“Mercy and truth are met together; righteousness and peace have kissed each other.”
Psalm 85:10 (King James Version)

On February 14, 2008 – Valentine’s Day, the Commonwealth Connector Board will meet to amend the 2008 Affordability Schedule. On the day many people pause to remember promises and re-affirm commitments – the Connector Board members will be presented with an opportunity to remember and re-affirm the promise made last year: the state will not penalize individuals and families in the Commonwealth who cannot afford to purchase the health care – how appropriate.

Weighing in the balance of the Connector’s Valentine’s Day decisions will be families struggling to survive amid record foreclosures, plummeting house values, expanding personal debt and growing unemployment. It is vital that the Connector not add to the misery index of these families by assigning financial penalties because these same families cannot find affordable health care. No, hopefully, in the words of the Psalmist, “Mercy and Truth” will both have a seat at the Connector Board meeting on Valentine’s Day.

Truth demands that we understand the necessity for an affordability schedule which holds individuals responsible for ensuring their own health – and we do. Mercy, however, urges that the Schedule shifts, slightly, only to accommodate the 2008 change in the federal poverty level. Read more…

THE INFO FROM KAISER FOLLOWS…

Requiring Individuals to Purchase Health Insurance – Ask the Experts, LIVE Webcast

Requiring individuals to obtain health care coverage — often referred to as an “individual mandate” — is a key part of a major health reform plan being implemented in Massachusetts and being considered in other states. The individual mandate is also featured in national proposals in Congress and on the presidential campaign trail. Tomorrow, January 31 at 1:30 p.m. ET, join kaisernetwork.org’s Ask the Experts live webcast panel for an in-depth look at individual mandates.

WHAT: This live webcast will address such questions as: What are the policy arguments for and against a mandate? Is it a necessary part of a strategy to achieve universal coverage and greater accessibility in the non-group insurance market? What would be required to make a mandate work? How have mandates functioned in other areas?

WHO: Larry Levitt, vice president of the Kaiser Family Foundation and editor-in-chief of kaisernetwork.org, will moderate the discussion with:
* Michael Cannon, director of Health Policy Studies at the Cato Institute;
* Sherry Glied, professor and chair of the Department of Health Policy and Management at Columbia University’s Mailman School of Public Health; and
* Len Nichols, director of the New America Foundation’s Health Policy Program.

WHEN: Thursday, January 31 at 1:30 p.m. ET
After the live program, a podcast, transcript and an archived version of the webcast will be available for viewing at any time.

WHERE: Watch the live webcast on kaisernetwork.org.

http://www.kaisernetwork.org/ask/insurance/31jan08

HOW: The panel of experts will take your phone calls and emails. Send questions in advance to ask@kaisernetwork.org or call 1-888-524-7378 during the live broadcast.

Please note: The toll-free phone number will function only during the live program and is for submitting questions only. The program is accessible via webcast on the Internet and not via teleconference. If you have never viewed a webcast before, please test your media player in advance of the live webcast at http://www.kaisernetwork.org/healthcast/howtoview.

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Health reform is about to face a critical test: Can it achieve financial stability? Success will hinge on three elements – renewal of the MassHealth waiver by the federal government, continued funding of the state share of the program, and a concerted effort to control costs. Each of these will be challenging and will require a renewed commitment from all the stakeholders who made health reform a reality two years ago.

Health reform is only possible because Massachusetts receives significant federal funds through a Medicaid waiver. The waiver is up for renewal in July. Renewal is contingent on a determination that the federal government will spend no more on the state’s Medicaid program than it would have in the absence of the waiver, the so-called budget neutrality test. This calculation is complex and subject to significant back and forth between state and federal administrators. Stakeholders should stay focused on the big picture and assist the Administration as it navigates through this process.

Failure to renew the waiver on acceptable terms would jeopardize the second element in achieving stability – adequate state funding. Read more…

When we embarked on the mission to expand access to health insurance three years ago, our goals were to expand access to Medicaid and Children’s Health (SCHIP), restore Medicaid cuts necessitated by the Recession of 2002-4, expand access for small businesses and their employees to the Insurance Partnership, provide affordable insurance to the middle class, and get to universal coverage, in part, through an individual mandate. We wanted to reduce cost-shifting in health care and maintain or expand the partnership with employers in providing access to health insurance. Of course, the goal was not simply to expand the actuarial pool to ease the double-digit premium rate increases, but to connect the newly insured to primary care providers in order to reduce the reliance on emergency departments and their high quality, but expensive care.

Our goal in expanding Medicaid and SCHIP was to enroll about 85,000 adults and children, and we are well on the way with over 73,000 now enrolled. We sought to enroll 160,000 in Commonwealth Care (subsidized insurance), and we have reached that goal. We have also enrolled 56,000 in Commonwealth Choice (non-subsidized, “affordable” insurance), although we believe there could be as many as 150,000 more to be reached in this category.

We have succeeded in increasing provider rates for hospitals and physicians and more support is scheduled, and will be needed in the coming fiscal year – especially in the recruitment and retention of primary care physicians. Read more…

Last month, the Patrick Administration launched HealthyMass, an historic health initiative designed to make Massachusetts a healthier place to live and work. Nine agencies from across state government—in their roles as employers, purchasers, providers, regulators, insurers, administrators, stewards of public health, and potential sources of health care financing—committed to collaborating to achieve five goals that reflect the values and principles of the Patrick Administration.

By aligning policies and practices, these agencies will work together to ensure access to care; contain health care costs; advance health care quality; promote individual wellness; and develop healthy communities. Collaboration is the key to success, and working together with those in state government—as well as other key stakeholders—will be essential. Early on in our work, we will decrease administrative burdens on providers; adopt strategies to improve quality of care; focus on decreasing the impacts of chronic disease; and align payments to support primary care and community hospitals.

Pay for performance initiatives are increasingly recognized as a strategy for improving health care quality, and many payers have adopted this strategy. Read more…

Today, Delta Dental of Massachusetts released a report – The Oral Health of Massachusetts’ Children – that shows that minority and low-income children have much higher levels of dental disease than white and high-income children. That may not seem surprising, given that there has been so much conversation about disparities in health care, but some of the stats do jump off the page:

- One in ten Black, Hispanic and low-income children in Massachusetts are suffering from pain in their teeth and mouth.

- Children from low-income families are nine times more likely to need urgent oral health care than higher-income children.

Left untreated, dental disease can make it difficult for children to concentrate and learn, leading to problems in school, and can also have devastating consequences for a child’s overall health.

Reviewing the data in the report, I was struck again by how unconscionable it is that any child should have to suffer from pain or untreated disease – especially since oral disease is almost entirely preventable. Read more…

For those of you who believe in that old French maxim, “the more things change, the more they remain the same”, some of the recent medical news stories may have shaken your cynicism. Whether it was Paul Levy at the Beth Israel Deaconess, publicly committing his institution to specific goals and promising to achieve safety measures putting that institution in the highest 2% ranking in the country, or Blue Cross announcing its willingness to stop paying fee-for-service claims to any providers who are willing to take a capitated fee (along with the chance of earning a hefty performance bonus), it sounds as though someone out there may be ready to do more than talk about the need for action to change our current dysfunctional medical system. I’m not surprised that Paul Levy is out front on tackling a tough issue, and I have confidence that he’ll get the BID to do everything in its power to make it happen. He has already solicited and received the public support of his board — a good first step — and announced his goals in public, a good second step. The next question is — which other hospitals will take up the challenge and join him? As for Blue Cross, although I’ve had my differences with them from time to time, they are state’s largest health plan, and they are in a unique position to start what Don Berwick refers to as the necessary “decoupling” of volume from value, and I wish them well on this offer. Again, the question is — which providers will take up the challenge and sign on? To use two old American maxims, “I’m not betting the family farm” on this, but I do “have my fingers crossed.”

Dolores L. Mitchell, Executive Director of the Group Insurance Commission of the Commonwealth of Massachusetts, the agency that provides life, health, disability and dental and vision services to over 285,000 State employees, retirees and their dependents.

Readers of this blog are well aware of the growing debate in the Commonwealth about how to slow our health care spending, sustain health care reform, and relieve a growing burden on employers, consumers, and government. Many of the proposed solutions – improved prevention and management of chronic illness, administrative simplification, and greater transparency of cost and quality information – have great potential. But their potential will be severely limited if they are not built on a payment system that rewards the best, most affordable care. We do not have such a system in Massachusetts today.

Last January, BCBSMA CEO Cleve Killingsworth challenged the company to examine how our method of paying hospitals and physicians could be transformed to better support the high quality care we all know our system is capable of delivering. Currently, Blue Cross and most other health plans base payments principally on the number of services provided, and the complexity of each service. For example, surgical and specialty care is rewarded more than primary care, and hospitals receive higher reimbursement when they perform more tests and procedures. As Karen Davis, president of the Commonwealth Fund, has written, “Fee-for-service payments create incentives to provide more and more services, even when there may be better, lower-cost ways to treat a condition…It’s not realistic to tell hospitals and doctors that they must improve quality if by doing so they are likely to lose money.”

What Cleve asked us to create was a system that would instead base payment on quality, outcomes, safety and efficiency – Read more…

Today, Massachusetts took another leap forward in the arena of consumer engagement in health care quality improvement efforts. Patients First has posted hospital-specific data on the incidence of pressure ulcers (or more commonly known as bedsores) in Massachusetts hospitals. This data adds to the growing list of measures on this consumer- friendly website developed by the Massachusetts Hospital Association in cooperation with the Massachusetts Organization of Nurse Executives.

This new data shows the ongoing trend of Massachusetts hospitals towards transparency and commitment to quality improvement. Patients First is yet another example of Massachusetts being “first” in health care innovation. We were the first state in the nation to offer the public hospital-specific staffing plans, detailing how many nurses are providing care — shift by shift. The Patients First initiative can also boast being first in the nation to publicly post data on another key quality indicator — patient falls.

Data from Patients First will help empower consumers and give them a much needed tool when seeking information about the quality of care provided at hospitals in the Bay State. Read more…

Last week (January 15-17), I journeyed to Sacramento, California to share my experiences as an uninsured Bay State resident who will be penalized under the provisions of Chapter 58. My trip was sponsored by the Foundation for Taxpayer and Consumer Rights, a California watchdog group opposing ABX 1 1; the Golden State version of the Massachusetts plan championed by Governor Schwarzenegger and Democratic Assembly Speaker Fabian Nunez. Initially, I was scheduled to testify before the Senate Health Committee, chaired by Senator Sheila Kuehl. However, the hearing was rescheduled until January 23 in order to allow for a thorough fiscal analysis of the plan.

The afternoon of Tuesday the 15th was spent making the rounds of various senate offices where I presented administrative staffers with my take on the Massachusetts “reform” effort. On Wednesday the 16th, I participated in a news conference convened by Jerry Flanagan and Carmen Balber of FTCR. The purpose of the session was to unveil a survey that showed scant support for an individual mandate among Californians, and to allow me to expose some of the many flaws in the Massachusetts scheme. We had planned to address the media in the Capitol Rotunda, but the fact that I had traveled 3,000 to deliver a negative appraisal of the Massachusetts law so incensed Speaker Nunez that he called the California Highway Patrol, which provides security for the capitol building to have us ejected! Read more…