six months. People are learning this is an 18-to-24-month process to get to break-even.”

On June 4 & 5, oral health providers, advocates, and community leaders will convene at the Sturbridge Host Hotel for an important dialogue about oral health in Massachusetts.

Oral health is a critical part of overall health; you can’t have a healthy body without a health mouth. Dental decay is the most common chronic childhood disease, and is linked to a higher risk for heart disease and diabetes later in life. Dental disease contributes to more than 51 million missed school hours and 104 million missed work hours every year. Fortunately, dental disease is almost entirely preventable when communities make better oral health a priority. We have the solutions, now we need action.

Join us in Sturbridge for the first of a series of sessions over the coming months as the MA oral health care community takes up the Surgeon General’s Healthy People Call to Action. Together we will define plans and specify activities and programs to promote oral health, prevent disease, and reduce disparities in Massachusetts’ oral health care needs.

This summit is free of charge, and registration and the agenda are available online at http://www.massoralhealth.org. Join us and make a difference for the future of the oral health and overall health of Massachusetts.

Today, the drug industry leveled its newest response to the proposed ban on gifts to health care providers (passed by the Senate last month) – more of a threat than a response. In a letter reported in today’s Herald, GlaxoSmithKline accused the state of being mean to the industry and told the Governor and Speaker that the company will reconsider its ties to Massachusetts if a gift ban is imposed. All this as the state moves to invest $1 billion in the life sciences industry.

The industry seems more interested in scare tactics than real issues. First, they argue the ban will prohibit all outreach to physicians about new drugs and kill sales rep jobs. Truth is: the ban in no way prohibits sales reps from meeting with providers and giving them product info – just no gifts. Next, they argue the ban will halt industry-sponsored research. Also not true – reasonable payments to docs in exchange for scientific and medical services may continue. Then, they complain the ban subjects physicians to stricter rules than legislators. Actually, legislators by law are banned from taking anything of value from lobbyists - the proposed gift ban subjects providers to the same rules as public officials.

Now the industry threatens to leave the state because it won’t be able to peddle promotional items, meals and gifts. Seems an extreme response to ethics standards. The Senate saw through these claims and approved a gift ban because of the proven negative impact of gifts on consumers and the state. Studies prove that gifts and payments influence prescribing decisions, increasing prescribing of newer, more expensive drugs without a proven safety and efficacy record. This drives up costs for consumers and the state and threatens quality. The industry is pulling out all stops to defeat the gift ban because they know gifts work. Gifts inflate their profits and our health care premiums.

It’s clear that the 2007-2008 legislative session won’t end with a whimper. This is turning into one of the session’s biggest fights. Please visit the website of the MA Prescription Reform Coalition for more info. This is a fight worth watching.
Lisa Kaplan Howe

First: What is Health 2.0? According to “The Wisdom of Patients: Health Care Meets Online Social Media,” issued by the California HealthCare Foundation, it can be defined as, “the use of social software and its ability to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health.” At Wednesday’s E-Health Consumer Luncheon, convened by HCFA’s E-Health Consumer Advocate Lisa Fenichel, this definition was brought to life in the presentation, “Patient Empowerment: Methods, Models, and Motivations,” by Sherri Dorfman, CEO, Stepping Stone Partners.

Through the lens of Wendy, a fictional healthcare consumer who wanted and needed to lose weight, four different Health 2.0 “products:” WeightWatchers.com, Wellcoaches.com, an employer incentive program, and BodyMedia (which uses an armband with sensors to collect the patient’s biometric information and a special watch to display it), were described and compared in terms of their social, financial, informational , and time costs and benefits.

And the winner is . . . When the participants voted at the end of the presentation for the Health 2.0 product they thought would work best for Wendy, Wellcoaches.com won handily, followed by WeightWatchers.com. Not surprisingly, those two were, in that order, the programs that depended most on human relationships to work. Clearly, technology in healthcare is most useful when it enhances the ability of people to mentor, support, educate, and empower one another. It is a powerful tool, but only a tool — not an end in itself.

Second: The World Congress Leadership Summit, “Consumer Connectivity and Web Empowerment: Transforming the Traditional Flow of Healthcare Information for Tomorrow’s Consumer,” was a daylong meeting packed with sessions focusing on the intersection of consumers and healthcare, via the web, with particular attention paid to PHRs (personal health records), patient support groups, online coaching, and hybrid models of online and in person patient-provider interactions. (Click here for presentations, using Access Code: BostonMay6.)

Many of the sessions I attended focused on the employer-provided “tethered” PHR. This secure, web-based “window” to one’s electronic health record is most robust when the employer is also a large healthcare organization whose providers are all using such an electronic record, so that information is readily available for the patient via this patient portal. The disadvantage of this model is its lack of portability — the information does not flow outside the organization. On the other hand, the “nontethered” PHR (one that a consumer owns and populates with his/her health information) has complete portability, but the burden of filling in one’s health information might prove too much for most people.

Obviously missing from most of the day’s discussions that I attended (besides consumers and advocates, that is!) until I — and then Lygeia Ricciardi, Clear Voice Consulting, and formerly of the Markle Foundation — brought it up, is the deep concern that most Americans have about their employers accessing their health information (although most employers promise that they will not). As many PHRs would not be covered by current privacy laws (if the vendors are not healthcare providers, they are not “covered entities,” according to HIPAA), and even those privacy laws are not well understood or enforced currently, some new policy and legal frameworks will have to be developed to ensure that patients are helped — not harmed — by more robust engagement that these new “products” promise.

There is much work to be done before patients and providers alike can reap the full benefits of interoperable electronic health records, but the buzz is definitely out there, and that will help engage consumers to move the process along.
Lisa Fenichel

The Connector Board’s next meeting is tomorrow, Thursday May 8th at 9am on the 21st floor of One Ashburton. Neither materials nor an agenda has been posted as of 2:30 pm Wednesday. When posted, the materials will be here.

The one item we know will be under discussion is the question of permitting individuals with an unaffordable offer of employer sponsored insurance (ESI) into Commonwealth Care. The staff will offer a presentation to the Board on the issue. On the surface, the thought of adding a potentially large group of individuals into CommCare could seem scary, and advocates are hoping the Board will think of the issue more broadly — as one with many potential solutions. Click here to see a memo to the Connector Board from some ACT!! Coalition members outlining thoughts on the issue.

Periodically, the Commonwealth issues a statement on the state’s financial condition for Wall Street types who buy the state’s bonds. It used to be available only to Wall Street folks. In a blow for transparency, the Patrick Administration now makes it publicly available. In a blow against transparency, they don’t seem to tell anyone, as far as we can tell. This time, WBUR’s Martha Bebinger found it: THE COMMONWEALTH OF MASSACHUSETTS INFORMATION STATEMENT: Dated April 16, 2008. For health junkies, the sections of interest run from A-24 to A-30. Here are some morsels we found interesting:

MassHealth:
Based on MassHealth’s most recent forecast, fiscal 2008 expenditures are currently projected to be approximately $50 million over the current fiscal 2008 spending authorization. … MassHealth’s recent forecast also indicates that fiscal 2009 costs for the program may increase between $100 million and $200 million above earlier projections reflected in the Governor’s fiscal 2009 budget recommendations filed in January, 2008. The revised estimate reflects, in large part, a projected increase in enrollment. (A-26)

Annual percentage growth in
per enrollee expenditures: (A-26)
FY 03: 11.0%
FY04: 10.0%
FY05: 0.0%
FY06: 7.0%
FY07: 4.0%
FY08: 3.0%

Commonwealth Care:
The fiscal 2008 budget included $472 million for the Commonwealth Care program. However, enrollment has been considerably higher than initially projected, and the Commonwealth currently anticipates spending for Commonwealth Care to be as much as $647 million. (A-28)

Faster-than-projected enrollment will also affect fiscal 2009 costs for Commonwealth Care. Previous enrollment estimates projected that 225,000 residents would be enrolled in Commonwealth Care by the end of fiscal 2009, a projection reflected in the $869 million allocated for the program in the fiscal 2009 budget filed by the Governor in January, 2008. However, updated estimates guided by recent enrollment trends suggest that enrollment in Commonwealth Care will be higher. A most likely estimate within a range of projections is that the program will enroll 255,000 residents by the end of fiscal 2009. This revised estimate reflects strong growth in membership and the continued challenge of estimating enrollment for this program in light of its relative newness and varying estimates of the overall number of uninsured. This enrollment projection suggests that Commonwealth Care will cost $1.082 billion in fiscal 2009, also accounting for costs associated with final bids from managed care organizations for providing plan coverage and enrollee premiums and co-payments for fiscal 2009 recently approved by the Connector Authority. Enrollment remains an area of significant uncertainty and could be lower or higher than 255,000 by the end of fiscal 2009. The cost estimates discussed above represent projections of gross funding needs for Commonwealth Care and thus do not account for federal reimbursement. (A-28)

255,000? Up from 225,000 which we also thought was high. $1.082B for CommCare for FY09? Up from $869M in the Governor, House and soon-to-be released Senate budget plans.

On Tuesday, the Mass. Senate will be taking up tax legislation that includes a $1.00/pack increase in the cigarette tax. The bill passed the House in early April.

HCFA and the ACT!! Coalition, working with Tobacco Free Mass, strongly support the proposed tobacco tax increase. As we’ve said before, tobacco taxes provide stable, predictable revenue, and also reduce smoking, particularly among teens.

Some see this as a contradiction, an oxymoron. But there’s no contradiction. Smoking levels do predictably decline - about a 4% drop for every 10% increase in the retail price. But the increase in the tax rate more than makes up for the decline in sales. In fact, every state that has passed a significant increase in the tax rate has seen an increase in revenue.

Cutting tobacco use improves public health, reducing health care costs and saving lives. A comprehensive study detailed the savings to our health and our health care budget due to a $1.00/pack increase:

• Preventing more than 46,100 Massachusetts kids from becoming addicted adult smokers
• Prompting more than 25,800 current adult smokers to quit for good
• Saving more than 21,500 Massachusetts citizens from dying prematurely from smoking
• Cutting future public, private sector, and household health costs in Massachusetts by more than $1.0 billion
• Reducing future state MassHealth program expenditures caused by smoking by more than $173 million.

Our current tax rate of $1.51 is second-lowest in New England, and every New England state has increased their tax since ours was last raised. New Hampshire’s Governor has proposed another cigarette tax increase just last week.

Amendments
Senator Montigny has proposed an amendment to the tax bill to earmark the new revenue for health reform. This would assure the public that the revenues will be invested in our health care system to futher improve public health. Polls have shown increased support for the tobacco tax increase when the revenues are devoted to health reform.

Senators Baddour and Tucker have proposed an amendment to strike the cigarette tax increase. They represent towns along the New Hampshire border, and may be concerned about the loss of business to stores near New Hampshire. This concern is misplaced. In fact, following our last increase, tobacco sales licenses increased along the NH border. People are willing to drive a distance to save on the sales tax when buying a refrigerator or computer, but not for cigarettes. Interestingly, because many smokers want to ration their supply (they know it’s bad for them), smokers generally don’t go out of their way to save money on cigarettes. With gas heading towards $4/gallon, the border impact will be reduced even more.

Senator Tisei has an amendment that would strike longstanding provisions in current law that prohibit stores from using cigarettes as “loss leaders” — selling them below cost to boost sales. The loss leader prohibition makes sense, given the addictive nature of tobacco products and the continued marketing of tobacco to kids.

One other amendment to note: Senators Walsh, Jehlen and Marzilli are proposing extending the 5% sales tax to liquor, with the revenue going to Substance Abuse Health Protection Fund.
Brian Rosman

Recently, the Connector released the FY2009 Commonwealth Care premiums, effective July, 1, 2008, by region. You can find the FY2009 premium chart on the Connector’s Open Enrollment page. Each region has at least one plan at the lower cost “affordability schedule” level. The affordability schedule determines the highest premium amount the Connector deems an individual can afford. Affordability levels for individuals below 300% FPL also set the level for CommCare premiums.

For every member, there will always be a low cost option based on the affordability schedule. However, each CommCare plan will have a different network and providers in your region, and the lowest cost plan may not always be appropriate for your care.

The cost differential among the plans will also be different depending on the region and depending on your income level. We strongly encourage consumers and providers to compare premiums and the provider network in their region, and make necessary changes during open enrollment in Commonwealth Care.

One helpful resource is the CommCare Hospital Network Chart, which shows the CommCare plans accepted by each hospital.

Important Dates and Notes

• Open Enrollment for Commonwealth Care will take place from May 1 to June 13 for all members. All CommCare enrollees can switch plans for any reason.
• In July and August, premium-paying members can still call MA-Enroll and switch plans.
• If you’re satisfied with your current plan, you don’t have to do anything. You will continue to be enrolled in your current plan.
• Current members should already be getting information about open enrollment in the mail. Those who are currently paying a premium, will receive an explanation of the open enrollment process, a grid comparing the plans in their area, and notice of copayment changes.

It is important that consumers check for the availability of providers and specialists they need. You can check the Connector’s Provider Search page on their website or call 1-877-MA-ENROLL (1-877-623-6765) or TTY (1-877-623-7773) to see if your provider will be covered under the plan you’re switching. For the most up-to-date information on specific providers you need, call the CommCare plan you are interested in.

The Health Care For All Helpline can also help answer your questions. You can reach us at 1-800-272-4232.
Diana Ong

Quality and Cost Council Advisory Committee Meeting This Week
Wednesday, May 7
1:00-3:00pm
China Trade Center, 2 Boylston Street
Daley Room, 5th floor

This meeting is open to the public. The Quality and Cost Council is asking the advisory committee to provide input on its performance to date, opportunities for improvement, and priorities going forward.
Deb Wachenheim

This morning, the Boston Globe ran a page-one article dramatically illustrating the need for comprehensive reform of Massachusetts’ children’s mental health system: In teen’s memory, a mental health push.

Tragically, Yolanda’s story is not unique. Over the past few weeks, the Children’s Mental Health Campaign has been holding forums across the state to give parents and advocates the opportunity to speak directly to legislators about shortcomings in the system of care and ways to make changes. At forums in Salem, Worcester, and Orange, stories of children in crisis and unable to access needed care were shared again and again. Additional forums are scheduled for Pittsfield, Hyannis, Webster, and Fitchburg.

For more information about children’s mental health reform efforts and about upcoming forums, go to
www.ChildrensMentalHealthCampaign.org.
Matt Noyes

New report from the National Insitute for Healthcare Management: Understanding the Uninsured: Tailoring Policy Solutions for Different Subpopulations:

One in four people without health insurance in America are eligible for government-funded health coverage but have failed to sign up for any government aid program, according to a new study. The study, by nonprofit research group National Institute for Health Care Management Foundation (NIHCM), says 12 million of the nation’s 47 million uninsured could sign up for Medicaid or the State Children’s Health Insurance Program (SCHIP), but fail to do so because they are unaware of the programs or find it difficult to enroll.

Nice section in the report on various efforts in Massachusetts to create options for the uninsured. One thing NOT mentioned in the report — Massachusetts’ extensive efforts to find and enroll eligible and uninsured persons. We really doubt that one in four MA uninsured are eligible for coverage. That’s because all state stakeholders, in and our of government, recognize the need to enroll folks in coverage.

What is Health 2.0?

According to “The Wisdom of Patients: Health Care Meets Online Social Media,” issued by the California HealthCare Foundation, it is “the use of social software and its ability to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health.” At Wednesday’s E-Health Consumer Luncheon, convened by HCFA’s E-Health Consumer Advocate Lisa Fenichel, this definition came to life in the presentation, “Patient Empowerment: Methods, Models, and Motivations,” by Sherri Dorfman, CEO, Stepping Stone Partners.

Through the lens of Wendy, a fictional healthcare consumer who wanted and needed to lose weight, four different Health 2.0 “products” were described and compared in terms of their social, financial, informational , and time costs and benefits.

WeightWatchers.com,
Wellcoaches.com,
an employer incentive program, and
BodyMedia (which gives a patient information about him/herself via a biometric scanner)

And the winner is: When participants voted at the end of the presentation for the Health 2.0 product they thought would work best for Wendy, Wellcoaches.com won handily, followed by WeightWatchers.com. Those two were, in that order, the programs that depended most on human relationships to work.

The takeaway: technology in healthcare is most useful when it enhances the ability of people to mentor, support, educate, and empower one another. It is a powerful tool, but only a tool — not an end in itself.

We welcome our friends at MITSS (Medically Induced Trauma Support Services) to the blogging world. MITSS provides support to patients, families and clinicians impacted by adverse medical events. They have started a Patient and Family Blog and another blog for clinicians. You can also access both blogs through the MITSS website.

The House debated until 11:30PM on Thursday, taking up public safety and education consolidated amendments. The House added another $55.7 million to the bottom line of it’s roughly $28 billion budget, bringing the total additions to about $110 million.

A big victory for the Oral Health Task Force was the adoption of Rep. Coakley-Rivera’s amendment supporting the BEST Oral Health program. The vital pilot program, which brings oral health education, screenings, preventive measures, and referrals to preschool children in Hampden County, was allocated $75,000. Thank you to all the co-sponsors of this amendment.

The House had a lengthy debate on a proposed amendment by Rep. Hynes that would have required the Connector to authorize plans without prescription drug coverage as meeting the minimum creditable coverage standard. The ACT!! Coalition opposed the amendment, and let representatives know that we view drug coverage as integral to comprehensive medical care. Speakers in opposition included Reps Walrath, Mariano, Fagan, Straus, Kulik, and Scibak. The amendment was defeated on a 28-124 roll call.

On Friday morning, the House will take up the consolidated amendments on state administration and constitutional officers. Roll calls will begin at 11. Later on Friday, the House will take up the transportation, environment, housing and economic development amendments. The House hopes to complete the budget on Friday.
Mehreen Butt

Congratulations to the New England Alliance for Children’s Health on a successful Children’s Healthcare Summit yesterday in Lowell.

Over 90 individuals from across New England and the country attended the informative day-long event featuring presentations on NEACH’s current work and future projects. A panel of experts from Washington, DC reviewed the last year’s challenges with SCHIP reauthorization and the continuing opportunities for advocacy. Next, business leaders from across New England gave a presentation on new opportunities to engage the business community on children’s health issues. Over lunch, representatives from each New England state gave overviews of the successes and challenges facing children’s healthcare in their own state. Finally, the group broke into working sessions to strategize around building a pediatric quality of care campaign in New England.
Sarah Snyder

After tackling Veterans Services, State Finance and Assistance, and Health and Human Services, the House took up Public Health programs late last night, and passed a consolidated amendment increasing funding for a number of important programs. Increases were included for environmental health, HIV, substance abuse, and teen pregnancy prevention.

Funding for tobacco control programs was boosted by $1 million. An increase in the tobacco tax, such as the $1/pack increase passed by the House, leads to an increase in use of smoking cessation services. Tobacco prevention and cessation services play an important role in keeping Massachusetts residents healthy, and reduce long-term healthcare costs. Special thanks to Representative Kaprielian and the 22 co-sponsors of the tobacco control amendment for their spectacular advocacy.

The House also increased funding for oral health programs by $400,000, including earmarks for the Community Coalition of Cape Cod, Taunton Oral Health Clinic, and the Forsyth Institute’s Center for Children’s Oral Health. Unfortunately, specific funding for Tufts Dental Facilities was not included. Thousands of special needs residents in Massachusetts are served by Tufts Dental Facilities, a nationally recognized public program administered by Tufts University. The amendment filed by Representative Scibak would have fully funded the program so it can continue to provide essential oral health services to Massachusetts residents with special needs. An increase for the Office of Oral Health, which was cut by almost $1 million in the House Ways and Means budget, was also not included in the Public Health consolidated amendment. Representative Fagan filed an amendment that would sufficiently fund the Office. The full-time dental director in the Office of MassHealth works collaboratively with the department of public health to facilitate integration of programs to improve oral health. Thank you to Representatives Scibak and Fagan for continuing their advocacy during a tough budget cycle.

Today, the Early Education and Higher Education caucus starts at 11:30, and the session will start at 12 noon. The House will also take up the public safety and judiciary consolidated amendments today.
Suzanne Curry

The Association of American Medical Colleges (AAMC) released a report this week calling on its member teaching hospitals to implement policies to regulate relationships between staff and students with the pharmaceutical and medical device industries. The two year Task Force on Industry Funding of Medical Education found that reliance on industry for gifts and other funding “influence[s] the objectivity and integrity of academic teaching, learning and practice” and the profession has an obligation to avoid conflicts of interest.

The report calls on teaching hospitals to:
• Ban all gifts from industry to physicians, other faculty and staff and students (both on-site and off-site), including all food and meals.
• Limit visits from sales reps to non-patient areas and by appointment or invitation of the physician only. Reps wishing to provide educational information about products should be allowed to do so only in supervised group settings that allow interaction and critical evaluation and should have an advanced medical or scientific degree.
• Prohibit faculty and students from accepting payments for attending industry-sponsored meetings and accepting travel funds (other than for legitimate reimbursement or contractual services).
• Prohibit physicians and students from allowing their oral and written presentations to be ghostwritten.
• Prohibit personnel with any financial interest in the pharmaceutical, device or equipment industry from participating in purchasing decisions.
• Strongly discourage participation of faculty in industry-sponsored speakers’ bureaus.
• Establish a central office to manage donations for continuing medical education and other educational funds.
• Implement ways to provide samples other than directly from physicians – such as through a central source in the hospital.

Makes sense to us. The report was unconditionally approved by all but three Task Force members – representatives from Pfizer, Amgen and Lilly.
Lisa Kaplan Howe

Thanks to Representative Ruth Balser, chair of the Mental Health and Substance Abuse Committee, yesterday the House restored funding to the Massachusetts Children’s Psychiatric Access Project (MCPAP). MCPAP helps address the shortage of child psychiatrists in Massachusetts by providing phone consultations to pediatricians’ offices. MCPAP has been overwhelmingly successful since its creation. Currently, more than 96% of all pediatricians participate in the program. Representative Balser has been a tireless leader on children’s mental health issues and is the lead sponsor of S. 2518, An Act Relative to Children’s Mental Health.

The House added $34.5 million to the budget in elder affairs and Medicaid consolidated amendments. The Disparities Action Network achieved a major victory when the House agreed to add language creating an Office of Health Equity within the Executive Office of Health and Human Services. The language details that “the office may prepare an annual health disparities report card with regional disparities data, evaluate effectiveness of interventions, and replicate successful programs across the state; provided, further, the office shall work with a disparities reduction program with a focus on supporting efforts by community-based health agencies and community health workers to eliminate racial and ethnic health disparities, including efforts addressing social factors integral to such disparities.” The DAN would like to thank the 47 co-sponsors for their support of this office and in particular, Representatives Rushing, Fox, St. Fluer and Sanchez.

The House also continued its support of health reform by continuing $3.5 million for the outreach and enrollment grants. These health reform outreach grants go to community organizations and are critical to enrolling people and helping them maintain their coverage.

And for Wednesday, consolidated amendments on public health, veterans and health and human services are being debated. Read yesterday’s blog post for the Oral Health Task Force’s priorities. Caucus at 10 am. Roll calls begin at 12:30 pm.

PBS’ flagship NewsHour broadcast a look at implementation of health reform in Massachusetts last night. The report included Gov. Patrick, Senate Pres. Murray, the Connector’s Jon Kingsdale, Lynn Health Center’s Lori Berry, patients on CommCare, critic and frequent blog commenter Ron Norton, and our own John McDonough.

Transcript, audio and video are here.