One-Two From Patrick Adminstration

Posted on January 26, 2012 by

This week the Patrick administration reaffirmed its commitment to health care in the Commonwealth.

First, the Governor’s State of the Commonwealth speech focused on payment and delivery system reforms that will stem the rising costs of health care:

The market is moving in the right direction and that’s very good news. But it is not enough.

Too many small businesses and too many working families still go through an annual ritual that starts with notice of another premium increase, and too often ends with a new plan costing the same or more for less coverage. Slowing the rate of increase is critical, but unless that slowdown is sustained, health care costs will continue to squeeze everything else – including job growth itself.

We need to put an end to the “fee-for-service” model. We need to stop paying for the amount of care, and start paying instead for the quality of care. We need to empower doctors to coordinate patient care and to focus on wellness rather than sickness. And we need medical malpractice reform. All of this is addressed in the bill I filed last year.
…
The Legislature has done considerable work on our proposed reforms, and I want to congratulate your care and thoughtfulness. Now it’s time to act. Before you take up next year’s budget, pass health care cost containment legislation. This is another hard decision. But for the good of the Commonwealth, let’s do this and do it now.

Over the last year and half our Campaign for Better Care has been meeting with legislators, presenting all around the state, and offer public comments regarding the issues of payment and delivery reform. We emphasized that curbing costs must be tied to measures that improve the quality of care and protect the vulnerable as we redesign care. We must make a serious and robust investment in public health and prevention. We need to ensure transparency in all aspects of the health system. The savings must accrue to us, so patients can reap the benefit of a less costly system.

The Campaign for Better Care has offered specific legislative ideas (pdf) around each our patient-centered principles. If you would like to get involved with the Campaign please contact Paul Williams at pwilliams@hcfama.org.

Second, yesterday’s release of the proposed budget for fiscal year 2013 makes progress on health care coverage, public health, and cost control. While $545 million in MassHealth savings are imposed, the budget assumes no further cuts to MassHealth benefits.

The administration’s has posted write-up of their health cost and their public health initiatives on the state’s site. As ususal, the Mass Budget and Policy Center put out their flash analysis last night, with more detailed analysis to come.

The budget proposal fully funds Massachusetts health reform programs, including the re-integration of some 37,000 legal immigrants into the Commonwealth Care program. Full coverage for this group was required by a decision of the Massachusetts Supreme Judicial Court earlier this month, in a case brought by HCFA affiliate Health Law Advocates.

The budget makes major progress in reducing costs through improvements in overall health and wellness. HCFA strongly endorses the proposed increase in the tobacco tax, and the ending of the loophole that exempts sugary soda and candy from the sales tax. These revenue sources will both improve overall health and provide needed funds for health programs. HCFA also supports the expansion of tobacco cessation benefits to Commonwealth Care, as called for in legislation HCFA has actively supported.

The budget includes over $5 million desperately needed by MassHealth to improve customer service and begin implementation of national health reform. Service has deteriorated dramatically as cutbacks have reduced staffing at enrollment centers. Funds are also provided to implement a modern on-line integrated eligibility system for all health programs, scheduled to roll out in 2014.

HCFA calls on the legislature to reverse a budget cut that substantially reduced dental benefits to adults in the MassHealth program. Good oral health is a requirement for good overall health, and we know that the reduction in dental benefits will lead to higher long-term costs. Truly the Commonwealth can afford to end the inexcusable pain and suffering affecting thousands caused by lack of dental care.

We’ll of course have more to say as the budget process continues.
-Paul Williams, Ana Aguilera and Brian Rosman

Posted in budget, Healthcare Cost Control, MA Health Reform, MassHealth/Medicaid, Oral Health, Public Health | Leave a comment

Conversations About End-of-Life Care

Posted on January 26, 2012 by

Having discussions about care that someone would or would not want in the final stages of his or her life is difficult and emotional for all involved, including the individual, loved ones, health care providers, and others. But it is something that needs to be done, ideally before someone is at the point of not being able to express his or her wishes. A one-hour free webinar today hosted by the Institute for Healthcare Improvement will feature discussions about how people can broach these conversations. The webinar is titled “Have you had “The Conversation”? Helping Loved Ones Discuss End-of-Life Preferences” and starts at 2:00pm. You can sign up at www.ihi.org. This event will, among other things, introduce a new project at IHI called The Conversations Project.

In order for patients and family members to feel comfortable having these discussions not only with one another but also with their health care providers, it is necessary that providers also learn how to discuss end-of-life care. On that note, we applaud the MA Board of Registration in Medicine for its new requirement, effective February 1, that physicians must take 2 CME credits in end-of-life care.

Most of us have had personal experiences, or know others who have had personal experiences, with end-of-life care for loved ones or friends. Health Care For All would like to start hearing your stories about those experiences as we look at how we can help make a difference in this area. Please contact Deb Wachenheim at dwachenheim@hcfama.org if you have a story to share.
-Deb Wachenheim

Posted in Health Care Quality | Leave a comment

Report Highlights Massachusetts Success In Children’s Enrollment

Posted on January 19, 2012 by

A survey released today by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) showcased experiences of four states – Massachusetts, Alabama, Iowa, and Oregon – at the forefront of the nation’s recent gains in children’s health coverage. The report’s findings were presented at a briefing held today in Washington.
 
The study reported that Massachusetts is the leading state for covering children in health insurance. Citing state figures, the report highlighted the 99.5% coverage rate for children in the Commonwealth. The report concluded that state officials and community partners showed a “deep and sustained commitment to children’s coverage.” The report credited the role played by community organizations, and a strong, broad stakeholder partnership joining community groups, advocates, providers and state officials.

The briefing featured a presentation by HCFA’s Children’s Health Policy and Outreach Manager, Dayanne Leal. Leal discussed the recipe for Massachusetts’ success. “Our success came from Massachusetts’ choice to invest in kids, a real commitment to doing the work, and creativity to make it happen,” she said.

The report was prepared by the Kaiser Family Foundation in conjunction with the Georgetown University Center for Children and Families. A video  of the presentations is also available at the Kaiser Foundation website.

At the briefing staff from both institutions presented the main findings and then a panel of experts panelists discuss the survey findings and implications. Panelists included Cindy Mann, Deputy Administrator, Centers for Medicare and Medicaid Services (CMS); John Supra, Chief Information Officer for the South Carolina Department of Human Services; Dayanne Leal, Children’s Health Policy and Outreach Manager, Health Care for All Massachusetts; Tricia Brooks, a Senior Fellow at the Georgetown University Health Policy Institute Center for Children and Families; and Samantha Artiga, an Associate Director at the KCMU. who gave their perspectives. The panel was moderated by Diane Rowland, Executive Vice President, Kaiser Family Foundation.

Federal Medicaid administrator Cindy Mann recognized the work Massachusetts is doing to enroll children and keep them enrolled. “Massachusetts is the clear national leader in covering children,” she said. Leal thanked Mann for approving Massachusetts Express Lane Eligibility waiver to include renewals for parents, which will be crucial as Massachusetts move to the next phase which is improving its coverage retention.

Posted in Children's Health, MA Health Reform, MassHealth/Medicaid | 1 Comment

Some More Good Stuff From MMPI

Posted on January 16, 2012 by

Kate Nordahl and the Mass Medicaid Policy Institute keep churning out more good stuff.

Next up are two timely papers:

  1. First is a fact sheet (pdf) on the just-concluded extension of our Medicaid waiver, the agreement with the federal government that allows the Commonwealth to collect federal Medicaid funds for the MassHealth program, Commonwealth Care, and much more. The fact sheet focuses on what’s new in this agreement, including the Pediatric Asthma Pilot, the Intensive Early Intervention Services for Children with Autism Spectrum Disorder, the Delivery System Transformation Initiatives, and Express Lane Eligibility, which allows the state to renew eligibility for children families based on their eligibility for SNAP (=food stamps).
  2. Second is a close look at “risk adjustment,” (pdf) a wonky but critical detail to be included in the proposal to provide integrated Medicare and Medicaid for adults with disabilities who are in both programs, called the dually eligible. What is risk adjustment? Here’s the report’s clear explanation:

    Risk adjustment is a system for adjusting payments to health plans to reflect the differing health needs of enrollees, with higher payments made to health plans with members needing more care and lower payments to health plans with members needing less care. Without risk adjustment, providers of integrated care would face strong incentives to enroll the less needy among the duals. By contrast, providers that attract more than their fair share of enrollees with high needs would be underpaid, and could face large financial losses or have to reduce expenditures.

    Risk adjustment for programs serving the dual eligibles should take advantage of diagnostic data complemented by information on functional status.

    The paper explains how best to do this, and why it’s particularly vital that functional status be added to the calculations.

Good winter reading, friends.
-Brian Rosman

Posted in Health Care Quality, Healthcare Cost Control, MA Health Reform, MassHealth/Medicaid | Leave a comment

Quality and Cost Council Meets Wednesday

Posted on January 16, 2012 by

The Health Care Quality and Cost Council is meeting January 18, 1-3 pm, at 1 Ashburton Place, 21st floor, Boston. Meetings are open to the public.

Agenda (pdf) items include follow-up from last month’s QCC annual meeting, including looking at enhancements to MyHealthCareOptions and improving quality measures. The Expert Panel on Performance Measurement will give a recommendation to the Council regarding public reporting of hospital readmissions.
-Deb Wachenheim

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Opening Doctors’ Notes to Patients

Posted on January 11, 2012 by

Tuesday’s NY Times reported on a research project called Open Notes, spearheaded by providers and researchers at Beth Israel Deaconess Medical Center, which looks at the impact of encouraging patients to view their outpatient medical records (doctors’ notes and all).

Providers and patients in three locations (Boston, rural Pennsylvania, and Seattle) were asked to participate in a one-year study, starting in the summer of 2010, during which patients would have electronic access to their full medical records and would be encouraged to view them. Before Open Notes began, the researchers looked at providers’ and patients’ expectations and attitudes about Open Notes. They surveyed participating and non-participating providers and patients.

In general, the patients were very enthusiastic about the opportunity to view notes and felt it would give them a fuller understanding of their care and what they needed to do to take care of themselves. Participating providers were also generally enthusiastic and had believed it would help improve patient-provider communication, patient education, and patient safety, while non-participating providers were more concerned about patient confusion and worry and reported that they may be cautious about what they write in the notes if they know patients will view them.

Privacy concerns did exist among a sizeable portion of patients but many patients also said they would share the records with others, such as family or other medical providers. Patients said they would be able to spend time digesting information that may be given to them quickly during a medical appointment. Some questions posed by the researchers include whether or not patients will withhold some information that they don’t want in the record and whether physicians’ notes will change if they know patients are viewing them. However, as the researchers point out, all patients in the U.S. have the right to view their records and their doctors’ notes if they so desire. And with more providers moving towards electronic medical records, it will become easier for patients to view the information. If it will help patients better understand their health and health care, and give them full information that they can carry with them to other doctors they may see, then it seems to fit right in with where MA and the country are going as we look to reform the way health care is delivered.

You can find the full research report in the Annals of Internal Medicine. The one-year project ended over the summer and we look forward to seeing the researchers’ final results.
-Deb Wachenheim

Posted in Health Care Quality | Leave a comment

[UPDATED] Covering All Legal Immigrants: Not $150 million this year, and not after next year, either

Posted on January 6, 2012 by

The state SJC just ordered the state to restore full Commonwealth Care coverage for legal immigrants. What’s it going to cost?

For lots of people, the $30 billion state budget is just lots of unimaginable big numbers. But for those those of us who pay attention to budget numbers, and understand the relative scope and costs of stuff, we want to correct a cost misconception that’s been floating around the press.

For example, the lede in today’s Globe story says this:

Massachusetts lawmakers must quickly come up with about $150 million to provide health insurance to tens of thousands of legal immigrants, after the state’s highest court ruled yesterday that they were illegally excluded from subsidized coverage available to other residents.

That’s not accurate.

The $150 million is the full cost for a full year. But if coverage is restored in February or March, the cost for the rest of this current fiscal year is much less, closer to $50 million. That’s a much easier lift. The state does supplemental budgets every winter, and often adds much more than $50 million. Finding $50 million is not a piece of cake, but hardly insurmountable. (for example, what is the state saving in unused snow and ice removal so far?)

Also, there are some countervailing savings, from the ending of the Bridge program. The net cost is less than the full $50 million.

For fiscal 2013, the state will need to allocate around $150 million more than it would have otherwise, due to the ruling. [Update: We had originally reported that the full year cost of around $150 million did not take into account the savings from ending the Bridge program, leading to a net cost of $125 million. We've since been told by Administration and Finance staffers that the $150 million estimate includes Bridge program savings, and that is the net additional cost. So we've corrected the post.]

(And you know what raises around $125 million? – equalizing the tax on “other tobacco products,” like little cigars and chewing tobacco so it matches the cigarette tax rate, and an increase in the cigarette tax to keep up with inflation. That would also improve health and lower overall health costs, too.)

But for fiscal 2014, the additional cost will only be half. That’s because in January 2014, the ACA provisions that provide federal coverage for all legal immigrants kick in. After 2014, all legal immigrants, including the “aliens with special status” covered by the court ruling, will be eligible for federal tax credits that will replace most of the cost of Commonwealth Care.

So the $150 million figure is only for one year. It’s not an ongoing cost. In fact, due to the ACA, the state will be relieved of hundreds of millions of dollars of costs that it took on as part of chapter 58. Yet another reason why we said for months that national health reform is good for Massachusetts.
-Brian Rosman

Posted in HCFA, MA Health Reform, MassHealth/Medicaid, National Health Reform | Leave a comment