Massachusetts hospitals, with the leadership of the Massachusetts Hospital Association, are committed to giving the public useful information that can be used to assess and to compare hospital quality. Voluntary initiatives like Patients First: Hospitals Continuing Commitment to Safe Patient Care, not only help patients become better informed about their care, it also allows hospitals to learn from each other how to improve that care. The State is also targeting health care quality. Two new initiatives are on the table: The Department of Public Health recently issued a report recommending the collection of statewide data to gauge how hospitals compare when it comes to certain infections acquired in the hospital, and the Health Care Quality and Cost Council, a state agency created by the health reform law, is developing a website to allow consumers to compare hospitals and physicians on cost and quality. However, these don’t even scratch the surface of all the organizations that require hospitals to collect and report their data. While the open review of quality and safety performance in hospitals is encouraged, there is a concern. Read more…

All eyes are on Massachusetts as we work to make our historic health care reform law a success, and many of them are trained on the Connector. That’s no surprise, given the challenging and controversial policy issues with which the Connector has wrestled (minimum creditable coverage, affordability), the key role played by Connector insurance programs in expanding coverage (Commonwealth Care and Commonwealth Choice), and the very public way in which the Connector makes decisions.

However, the Connector is hardly the only state player involved in implementing health reform. Our “team” includes MassHealth (expanding health coverage for children and others and leading the charge on renewing our Medicaid waiver), the Division of Insurance (implementing new health insurance rules), the Division of Health Care Finance and Policy (issuing “fair share” and “free rider” regulations and designing new eligibility rules for the Uncompensated Care Pool), and the Division of Unemployment Assistance (collecting “fair share” payments and Health Insurance Responsibility Disclosure forms from employers).

There’s also another state agency that those not familiar with Chapter 58 might least suspect to be involved with health reform, but in fact plays a critical role: our state’s Department of Revenue (DOR). DOR is vested with major responsibilities associated with implementing our new “individual mandate” requiring adults who can afford health insurance to have it. It will create and issue the tax forms through which Massachusetts residents will declare whether or not they have health insurance; work with the Connector in implementing a fair and efficient process for “hardship appeals”; and collect penalties from those who truly can afford insurance but do not have it.

DOR has already posted on its website a first draft of the tax form that Massachusetts residents will have to file early next year, declaring whether or not they had health insurance as of December 31, 2007. It will soon post a draft of the instructions that accompany this form. Commissioner Henry Dormitzer and DOR staff welcome comments and suggestions on these documents, through emails to DOR’s Forms Manager at fordp@dor.state.ma.us. Please take advantage of this opportunity to weigh in on an important part of health reform.

Leslie Kirwan
Connector board chairwoman
Secretary of Administration and Finance for Governor Deval Patrick

Perhaps the best and most important entry in recent months to the Commonhealth blog was submitted by Nancy Turnbull on July 9, titled “How About Some Transparency for Health Plans Too.” If you missed that entry, I strongly recommend that you go back and read Nancy’s common sense discussion. She correctly points out how the health insurers were big winners with health care reform, and while they talk a good game on transparency for providers, they conveniently leave themselves out of the proposals.

Small businesses couldn’t agree more. We firmly believe that “payers” of health care dollars (consumers, employers, taxpayers) deserve full transparency from all “receivers” of health care dollars (insurers, hospitals, doctors, etc.). Insurers should be mandated to make fully public the average premium cost of typical coverage for all types and sizes of purchasers. Read more…

The Connector has determined that the best way to keep costs down is to have the Commonwealth Care plans bid and award the auto-assigned patients to the lowest cost plans. Low income people who did not understand the ins and outs of this complicated Health Reform program (confusing to us all at first!!) and did not respond to a dauntingly thick and confusing mailing from the Connector were auto-assigned to health care plans. 75% of patients who didn’t choose a plan were assigned to the lowest cost plan that presumably had arrangements with providers in their service area and 25% were assigned to the next lowest cost plan. The problem is that in many service areas around the Commonwealth, the plans had no pre-existing arrangements with the community health center or the hospital in the service area. Read more…

Postings to this blog over the past several weeks have addressed many aspects of our health reform law, including the challenges and successes that we share. This past week, I continued my work to educate and analyze these issues with fellow legislators and counterparts in states across the country. The Annual Meeting of the National Conference of State Legislatures was an opportunity to do just that. Over 9,000 legislators, legislative staff, advocates, and other policymakers—domestic and international—came to the Boston Convention and Exhibition Center to share best practices, new developments, and evidence to inform policy development in many areas.

As health reform continues to dominate state agendas across the country, one session in particular consisted of perspectives from a few states in varying stages of reform, and demonstrated the need for flexibility in state approaches to expanding access to health care, and the tensions between access, cost, and quality. I was joined on a panel by officials from California, Indiana, and Vermont to discuss the substance of pending and enacted health reform proposals in our respective states, and the policy and political challenges we face.

California has several proposals on the table—from both Democrats and Republicans, from both the Executive and Legislative branches, and from both the Assembly and Senate. Read more…

True or false: offering hospitals financial incentives to reduce racial and ethnic disparities actually helps reduce disparities.

Answer: we don’t know, but the MassHealth program is hoping to find out. This October, MassHealth’s contracts with the state’s hospitals will introduce a “pay for performance” program that will pay hospitals bonuses if their care meets certain quality benchmarks. Pay for performance was mandated by last year’s health reform law, which also required that the benchmarks include reducing racial and ethnic disparities.

Pay for performance (P4P) is a relatively new and largely unproven strategy for motivating quality improvement. Including disparities measures among the P4P benchmarks is unprecedented and methodologically complicated. A roundtable of experts examined the challenges and issued these recommendations for the future development of a P4P plan for reducing disparities. Read more…

Some 20 years ago, the New England Journal of Medicine published an article called “Is the Genie Out of the Bottle?” The genie was coronary artery bypass graft surgery for people with coronary artery disease or blocked arteries. The problem was that the surgery had already become standard treatment before studies had clarified the circumstances in which it was appropriate.

Cutting-edge medical research and technological advancements are at the heart of evolving efforts to prevent and treat disease. Only through innovation have we been able to decrease deaths due to cancer and heart disease, manage diabetes and prevent devastating complications such as blindness from diabetes, and tailor treatment for individuals based on genetics.

But there remains widespread use of procedures, medications and other therapies before their benefits and risks are fully understood. As providers, payers and policymakers, we all contribute to this phenomenon. But, ultimately, everyday people bear the consequences: higher costs and lower quality in health and health care.

Take estrogen replacement therapy. Read more…

The current rules of the individual mandate and Commonwealth Care eligibility have inadvertently created a pocket of people caught in a “Bermuda Triangle” of missed health care coverage. These people are employed, earn $29,412 or less (300 percent of the federal poverty level), and find themselves caught in the trap of being offered health insurance through their employer (thus becoming ineligible for Commonwealth Care), yet earning too little to be able to afford it. The Connector created the waiver process to exempt them from the individual mandate — good news for their wallets, as they can avoid penalties, yet they remain uninsured.

The question and challenge before us is, simply: How do we fix this coverage quandary? Consider the irony for a group of people doing the “right thing” — working full-time in low-paying jobs — unable to access affordable coverage, while others who may not be working can enjoy robust coverage at subsidized rates. Read more…

Chip’s term on the Connector board expired. AG Martha Coakley has named Nancy Turnbull to replace Chip. Here’s the press release…

BOSTON – Today, Attorney General Martha Coakley appointed consumer advocate and health policy expert Nancy Turnbull to the Board of the Commonwealth Health Insurance Connector.

“Nancy Turnbull is a leading advocate in Massachusetts health policy and she will be a powerful voice for consumers,” said Attorney General Martha Coakley. “I am confident that Nancy will work cooperatively with all the stakeholders to advance the interests of citizens of Massachusetts as health reform goes forward over the next three years.” Read more…

As the health care access bill rolls out we are increasingly concerned about how cost is going to come under control without compromising quality or access. In some ways the cost issue is very easy to understand: we either impair access (by diminishing the supply of providers), ration care (by denying coverage or access to certain treatments), or work together to both engage our patients in healthier lifestyles and find more efficient ways of delivering the care that is needed. Nobody wants the first two choices. But a concerted and innovative effort will be necessary for us to make significant progress with the third option. What we are doing now is not working. Read more…