Washington Post Visits HCFA: “Meet Kate Bicego, the woman who knows how to implement Obamacare”

Posted on April 27, 2012 by

Yesterday, Sarah Kliff from the Washington Post’s Wonkblog visited HCFA and Community Catalyst, and here’s her fabulous report: Meet Kate Bicego, the woman who knows how to implement Obamacare.

Kate is HCFA’s Helpline Manager, and, as Kliff reported, she and the other Helpline staffers are the crucial link in turning the promise of coverage into reality:

If anyone can claim to know how best to implement Obamacare, it might be Kate Bicego.

Bicego isn’t affiliated with any university or government agency. She isn’t a household name in health policy. She works in a nondescript cubicle in downtown Boston, on the 10th floor of a nondescript office building.

What Bicego does do is run the Massachusetts health insurance help line. For six years, she’s been the one making sure the state’s health reform law does what it’s supposed to and cover the uninsured.

“Here we are, many years out from [Massachusetts’] health reform, and people still have problems navigating the system,” says Bicego. “They still need our help.”
…
The Massachusetts health insurance hotline is run by Health Care for All Massachusetts, a non-profit that advocated for the 2006 law. State offices answer basic questions: where to get a form, which agency handles which kind of coverage. There is no government agency, however, to explain how to fill out a complex form, or troubleshoot a dispute with a given agency over a coverage determination. That’s where the helpline comes in.

“If you call Medicaid and say ‘I’m pregnant and I want to apply,’ they’ll send you a form,” says Bicego. “We’re the ones that help fill out that form.”

Even six years into Massachusetts health reform, there’s still significant demand for those services: the help line handled 40,000 calls in 2011 alone. The help line team can now fill out an application for Medicaid and other state-subsidized programs in five minutes flat.

Kliff listened as our counselor Hannah Frigand helped a client:

The scene when I visited the help line’s offices Thursday: A colleague of Bicego’s, Hannah Frigand, is on hold with the state Medicaid office. She’s working on the case of a woman who previously had insurance through her school, but whose coverage lapsed after she graduated. Now pregnant, she had an urgent need for care but was running into roadblocks getting her application processed quickly.

“There’s universal access, but people still transition a lot,” Frigland tells me while she’s still on hold. “Especially in this economy, people are coming on and off of the economy, switching jobs, there’s a lot that’s going on.”
…
When my half-hour visit to the helpline was ending, Frigland was wrapping up her call with the state Medicaid office. She did reach one person there, but he wasn’t sure if he had the authority to sign off on the expedited application. He transferred Frigland to his supervisor’s voicemail. “We do know he has the authority, but he says he’s not sure,” Frigland says. “It’s frustrating, but we’ll keep on trying.”

Besides helping individuals get coverage, our Helpline also provides crucial feedback to MassHealth and Connector officials, identifying bottlenecks and advising on improvements. Kliff picked up on that, too:

Issues completely removed from health policy can become significant hurdles. Like the time, two summers ago, when a state agency ran out of paper. Government rules prevented the department from ordering more before the end of the month, so health insurance termination notices ended up going out late, a potential disruption in coverage for some.

Bicego and her colleagues have shared these kinds of insights with the federal government as it gets ready to implement the Affordable Care Act. She also meets with the Massachusetts Medicaid department and the Connector, which administers the rest of the state subsidies, to talk about what isn’t working within the state.

“What we’re able to do is take what we learn here and tell them about our experience,” says Brian Rosman, researcher director for Health Care for All Massachusetts. “The best was when the Medicare person asked what the best way to ask about income was. And she was like, ‘I know exactly how to ask people because I’ve done it 10,000 times.’”

HCFA is proud of our Helpline, and the vital role it plays in making health reform work, both here and nationally. You can help, too, by supporting our work. Tuesday, May 8 is our annual fundraising dinner. Find out how you can help here, and attend to meet Kate, Hannah and the rest of our Helpline stars.

Posted in HCFA, MA Health Reform, Outreach | 1 Comment

Press Statement: Health Care For All, MASSPIRG, AARP Deeply Disappointed by House Repeal of the Pharmaceutical and Medical Device Gift Ban

Posted on April 26, 2012 by

The state’s largest consumer, health care and senior organizations are deeply disappointed that House members voted to repeal the Pharmaceutical and Medical Device Gift Ban and Disclosure Law, commonly known as the gift ban, during yesterday’s budget debate.

Included in health care cost containment legislation passed in 2008, the gift ban law is an important consumer protection law aimed at driving down our highest-in-the-nation, spiraling health care costs. The law reins in Big Pharma’s aggressive marketing tactics by banning gifts and/or payments of more than $50, including restaurant meals and entertainment, to physicians from drug and medical device companies. The law also established strict disclosure rules requiring that all financial arrangements between pharmaceutical and medical device companies with prescribers in the state be disclosed on a website maintained by the Department of Public Health.

The repeal of the gift ban law, included in a consolidated Public Health Amendment, would now mean that drug and medical device companies can spend unlimited dollars on gifts and restaurant meals to prescribers, calling into question the integrity of doctor-patient relationships. Gifts and other payments from the drug and medical device industry would also no longer have to be reported and publically disclosed.

“Nothing should come between the patients and their physicians. In order for patients to have confidence in our health care system, they need to know that the treatment plans recommended by their doctors were not influenced by fancy dinners or gifts,” said Amy Whitcomb Slemmer, Executive Director of Health Care For All, “Repealing our state’s gift ban law would not only increase health care costs, but also put relationships between doctors and their patients in jeopardy.”

The gift ban does not outlaw all contact between sales representatives and physicians – doctors are still free to work with the industry toward innovation and attend educational meetings with meals as long as such meetings occur within the provider settings or if the prescriber pays for his or her own meal at a restaurant.

The ongoing effort to weaken or repeal the gift ban law is not led by physicians or patients, but by the Massachusetts Restaurant Association and the pharmaceutical and medical device industry.

“Bottom line: Consumers should not have to pay for the free lunches that drug companies feed prescribers,” said Bill Johnston-Walsh, state director of AARP Massachusetts, which represents more than 800,000 members age 50 and older in the Bay State. “We are disappointed that the Massachusetts House eliminated an important tool to help rein in spiraling health care costs, especially when there is no evidence that the gift ban law has hurt other industries – and at a time when consumers are still struggling to afford the medicine they need to stay healthy and out of more expensive care.”

Deirdre Cummings, Legislative Director for MASSPIRG, said “The House of Representatives sided with the Pharmaceutical industry over consumers when they repealed the Prescription Drug and Medical Device Ban as part of the House Budget. Massachusetts banned Big Pharma from picking up the tab for wining and dining our doctors for good reason — because we ultimately end up paying that bill in the form of more expensive, often unnecessary drugs. With our state already paying some of the highest health insurance premiums in the country, this action is clearly counterproductive.”

The Restaurant Association claims that the limits imposed on the wining and dining of physicians has cut into their profit margins. Although restaurant receipts were down in 2008 and 2009, so were sales in virtually every industry because of the global economic recession. As the state emerges from one of the largest economic crises in history, restaurants have seen their business pick back up. In fact, according to the most recent data released by the Department of Revenue, restaurants are on track to have their best year ever in 2012, up more than $18 million so far over 2011 revenues. Restaurant revenues in 2011 were also up by more than $33 million over 2010 numbers.

Additionally, opponents of the gift ban have said it hurts biotech convention businesses and prevents the industry from doing business in Massachusetts. However, the facts show that these predictions have not come to pass. In 2012 alone, more than 50 medical-related conventions have been held or are scheduled to take place in Massachusetts. The BIO International Convention, the industry’s largest convention, will be coming back to Boston in June 2012. Massachusetts has also had its best year to date for biotech venture capital in 2011, beating the 2010 historic high.

The next step is on to the Senate, where advocates for preserving the law will urge Senate members to uphold the existing gift ban law and not put industry profits before patients’ health and their pocketbooks. At a time when government, businesses and consumers are focused on improving health care quality and controlling costs, the very last thing the Legislature should be considering is repealing the gift ban law.

Posted in Prescription Drug Reform | 1 Comment

Payment Reform – The Impact On Jobs & The Economy

Posted on April 26, 2012 by

What will the impact of lowering health care cost growth be on jobs?

The health care provider industry is warning about the possible loss of jobs in the health care provider industry. This is apparently striking a chord among some policymakers, who worry about killing the goose that lays the golden eggs. Health care is a growth industry in the Bay State.

There’s no question that reduced health spending will impact providers. Keeping people healthier, and re-orienting the delivery system towards prevention and wellness may reduce the need for acute care and some specialists. It also might increase employment for professions like community health workers, nurse educators, and nutritionists. We don’t know what will be the net impact on health care jobs.

But for the overall economy, reducing the cost of medical care will be a huge plus. Today’s report by the Blue Cross Foundation, Benefits of Slower Health Care Cost Growth for Employees and Employers was authored by Jon Gruber and based on his econometric modelling. Here’s the conclusion:

Rapidly escalating health insurance costs are a genuine threat to Massachusetts businesses and workers. Although rising health care spending may be a boon to the health care sector, it causes substantial harm to both employers and workers in the state as a whole. As this analysis shows, even under relatively conservative assumptions regarding the future growth in health insurance premiums, the harm to employers and workers is clear: employer spending on ESI will skyrocket, wages will suffer, unemployment will increase, and business profitability will decline.

Even modest reductions in health care spending growth would have dramatic positive effects on employers and workers. State and local governments, too, would benefit substantially from lower health insurance premium growth. Expenditures on their largest and fastest growing budget items would increase more slowly, and higher wages, employment, and corporate profits would generate more tax revenue.

Much is at stake in the current debate over health care costs. While designing and implementing policies to control increases in health insurance premiums and medical spending will not be easy, the resulting improvements in the state’s labor market and in the health and vibrancy of the state’s economy are well worth the struggle. Without strong action, health insurance coverage will erode, workers’ wages will stagnate, and employers will have fewer resources to invest in growing and strengthening the Massachusetts workforce and economy for the opportunities and challenges of the 21st century.

We understand the the legislative bills will include substantial provisions on workforce development and retraining. This research also provides strong justification for proposals like the Public Health Trust, which would invest in cost-saving community prevention. The insurers and employers contributing to the fund would reap the benefits of lower health costs.

This report should encourage employers to redouble their push for aggressive steps to lower costs by improving care.
-Brian Rosman

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Breaking: Procedural Progress on Payment Reform – Senate Debate Expected Mid-May (UPDATE From Sen. Moore)

Posted on April 25, 2012 by

Today the Joint Committee on Health Care Financing discharged the Governor’s payment reform bill, and the bill was assigned to the Senate Ways and Means Committee. This is the procedural step for the Senate to go first on its version of payment reform. From State House News:

Fourteen months after Gov. Deval Patrick filed a proposal on the issue, Senate President Therese Murray said Wednesday she expects the Senate to take action in mid-May on a bill making major changes to the way health care is delivered and paid for in Massachusetts.

“Probably … the week before budget,” Murray told the News Service, referencing the fact that the Senate intends to consider its annual budget plan the week before Memorial Day.
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The release of the governor’s bill without changes suggests that the House and Senate were unable to forge agreement on a unified, pre-negotiated proposal, one that could help speed consideration and limit disagreement as lawmakers head toward their five-month campaign and holiday season recess.

This would put Senate floor consideration the week of May 14.

We’re encouraged by the news, and look forward to a strong bill that advances the twin goals of affordable health care and a patient-centered, high-quality delivery system, including public health.

-Brian Rosman

UPDATE – Senate Health Care Financing Chair Richard Moore released a statement on today’s action:

April 25, 2012 … “The Health Care Financing Committee has discharged the Governor’s Payment Reform proposal to the Senate Committee on Ways & Means today. This is an important procedural step, and represents real progress for one of the most complex and daunting challenges the Legislature will confront this session, and in recent memory. Most importantly, today’s action suggests that the Senate is prepared to move forward with a proposal for consideration by the entire Senate sooner, rather than later. The bill that advances to the Ways & Means Committee today will be subject to a significant redraft by the Committee. I expect that this improved bill will balance our desires to deliver meaningful reforms to our health care system, which means genuine cost savings and ultimately better care for consumers, while appreciating the importance of a vital pillar of our economy – our health care system. To say the least, accomplishing as much is as complicated as it is imperative.

“The Health Care Financing Committee has spent much of the past few years engaged in a continuous dialogue about the future of our health care system. This has included 5 statewide hearings on Governor Patrick’s proposal, countless meetings and conversations with stakeholders and other interested parties, and a robust amount of research and investigation about both health care and economic policy. As a result of this work, the Senate stands at the cusp of presenting a proposal that delivers on the promise of identifying real cost savings while not jeopardizing the high quality of care we expect, and deserve.

“I have been encouraged by my work with Chairman Steven Walsh, and have enjoyed collaborating with him on innovative policy solutions. Our work to date will result in a more comprehensive Senate bill, an appropriate response from the House of Representatives, an ultimately deliver a thorough, but efficient, conference committee report.”

Posted in Healthcare Cost Control | Leave a comment

House Budget Debate: HCFA Priorities

Posted on April 25, 2012 by

The House budget debate turns to health care-related issues today. For the past week HCFA and the coalitions we help lead have been pounding the halls of the State House seeking support for budget amendments that strengthen our health care system and protect access to affordable coverage. We have also opposed a number of amendments that would weaken our important restrictions on inappropriate prescription drug marketing.

Here are some of the issues we have been working on:

Oral Health
MassHealth adult dental benefits were not restored in the House Ways & Means budget. Representative John Scibak filed two amendments (417 and 421) that will work together to restore fillings. Representative Scibak’s colleagues rallied behind him in support of the amendments, with 64 of them joining him as cosponsors. This is just the first step in the process of incremental restoration, and both HCFA and the Oral Health Advocacy Taskforce remain steadfast in their commitment to the full restoration of MassHealth adult dental benefits. In the meantime, restoring fillings will allow dentists to remove decay and stop infections, which will help to prevent serious health problems and costly ER visits.

MassHealth
Since the recession, MassHealth’s enrollment has been growing, yet its administrative resources have been shrinking. There has been a substantial increase in processing backlogs and phone wait times at MassHealth. Delays in eligibility determinations and coverage renewals impede access to care for thousands of Massachusetts residents. Additional investment in the MassHealth operations, customer service and information technology functions will begin to address these problems and ensure timely enrollment and re-enrollment for MassHealth and Commonwealth Care members, while beginning to implement payment reform strategies and the Affordable Care Act. HCFA is supporting two amendments introduced by Rep. Aguiar (729 and 732) to improve MassHealth operations and systems capacity.

Outreach
The MassHealth Outreach & Access to Care Program supports local consumer-focused organizations and community health centers to help Massachusetts residents navigate the health care system. In 2011, the grants enabled 51 organizations across the state assist over 272,000 Massachusetts residents. Without this funding, many community organizations would be forced to lay off workers, reduce services, or even shut down. Rep. Andrews has proposed an amendment (497) that would fund the program at $2.5 million.

Health Disparities
Since 2009, the state budget has authorized the use of EOHHS administrative funds for the Office of Health Equity. The Office provides a central focus for disparities work across all of the state’s health agencies, and ensures that racial and ethnic disparities are considered whenever policy is being discussed. This year’s House budget leaves out language authorizing funding for the Office of Health Equity. Representatives Rushing and Sanchez have each introduced amendments (437 and 379, respectively) that would add the language. These amendments do not add to the state budget, but demonstrate the importance of work to reduce disparities.

Health Quality
The Division of Health Care Quality at the Department of Public Health works to make sure the quality of health care that everyone receives in MA is the best it can be. The Division licenses and inspects hospitals, nursing homes, and other health care facilities, receives and investigates complaints, publicly reports and works to reduce infections and serious events, and participates in many collaborative quality improvements initiatives in MA. Rep. Provost has filed two budget amendments to provide needed funding to the Division. Amendment 335 would increase funding to $4.2 million. This line item funds the important facility licensure work of the Division. Amendment 332 would increase funding in line item 4510-0710 to $6.3 million. This line item funds all of the other work of the Division and cuts would greatly impact its ability to ensure high-quality care is provided across the Commonwealth. HCFA is also supporting amendment 377, filed by Chairman Sanchez, which would increase funding for the Department’s Health Promotion and Disease Prevention work to $3.4 million.

Affordable Prescription Drugs
The Pharmaceutical and Medical Device Gift Ban law prohibits drug and medical device companies from providing gifts, such as meals or entertainment, to doctors, nurses, and other health care providers, as part of their marketing practices. Repealing the Gift Ban law would allow drug and medical device companies to spend unlimited dollars on gifts and meals to prescribers, calling into question the integrity of doctor-patient relationships. We support an amendment filed by Rep. Lewis (406) to strike outside section 46 and preserve the pharmaceutical and medical device gift ban and disclosure law; and oppose all amendments (59, 60 and 318) that would weaken the pharmaceutical gift ban and disclosure law.

Rx Drug Coupons
Prescription drug coupons are an extremely successful marketing strategy used to increase pharmaceutical company profits at the expense of health care consumers, while causing drug costs to soar. Drug companies use coupons to entice consumers to purchase a more expensive name brand drug, which may have cheaper and equally effective generic or therapeutically equivalent alternatives. While some consumers temporarily pay lower co-pays, coupons are typically available only for a limited supply of high cost brand drugs, leaving patients with higher copays for the remaining duration of their prescriptions. Moreover, the use of coupons would lead to increased long-term costs for all consumers as insurers and purchasers pay more for the higher cost drug promoted by the coupon. We oppose amendments 177 and 336 that would repeal the current prohibition on the use of prescription drug coupons and rebates, undermining current efforts to control health care costs.

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Feliz Cumpleaños to Massachusetts Health Reform – Similar Gains in Hispanic Coverage Expected Nationally Under ACA

Posted on April 24, 2012 by

Univision Coverage of Press Conference on Hispanic Coverage in MassachusettsLast week Health Care For All and Community Catalyst, Massachusetts leaders and consumers gathered at the State House to highlight the success of health care reform among Hispanics in the state. This month marks the 6th anniversary of passage of Chapter 58 in Massachusetts and the second anniversary since the Affordable Care Act was signed into law by President Obama – two landmark pieces of legislation that have opened the doors to care for millions of residents first in the state and now nationwide.

The progress made in Massachusetts will extend nationally as the Affordable Care Act is implemented in 2014. At the celebration (see pictures here), hosted by Senator Kenneth Donnelly, we noted the impact of Chapter 58 in coverage for Hispanics:

Coverage for Massachusetts Hispanics has declined from 25% to 4% from 2005 to now
“Chapter 58 has made a life changing difference for hundreds of thousands of Massachusetts residents, and we know that it has had a remarkable impact specifically on our Hispanic population,” said Amy Whitcomb Slemmer, executive director of Health Care For All. “Prior to 2006, a disproportionate number of Hispanics were uninsured – nearly 1 in 4 was without access to health care coverage. As 2010, 96 percent of the Hispanic population was insured. This is a remarkable success connecting patients to the care they need.”

The event was covered by Univision, Telemundo and several Spanish-language print media, as well as by Channel 22 in Springfield:
Channel 22 Springfield coverage of Hispanic press conference

The event included two people assisted by the HCFA Helpline who told dramatic stories of how their coverage through health reform made a difference for them.

“Five years ago, I was diagnosed with prostate cancer and I had to go through emergency surgery. I was very worried and I couldn’t sleep at night because I couldn’t afford to pay for health insurance,” explains Eugenio Hernandez, a Commonwealth Care beneficiary. “I called Health Care For All because a friend of mine told me about the Helpline and with their help, I was able to enroll in the subsidized plan. I could access radiation and follow up treatment and now I am cancer and fear free. This reform has saved my life”

“I was the victim of assault and battery in New York City and I was in a coma for almost two weeks. I was hospitalized and had to undergo several operations and, even though the state of New York took care of a lot of the costs, I started receiving bills from the hospitals that I couldn’t afford,” said Pelagio de la Cruz, who benefited directly from Chapter 58. “When I returned to Massachusetts, I knew that I would need access to long term care. I called the HelpLine and now all the services that I need are covered by my insurance. I feel very lucky that I live in Massachusetts”

Posted in MA Health Reform, National Health Reform | Leave a comment

Globe Letters Look Towards Effective Payment Reform and Cost Control

Posted on April 23, 2012 by

Last week the Globe editorialized for a go-slow approach to a state regulatory role in payment reform. The editorial did recommend a number of our priorities, supporting “promoting accountable care, furthering transparency, highlighting effective practices, increasing consumer knowledge and incentives, and encouraging more competition among providers and between insurers.”

Today a trio of letters were published in the Globe calling for a comprehensive reform proposal, now. HCFA Executive Director Amy Whitcomb Slemmer made the case that major health care reform calls for significant government role:

Your editorial “In fight to cut health costs, resist stiffer regulation for now” (April 17) missed critical concerns of patients and consumers and the opportunities we see for significant reform. Unregulated market pressures have led to more out-of-pocket costs, including higher copays and deductibles, and have limited our choices of providers. These work-arounds are no substitute for true reforms that focus on coordinated primary care (including improved access and valuation of mental health and substance abuse services), patient empowerment, and full system transparency. This level of improvement and system redesign requires a significant government role to establish ground rules, monitor impacts, and protect patients’ rights.

The House and Senate proposals being drafted now have the potential to remake our health care system — lowering the cost of the health care we receive, while improving the quality and protecting the most vulnerable patients and consumers among us. Re-orienting the way doctors, hospitals, and other providers are paid can align incentives to promote patient-centered care focused on overall health and disease prevention, ultimately lowering health care costs for everyone. Requiring payment to be tied to outcomes and patient needs, rather than volume of services delivered, moves us from our current sick care system to a health care system that supports keeping us well.

We have an opportunity in Massachusetts to again lead the nation in health reform. We embrace comprehensive legislation. Health care consumers and patients can’t wait.

This call was echoed by Don Detweiler of Lexington, a GBIO health team leader, who wrote that “past improvements in service coordination and cost control have been reversed after the spotlight of public pressure has dimmed. Without some mechanism applying government oversight to medical spending, this pattern will assuredly be repeated. We cannot wait another two years, as your editorial suggests, before we are proactive in our approach to health care cost containment.”

Deborah Wengrovitz from Concord, another GBIO leader, added her voice, too. Deborah reminded us that “two years is far too long to wait for confirmation that health care cost containment efforts are succeeding or not. This is especially true for the thousands of patients dealing with ongoing medical costs due to chronic medical or mental illnesses and for consumers who are on the financial edge.”

House and Senate leaders have pledged that significant health care cost containment will be advanced this session. Serious, effective proposals have been advanced by the Governor, the Attorney General, and by numerous stakeholders, including HCFA and GBIO. We are confident that a strong, responsible bill will be enacted by July 31.
-Brian Rosman

Posted in Healthcare Cost Control | Leave a comment