OK folks, so here’s how this started. On Monday, my longtime friend and former state senator Ed Burke, sends an email telling me that Beth Israel Deaconness CEO Paul Levy started ablog and I should check it out. So I did and we mentioned it on Monday. Paul is grateful for the plug and opines that he’s eager to provoke responses in the less-than-adulatory category. Ever eager to help, I took up the challenge and made this post later this week.

I think we may have started something. So Paul responded to our posting yesterday. I’m reprinting his response in full below without comment or response and will save that for later.

So, dear readers, c’mon now and weigh in. What do you think? Has Paul put my in my place? Is he missin’ somethin’? Let’s see where this goes — and you help out…
John McDonough

Well, I asked for criticism and am pleased to have it, but I think the commenter has it wrong. The current system is not great for BIDMC, by any means. We are lucky to make any operating margin at all in the current system, and we are intensely involved in looking for ways to make our hospital more efficient and deliver higher quality care. If you think that we don’t need budget discipline and financial accountability in the current environment, you are way off base. Further, part of our approach is to encourage low acuity patients, those who do not need high-level tertiary care, to be seen in community hospitals.

Yes, when Medicare rates go up only 2%, well short of the inflationary pressures we face in supplies, pharamaceuticals, and salaries of nurses and rad techs, we try capture the shortfall from other insurers. And, it is a good thing they are there, or else we could never deliver the quality of care to Medicare recipients that they deserve and expect.

That being said, the increase in healthcare costs is not, for the most part, a result of growth in hospital costs. It comes from the large increase in drug-related costs and from the greater utilization of out-patient procedures that didn’t exist years ago.

As far as value delivered, please recall that the major advances in diagnosis and treatment of disease originate at academic medical centers like Beth Israel Deaconess. Payments for clinical care generally do not support that important research. It is supported by federal grants from the NIH and by philanthropy from generous people.
Paul Levy

Today the Connector Board approved the last round of materials necessary to prepare for Commonwealth Care. With only three days left until October 1st, we’ve entered the final countdown. After reviewing a last set of contracts and regulations, the Board gave the all clear and Executive Director Jon Kingsdale said Commonwealth Care is ready to be launched.

Readiness Update
Connector COO Rosemarie Day told the Board that all systems are “Go” from the administrative end. She said all the software has been checked and they will be able to accept enrollees through the Virtual Gateway starting October 1. Eligible individuals should get letters this week alerting them to the launch of Commonwealth Care, and next week they will receive enrollment materials.

Board members wanted to check that certain systems were operating properly. Dolores Mitchell wanted the staff to track where people had heard about Commonwealth Care, so that information could be used later for outreach. Celia Wcislo asked to have staff call enrollees to facilitate the process. Rosemarie said that they would be sure to do so for Phase II (enrollment of people with incomes from 100%-300% fpl), and would try to do so for Phase I (enrollment of people with incomes below 100% fpl). The Board will get biweekly reports about the progress of enrollment, and about what types of concerns enrollees have when they call customer service.

Rosemarie then briefed the board about the Phase II contract with Maximus, which will operate customer service and handle premium billing. The contract is worth $9.6 million, assuming that 100,000 people enroll in Commonwealth Care. If more people enroll the cost will be larger, if fewer enroll, it will be lower. Celia asked about Maximus’ language capabilities and about whether they provide health insurance to their employees. Rosemarie verified that the customer service representatives speak Spanish and have access to a language line, and they do have health insurance. Jon Gruber raised a concern about giving Maximus a competitive advantage in bidding for future contracts if the have exclusive access to customized software. The Board discussed the possibility of making the software public, but did not reach a clear resolution of the issue. The Board then agreed to the contract.

Regulations
The Board knew that it needed to approve some portions of the regulations for the launch to work properly, but was concerned with other parts that were not essential to the launch. The provisions that were cut included two criteria for hardship waivers, a section about excluding some people from eligibility, and references to plan type V.

Chip Joffe-Halpern suggested that the Board reinstate the option of payment plans for people who fall behind on their premium payments. The Board strongly supported this addition.

The biggest concerns centered around the hardship waivers. The draft mirrored MassHealth regulations which allow the agency to waive premiums if an enrollee has extreme financial hardship due to a number of specific factors. Board members raised concerns about the criteria regarding percent of income spent on medical expenses and significant, unexpected increases in essential expenses. The Board decided to strike two these criteria for the time being and refer them to a committee. Celia raised, and Julie Bowler echoed, a concern about whether enrollees with hardship waivers would still be responsible for co-pays. Executive Director Jon Kingsdale said that as the regulations stand, the hardship waiver removes the enrollee’s responsibility for premiums, but not for co-pays. Celia made sure to confirm that the Board will address the hardship issue again and in more detail.

The Board also discussed and resolved a variety of other concerns about the regulations. Celia made sure that the definition of families was modified to include two adults with no children. The Board decided to strike section 3.09, which excluded people who get coverage through certain other sources, for example fishermen and students. The Board wasn’t sure if they had the statutory authority to make this exclusion, and weren’t sure they wanted to make it if they did. The Board decided to discuss this issue further and return to it later. Celia also raised the related concern that employer-offered plans that leave people underinsured should not make people ineligible for Commonwealth Care.

Insurance Commissioner Julie Bowler was concerned about the about 60-day “free look” provision, which allows enrollees to switch plans soon after enrollment. EOHHS Secretary Tim Murphy (sitting in for Beth Waldman) said this is an important provision for protecting people who are auto-assigned, and the Board decided to keep it. Chip asked that the 10-day notice of termination for non-payment to be extended to 14 days, and since the staff did not object, the rest of the Board agreed. The Board corrected a few other minor problems, then passed the regulations.

MMCO Contracts
Patrick Holland gave the board a presentation about the MMCO contracts. He began by discussing the negotiation process used to develop the contracts and mentioned that the prospect of auto-assignment based on lowest price was very helpful for keeping the bids low. He also noted that coverage will be provided to the entire state; of the 38 service areas, 28 have three or more plans and only 7 have only one plan. Patrick then presented the capitation rates, which range from about $275 to $390 depending on plan type and geographic area (see page 13 of presentation). Next, Patrick explained the auto-assignment process: any MMCO whose rates are within 3% of the lowest bidder will receive a portion of the auto-assigned enrollees (see page 17 of presentation). Finally, Patrick discussed the risk sharing provisions in the contracts. He noted that the risk sharing allowed the MMCOs to offer lower capitation rates and helped offset uncertainty. One form of risk sharing is aggregate risk sharing, under which the Connector will share half of the MMCO’s costs if it is more than 5% above the expected level (also, the state would share in the savings if costs fall more than 5% below the target). Another form of risk sharing is specific stop loss, under which, if the costs for a specific enrollee exceed $150,000, the rest of the cost will be covered by a pool of funds contributed by all the MMCOs. Each MMCO will pay 1.25% of the monthly capitation payment into the pool. The final risk mitigation strategy was to allow plans to cap enrollment. This can only be done after March 31, 2007, and only if the MMCO shows that further enrollment would cause undue financial hardship and the MMCO agrees to cap all plan types.

As Patrick presented, some board members raised concerns about the contracts. Most significant was Celia’s concern about ensuring that all enrollees have adequate access to care. Patrick assured her that all plans must have a hospital within 15 miles or 30 minutes of all enrollees or have two open primary care sites. After Patrick’s presentation, the Board voted to approve the negotiated agreements with the MMCOs.

Closing comments
At the close of the meeting, Chip, who works with uninsured people in his regular job, told the story of a couple he had met recently. The husband worked, but his employer had stopped providing insurance. The wife got insurance through her employer, but when she was incapacitated, she lost both her job and her insurance. They were covered by MassHealth for a time, but when they began receiving social security payments, they lost their MassHealth eligibility, and they won’t be eligible for Medicare for two more years. But they will be eligible for Commonwealth Care, and Chip was able to tell them they could enroll in January. The husband was so happy he was in tears. Chip reminded the board that helping people like this is what Commonwealth Care is all about.

Eric Benson

Today I attended a meeting of the private market merger commission. (This was the first full Commission meeting we knew about in advance, and not the first meeting of the Commission.) The meeting was a contrast to the Connector Board meeting going on at the same time. No buzz, no media, no debate, no health care who’s who, no “see and be seen” scene and no shortage of chairs.

There were plenty of empty chairs. Only 2 of the 9 commission members were in attendance (Rina Vertes and Gary Lin) and 2 others represented by designees: Nancy Schwartz, chairing the meeting on behalf of Commissioner Bowler and Paul Rumler, who was sitting in for Sen. Wilkerson. There were three people representing the team chosen to conduct the study mandated by health reform, and four in the audience.

Study Team Chosen: We learned that Gorman Actuarial has been chosen to conduct the study of the merger of the small and nongroup insurance markets. The Gorman team includes Steve Tringale (a local and highly respected health industry expert) and Elinor Socholitzky who will assist with policy interpretation. Also involved is Charles DeWeese of DeWeese Consulting, Inc. The team, led by Bela Gorman, seemed daunted by the task of pulling together such a comprehensive report under a tight timeline, and very capable and eager to be involved with a project this complex and interesting.

How to Get the Data: Gorman reported that the insurers and intermediaries have been asked to submit data within three weeks. The obstacle of having to go through intermediaries has delayed the time line by a week, and the group still hopes to complete the study by their December 1 deadline.

Who Counts: Only six major insurers have been asked to submit data. There was a short discussion about this, with consensus that those were the only insurers from which they were likely to get data and that they are carriers for more than 80 percent of the market, but a firm decision was deferred until there could be a quorum.

The Big Questions: The group agreed to have a longer meeting two weeks from now to discuss assumptions. This should be an important meeting. I’m hoping to learn how they will consider decisions of the Connector Board regarding the affordability standard for the individual mandate. If the Board votes to exempt certain income groups from the individual mandate, it will impact takeup rates, the average health in the risk pool and premiums. I hope that they are watching the Connector and that the Connector is watching them. (We’re happy to facilitate, of course.)

Future Meetings: The Commission agreed to meet every Thursday at 10. (conflicting with Connector Board meetings) Next week’s meeting will be a short update. The following week, the Commission and the study team will discuss the sticky issue of assumptions. We will post any material we can to our web site and keep you posted.
Melissa Shannon

Folks at the Commonwealth Health Insurance Authority have announced an event at 10:15 am on Monday, October 2nd at the Neponset Community Health Center in Dorchester to launch enrollment into the Commonwealth Care Program.

“This event represents the culmination of much work toward health care reform in Massachusetts. Please join us to kick off the new program.”

Word is Governor Romney will be there and possibly the Speaker of the House Sal DiMasi. No word on the Senate Pres or the LG.

Beth Israel Deaconess CEO Paul Levy is delighted we mentioned his blog here the other day. He also wrote regrets that comments on his site have been too non-critical. So let’s give him his wish for some non-adulatory comments. Here’s Paul’s recent post about what some consider a hot issue: should we create a Canadian-style single-payer health system (US or Massachusetts): http://runningahospital.blogspot.com/2006/08/single-payer.html

“…a government-controlled single payer system would inevitably face budgetary pressures and would shift costs to providers, suppliers, and patients, and would ultimately lead to rationing of services and a slowing down of innovation. I’m not saying the current US system is ideal, but at least it offers the possibility of competition among insurance companies and gives my hospital a chance to negotiate better reimbursement rates in return for offering higher quality and better value to consumers than my competitors provide.”

Lots of single payer fans advance the idea that opposition to single payer only comes from the big bad health insurance industry and that’s why we don’t have it. Paul’s post bursts this balloon and makes clear something important – it’s not just insurers, it’s hospitals, physicians and other providers. Why? Because health care providers do better under our messed up, deregulated, market-based multi-payer and fractured system when they can play payers off each other, and make up losses from one by jacking up prices from others. Their worst nightmare – a single payer with real power to create financial accountability and budget discipline. Even more than the power of the insurance industry, that’s a key reason single payer is not on the horizon.

A one payer or regulated multi-payer system – regardless of administrative savings – is anathema to providers. It’s refreshing to see Paul put it into words – more than a few hospital CEOs pay convenient and disingenuous lip service to single payer and they would run quickly in the other direction if faced with a real single payer plan and it’s budget constraints.

Here’s the real reservation. Paul’s field of vision seems to end at Longwood and Brookline Aves. Yes it’s undoubtedly great for Beth Israel Deaconess and other hospitals that their revenues can grow at 2/3/4 times the rate of inflation. How sustainable is this? Is this good for society? Are we getting real value for these massive infusions of money?

Back in the 1960s, Nixon’s economic advisor Herb Stein said unsustainable trends can’t go on forever. What other societal needs get pushed aside to pay the tab for our extra heavy dose of hospital services? Has Paul seen the latest report from the Commonwealth Fund on how astoundingly and embarrassingly mediocre our US medical care system is?

Paul’s a former regulator and MWRA head, so he understands government vs. private in a highly sophisticated way. It would be great to see him apply those keen insights to health and medical care beyond the economic self-interest of Beth Israel.

Kaiser Family Foundation and the Agency for Healthcare Research and Quality surveyed 1,216 adults in the U.S. about quality of healthcare and patient safety.
Some highlights:

• 51% said they are dissatisfied with overall quality of health care and 41% are satisfied.

• 36% have seen info in the past year comparing the quality of health plans, hospitals, or doctors, and about half (20% of the overall population) have used the info to make care decisions.

• 60% said coordination of care among their health care professionals is a problem, and 26% say it is a major problem.

• Many individuals have taken steps to coordinate their own care. EG: 34% report they or a family member have created their own medical records to ensure that all medical info is in one place. 54% have ever brought a list of all their medications to the doctor’s office with them.

• After being read a common definition of “medical error,” 43% said that they think preventable errors are made very or somewhat often. 48% believe preventable errors are more likely to be made by individual physicians than by the institutions where they work (36% believe the institutions are more likely to make the errors).

• 87% said doctors should be required to tell patients if there was a preventable medical error resulting in serious harm. 87% support required reporting of serious medical errors. 63% say if errors are reported, the information should be released to the public.

This survey makes clear the need to bring an active consumer voice to health care quality improvement. Consumers are concerned about the quality of their care and many are taking thier steps to improve the quality of care they receive. We at HCFA believe many consumers are ready to take the next step and help improve quality of care at a systemic level.
Deb Wachenheim

Check out our minutes of the last Connector Board’s Outreach Subcommittee meeting, including the draft seals of approval that were distributed to meeting attendees. Click here to view the minutes.

Every late September, the Kaiser Family Foundation releases a report on health insurance premium increases. Click here to link to the Health Affairs article. The chart above is one of the most reproduced charts in US health policy — updated every fall. A picture is worth a thousand words, and this one is worth more than that. The data reflect premium increases from spring 2005 to spring 2006.

Good news: for the 3rd consecutive year, the rate of increase is down, now about where it was in the year 2000 when people began complaining about premium increases again. The magic number is 7.7 percent — the increase in the average family coverage premium.

Bad news: for at least the 8th consecutive year, increases in health insurance premiums outpace increases in overall inflation and workers wages — even though the discrepancy is narrower than any year since 2000. Since 2001, premium increases for individual coverage have gone up 81 percent and for family coverage 59 percent, while the average deductible has increased by 60 percent.

And enrollment in “consumer driven” products? Up by modest amounts at best.

Click here to get the executive summary of final report from the Citizens Health Care Working Group. The creation of the Group was authorized in 2003 by Congress in the Medicare Modernization Act. The Group has been working like crazy for 18 months to come up with consensus recommendations on reforming the US health care system.

What’s not to like? Nothing from what we see. Good process involving feedback from thousands of ordinary Americans. Solid recommendations for universal coverage, cost control, and quality improvement. Will it make a difference? Who the heck knows? They deserve credit and thanks for trying.

Just heard about this. Beth Israel Deaconess President and CEO Paul Levy has started his own blog this past August. Click here to see it. He weighs in on weighty topics such as single payer (he’s against it) and SEIU 1199’s union drive (he’s not wild about that either). He draws a fair number of comments, though not many from critics. Worth checking out. Maybe he’ll kick off a trend among other hospital CEOs.

You read it here first: The Connector Board is meeting on Thursday morning, September 28, scheduled from 9:00 am to 12:30 pm.

The meeting is in the State House, room B-1.

The agenda includes a readiness report on the rollout of Commonwealth Care next week, and votes on the Maximus customer service contract, regulations on enrollment, appeals, premiums, benefits and copayments, and the contracts with the Medicaid MCOs.

We will try to get the meeting documents on our Connector web site (www.hcfama.org/act) as soon as possible.

The Special Commission to study the merger of the Non Group and Small Group Insurance Markets will meet on Thursday September 28th from 10 to 11:30 at the offices of the Division of Insurance (One South Station, Boston). We understand the Commission is weighing the three proposals from firms wishing to do the merger study, and that they will vote on their choice at this meeting.

The market merger is an important piece of health reform to keep an eye on. Changes in the private insurance market impact not only those who are currently uninsured who will need to purchase insurance, but everyone currently in the individual and small employer markets. The merger will also play a role in the structure and success of the non-subsidized Insurance Connector plans for folks with incomes over 300 percent of the poverty level.

Come to let the Commission know that you care about the private insurance pieces of health reform!

For 20 years now, John Kitzhaber has been one of the most interesting individuals in U.S. health policy. An emergency room doc, Oregon State Senate President and two-term Governor, he was the force behind the Oregon Health Plan which combined a major expansion in Medicaid eligibility with a priority list of services that would — and would not — be provided to Medicaid enrollees.

Kitzhaber’s on a new kick now — to get federal agreement to give Oregon all the dollars spent on health services in the state (Medicare, Medicaid, lost revenue from tax deductibility of health insurance, and more) and allow Oregon to develop a whole new system from the ground up — details of that to come after permission for the dough is granted.

On many levels, sounds screwy, and on another level, makes huge sense. Judge for yourself — click here to visit Kitzhaber’s Archimedes Movement website.

Kitzhaber also has a web-flick outlining the principles behind the new effort. Click here for the 1:36 youtube preview. Click here for the piece on the Health Partnership Blog that links you to the entire 44-minute video.

Any of our readers have any takes on this? Is anyone booking Kitzhaber to come to town? Should we check this out? What do you think? Want to know more???

With the October 1st start date for the first phase of enrollment into Commonwealth Care - no-cost coverage for uninsured adults at or below the poverty line - the Connector and MassHealth have released a number of information resources for providers, enrollment workers, and the public.

On this page are a number of helpful items, in several formats, including:

• The cover letter and program information (English and Spanish) that will be sent out to current Pool-eligible people at or below 100% of the poverty line, informing them of their eligibility for Commonwealth Care. About 50,000 people will get these letters, starting in October amd going through December.
• A “Frequently Asked Questions” that presents a good overview of the basics of the Commonwealth Care program.
• A letter to providers about eligibilty codes and notices

Also available is a detailed powerpoint presentation being used in training providers about the program.

Altogether, this information will answer many (but not all) of the myriad questions everyone is asking about the program.

Brian Rosman

The Quality and Cost Council met on Wednesday, September 20, with a spare agenda devoted mainly to organizational issues.

The first topic was dividing into subcommittees. Council chair EOHHS Secretary Tim Murphy sent a detailed memo to Council members proposing 4 subcommittees: health care quality, health care cost and data collection, public communications, and governance and administration.

There was some discussion of the subcommittee breakdown. Charlie Baker asked what are the goals of each subcommittee, and Tim answered that each group’s first task would be to frame its own charter. Charlie volunteered to provide Harvard Pilgrim’s template for the task.

The communications subcommittee is supposed to make recommendations around the Council’s web site, required by the statute. The members discussed the relationship of the council’s web site and the existing EOHHS website (www.mass.gov/healthcareqc). Charlie Baker laid out the options – two independent web sites, either complementary or overlapping, or one web site that is operated by EOHHS and the Council.

Inspector General Greg Sullivan reminded the members that the Council is an independent entity, and must have its own site. Murphy responded that no funds are available for the Council, with all of the $10 million appropriated for health care reform implementation already allocated to other agencies. Sullivan replied that the $10 million is supposed to include the Quality and Cost Council (he’s right, according to line item 1599-2006, which states “the secretary shall transfer funds from the sum appropriated herein for the cost of the health care quality and cost council in fiscal year 2007”).

The Council voted to set up the 4 suggested subcommittees, with data collection being part of the charge of both the quality and cost groups, based on a discussion between Bob Siefert and Charlie Baker. Volunteers signed up for the various subcommittees, which are to meet in the next month. Their meeting are also subject to the open meeting law, and we’ll announce their meeting on the blog if we get advance word.

Next, EOHHS General Counsel Kristen Apgar discussed the requirements of the state ethics law, which undoubtedly applies to the Council members. The Council authorized a letter to be sent to the Ethics Commission seeking guidance.

Finally, the Council authorized formation of the 28-member Advisory Committee established in the statute. They will review the proposed performance benchmarks and other reports. The statutory framework for both the Council and the Advisory Committee are laid out in this document distributed for the meeting.

Brian Rosman

In case you haven’t seen it, the new Commonwealth Fund report on US health system performance, published by Health Affairs, is essential reading. Click here to see it. Here’s the summary:

The United States has many of the world’s best-equipped hospitals and most highly specialized physicians. At 16 percent of gross domestic product (GDP), U.S. health spending is double the median of industrialized countries and since 2000 has been growing more rapidly than before. Yet the United States is the only major industrialized country that fails to guarantee universal health insurance; coverage in this country is deteriorating, leaving millions without affordable access to care. The U.S. health system also is not the best on quality of care, nor is it a leader in health information technology (IT).

“Room for improvement.” Guess if you can’t say anything nice…

Seriously, shouldn’t consumers be mighty angry that we spend so much money on medical care and get such lousy results? We just keep putting up with it.

So, let’s ponder larger questions related to Kerry Healey’s new health agenda (5 out of 50 “tough smart solutions“…)

First, if this is all she has to offer on health care, we should all pull a Dickens on her: “please ma’am, we want some more…” Cuz these five underwhelm in contrast with the scope of health system problems facing the Commonwealth. Let’s hope the LG has more up her sleeve than these meager pickins.

Second, hmmmm, nothing to say about Massachusetts health reform (Chapter 58). Nothing? Gov. Romney’s premiere legislative accomplishment. A major challenge for the next Governor, whether Kerry, Deval, Christy or Grace. Nothing tough or smart to say? Oh, well.

Third, attacking health care costs? Not with this list. Lucky for the LG, she can say, “I’ve put out detailed proposals to bring health care costs under control” and 99,999 out of 100,000 won’t ask what those proposals actually do.

Fourth, how about the fastest growing insurance phenomenon in Massachusetts, the rising tide of “underinsured,” folks whose family budgets are straining under the weight of deductibles, co-pays and co-insurance. Any tough or smart solutions for them? Boy, could they use them.

Electronic health records, administrative costs, quality improvement, racial and ethnic health disparities, pay for performance, hospital acquired infections, obesity epidemic, substance abuse prevention — so many opportunities for genuine tough and smart solutions.

Is this all there is?

Today, MA LG and Republican Gubernatorial Candidate Kerry Healey released 50 “Tough Smart Solutions to Change Massachusetts.” Click here to view. As her first set of detailed policy proposals, we were curious which ones related to health care. Five deal with health care and five deal with beating up on illegal immigrants.

Here are the five health items:
#13: Keep doctors in Massachusetts and reduce health care costs by adopting medical malpractice reform.
#21: Lower health insurance costs for cities and towns by allowing them to purchase coverage through the state.
#29: Reduce health care costs by helping consumers comparison shop for treatments and facilities.
#30: Require state government employees pay 25 percent of their health care premiums; a rate that is in line with the private sector.
#40: Provide tax incentives for individuals who care for their elderly relatives at home.

Quick reacs on each one:

#13: Keep doctors in Massachusetts and reduce health care costs by adopting medical malpractice reform. Details include: 1. Reform current $500,000 cap on non-economic damages…2. Tighten the state’s current medical tribunal system…3. Allow medical providers to disclose and, if appropriate, apologize…4. Reduce lawyers’ fees…

Comments: Pretty timid and vague overall. Impact on reducing health costs – minimal to non existent. By the way, limiting non-economic damages hurts low and middle income victims of medical negligence. Rich people by definition have more economic damages when they are injured in medical care and can sue for lots of money. Lower and middle income victims, housewives, children, disabled folks have much lower economic damages. Pretty anti-consumer, especially when there’s nothing in the platform to address the epidemic of medical errors. Item 3 – apologies – good idea. We’re thinking of backing this one.

#21: Lower health insurance costs for cities and towns by allowing them to purchase coverage through the state.

Comments: As Healy notes, a promising process is already underway inside the State House on this topic, involving municipal officials, unions and the Group Insurance Commission. If they reach agreement, this will happen legislatively regardless of who is governor. By the way, cities and towns have been able to do this since 1991, and no city or town has taken up the option. The question is whether cities and towns are able to join the existing pool of state workers or whether they have to create a separate risk pool, which saves them nothing. Existing unions in the Pool have resisted allowing the munies into the larger pool and that’s where movement may occur.

#29: Reduce health care costs by helping consumers comparison shop for treatments and facilities.

Comment: Gee, maybe no one told the LG, but the Romney Administration has been taking credit for doing this for about a year now. Click here to see the site. If LG Healey wants to propose something radical, ask the Romney Administration to ask consumers why none of them are using this site.

#30: Require state government employees pay 25 percent of their health care premiums; a rate that is in line with the private sector.

Comment: Proposed every year by the Romney Administration (and his three Republican predecessors), and rejected every year overwhelmingly by the Legislature. Something new here?

#40: Provide tax incentives for individuals who care for their elderly relatives at home.

Comment: In July, Legislature passed and Gov. Romney signed major senior choice law allowing Medicaid dollars to follow the senior, whether they choose home or nursing home. No mention here of the new law or the cost of this proposal. Also no mention how big the tax incentives. Some smart person should ask Healy for a cost estimate of this one. Could be quite large.

Next blog – let’s explore what’s not on Healy’s radar screen.

Last week, HCFA’s E-Health Consumer Advocate, Lisa Fenichel, participated in a meeting, “Developing the Consumer Agenda for Health Information Technology,” sponsored by the United Hospital Fund, located in the Empire State Building. She and nine others, who are involved in health privacy, health information technology, and their intersection, spoke about the national scene, including legislative issues and governmental priorities, and state and regional HIT initiatives.

Representatives from organizations in California, New York, Washington, D.C., and Massachusetts (Lisa) compared their progress in and problems with getting consumers and advocates involved in shaping the e-health agenda. The big issue that all groups are struggling with is how to make e-health issues relevant, understandable, and engaging to consumers.

The participants also focused on the absence of policies to direct and frame the networking of e-health records. Without such policies, progress will be very limited. Everyone agreed that the Common Framework that Connecting for Health devised is a useful tool for framing the policy discussion, and there was talk of coming up with a legislative agenda based on the outlined principles.

The group expressed great interest in the E-Health Consumer Summit, which was held at HCFA this past June 23, and noted that HCFA is the only organization known to these participants to have an E-Health Consumer Advocate!

In the new MA health reform law, the House and Senate agreed to restore coverage for dental services to 650,000 MassHealth adults. Gov. Romney vetoed the restoration and the House and Senate overrode the veto. Coverage was restored in early July. Keep that in mind when you read excerpts from this article in today’s Wall Street Journal on how health plans across the nation are saving money by investing in good oral health.

Amid mounting evidence linking poor oral hygiene to a range of expensive medical problems, health plans are starting to cover more dental treatments and preventive services. The idea, insurers say, is that paying for certain services now, such as additional cleanings, gum treatments and prescription mouth washes, can reduce the incidence of other health problems down the road. A number of studies suggest that early prevention and treatment of gum disease may result in significantly improved outcomes for pregnancy, heart disease and diabetes, often leading to substantial medical-cost savings.

Many of the insurers’ enhanced benefits are focused on people with these health risks. Cigna Corp.’s Oral Health Integration Program, implemented earlier this year, covers additional deep cleanings known as scaling and root planing during pregnancy at no extra cost, or an additional regular cleaning (over the usual two a year) for pregnant women who don’t require scaling and root planing. A similar benefit is available for patients in Cigna’s diabetes and cardiac-care disease-management programs.

In March, Washington Dental Service, a member of the Delta Dental Plans Association, introduced enhanced benefits, including coverage of antimicrobial mouthwashes for pregnant women, to its members in 2,000 companies in the state. Aetna Inc., with 8.8 million members who have both dental and medical coverage, has conducted pilot programs designed to get pregnant women and people with chronic disease to visit a dentist. The company expects to offer a third regular cleaning each year, or additional deep cleanings as needed, to all such at-risk patients next year.

“We can save medical costs by getting people to have dental care at the right time in their lives,” says Glenn Melenyk, dental consultant at Blue Cross Blue Shield of Michigan in Detroit. The insurer, with 1.1 million dental members, started pilot programs in 2005 that cover an additional regular cleaning per year for diabetics and heart patients. In July, it expanded the pilots to include pregnant women who obtain a coupon from their obstetrician.

The enhanced benefits come at a time when many employers are under pressure to cut medical costs. But some big employers are signing on. Ford Motor Co. and Kellogg Co. are among those offering benefits in Michigan via Blue Cross Blue Shield, and Pacific Research Laboratories and KCTS Public Television are participating in Washington Dental’s enhanced benefits. Some health plans, including Michigan Blue Cross, Washington Dental and MetLife Inc., are offering the extra coverage at no additional cost to employers or employees. Washington Dental says it achieved this by cutting back coverage of other services for which there is less evidence of benefits, such as routine X-rays. (Currently, insurers say, dental care makes up only about 4% of employers’ overall health-care budget.)

Costco Wholesale Corp. of Issaquah, Wash., earlier this year participated in a pilot with Aetna Medical & Dental, in which nurses called employees with diabetes or heart disease or who were pregnant, to encourage them to visit a dentist. Donna Sexton, Costco’s director of employee benefits, says nurses reached about 2,200 of Costco’s more than 153,000 Aetna members. About 36% of them have indicated they would go see a dentist as a result. That is “pretty good compared to other types of outreach,” Ms. Sexton says. “The bottom line is, if it helps the health of the baby, or the health of an employee or dependent improves, there will be an overall reduction in costs.”

Insurers who offer both dental and medical-care coverage say they expect that spending more on preventive dental care will yield big savings on the medical treatment of costly chronic illnesses. Insurers that offer only dental coverage expect to save money on periodontal surgery. Stand-alone plans also say they want to be more attractive to workers, who increasingly have to pay all or part of their dental-insurance costs themselves as more employers make group dental a voluntary rather than an employer-paid benefit.

The emphasis on preventive care is the result of an increasing number of studies linking oral health to general health and well being, dental specialists and insurers say. The reasons for the connection aren’t fully understood. In the case of preterm births, bacteria around the tooth root may cause the body to produce a substance that induces labor. The evidence suggests that the same bacteria in the mouth can provoke the body into producing factors that clog arteries, worsening heart disease and stroke risk. With diabetes, any inflammation in the body makes controlling blood sugar more difficult, according to Kenneth Krebs, president of the American Academy of Periodontology.

A two-year study of 144,000 insured patients by Aetna and the Columbia University College of Dental Medicine released in March found that earlier periodontal treatment reduced overall medical-care costs by 9% for diabetes, 16% for coronary artery disease, and 11% for cerebrovascular disease, or stroke. Another recent study of pregnant women with a serious gum disease published in the Journal of Periodontology found that early treatment with scaling and root planing (which removes plaque and tartar from around the tooth root) reduced preterm births by 84%. Additional research is under way to try to explain the association between these illnesses and periodontal disease.

Gum disease is a common health problem in the U.S. More than three-quarters of the adult population over the age of 35 eventually suffer from some type of it, ranging in severity from inflammation and sensitivity, to advanced periodontitis, a serious gum infection that can lead to tooth loss. Some insures are also now covering topical or injected antibiotics for gum disease.

In addition to preventive treatments, some insurers have also begun offering more coverage of costlier advanced treatments for missing or damaged teeth. Some employers are looking to offer dental implants and newer filling materials, say the insurers, because workers are demanding the latest technologies. Principal Financial Group Inc. will introduce new supplemental benefits by mid-2007, including coverage for dental implants, for employers who pay for it, according to company officials.

A number of insurers, such as Guardian Life Insurance Co. and Cigna, have created new ways for consumers to increase their coverage limit for extraordinary expenditures such as root canals and dentures — for instance by allowing consumers to “roll over” unused dental allowance from previous years. More plans also cover composite or “white” fillings at the same level as metal fillings, says Sally Cram, a periodontist in Washington, D.C., and spokeswoman for the American Dental Association.

Some insurers, including Guardian, Cigna and Principal Financial Group, are offering to cover dental implants as an alternative to traditional partial dentures or bridges. Titanium dental implants, which are tooth-root replacements surgically placed in the jaw, have been regarded as experimental though they have been used for more than 20 years, and rarely were covered by most health plans. Many plans have based payments on the least-expensive treatment that can be used. A single tooth implant costs $4,000 to $5,000 with surgical placement and restoration; traditional bridgework to replace a missing tooth costs about $3,000, according to Richard Goren, national and group dental director of Guardian.

But implants are in increasing demand because they work better for people who have lost bone mass, or who have only one or two missing teeth, and they last longer than bridgework, dentists say. “More than half our new customers [employers] have requested it since June 2005,” says Dr. Goren. Most insurers that include implants cover them at 50% of cost, says the American Academy of Implant Dentistry.