When we get our checks from the Fed this summer to spend on consumer goods and services to try to resuscitate the struggling US economy, let’s all spend it on health care! Let’s join together in a collective strategy to suppress health care inflation in the Commonwealth, to ensure the success of the Massachusetts model of health reform. The Connector has already thought of this considering recent proposals that would jack up premiums… and shift more cost to consumers. These are short term budget fixes, not reform.

From my previous entries on this blog, you know I have not been enamored with the promise of reform in Chapter 58. The real opportunities for reform take a backseat to increasing access by expanding coverage and simply pumping more dollars into a system that is almost irreparably broken. Read more…

“Row harder.” That’s what some are saying to poor and sick consumers who they want to hit with large co-pay and premium increases, intended to cover financial gaps faced by the Connector due to successful enrollment efforts.

Locally and nationally, rough fiscal waters are ahead for healthcare. Threats by the federal government to further decimate funding for children’s healthcare and Medicaid loom like a black cloud over our state’s noble first-in-the-country healthcare experiment.

The time is now for new, big ideas about how Massachusetts keeps healthcare reform on course. Consumers, taxpayers, and the state are doing their share of the rowing. It’s time for businesses, insurers, and hospitals to grab an oar.

A recent Boston Globe editorial asked, “If people on limited incomes must pay more, why not employers?” It’s an important question at the right time. It should also be applied to insurers and hospitals. The $295 fee employers who fail to offer affordable insurance must pay is a paltry sum, in light of what is now being asked of Connector insurance enrollees, the state, and taxpayers. If consumer rates go up, so should assessments for negligent businesses. The state should also revise the anemic regulations that determine which employers are obligated to pay assessments. Read more…

RECENTLY, THE STATE STARTED REQUIRING THAT ALL PEDIATRICIANS SCREEN THEIR MEDICAID PATIENTS FOR MENTAL HEALTH PROBLEMS.

IT’S A COURT-MANDATED MOVE AIMED AT IDENTIFYING TROUBLED CHILDREN AND GETTING EARLIER TREATMENT. BUT SOME ALSO WORRY THE SCREENINGS COULD PUT MORE STRESS ON A MENTAL HEALTH CARE SYSTEM THAT’S ALREADY UNDER STRAIN.

Click here to listen to Karen Brown’s story.

Here’s the statement from Connector Board chairwoman Leslie Kirwan:

“As the Commonwealth Care bid process moves forward, it is apparent that more time is needed to not only analyze the premium bids for Commonwealth Care, but also to determine how they relate to proposed cost-sharing decisions.

“The postponement is a prudent course of action. The bids we received were not satisfactory. As we continue to accumulate information, we want to be deliberate about making key decisions.”

Sounds like the Comm Care bids came in (as my kids would say) WAY high. Does anyone know?

The Commonwealth Health Insurance Connector Authority’s plan to raise enrollees’ monthly contributions to Commonwealth Care, though met with cries of outrage, is a reasonable step in response to escalating costs and unexpected enrollment levels. The proposed rate schedule is very progressive, and the dollar amounts are small – we have already raised the ceiling for zero contribution from 100% to 150% of the federal poverty level (FPL), and increases are $5 up to 200% of FPL, $10 up to 250%, and $15 up to 300%. But why are even these modest increases necessary?

First, there is a state fiscal issue: The budget is already in structural deficit, costs of government are rising (in large part because of health care), there are powerful competing priorities such as education aid, revenues are threatened by an economic slowdown, and tax increases are off the table (with a proposal to eliminate the personal income tax headed for the ballot).

Second, the federal government is critically involved because it must approve the state’s Medicaid waiver, and commit itself to paying a 50% share of the cost of MassHealth programs; and the President has proposed reducing Medicaid funding in next year’s budget. Read more…

The Centers for Medicare and Medicaid Services expects health care spending nationwide to double over the next ten years…and represent close to 20 cents of every dollar by 2017.

This slide presentation takes you through more details.

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I would like to use this visit to the blog to call attention to a new article by Laurence Baker, Elliott Fisher and John Wennberg, published on the Health Affairs website a couple of weeks ago. The authors analyzed hospital use by chronically ill patients in California and found a wide variation of resource use across hospitals treating patients with similar characteristics. The authors suggest that understanding the variation presents an opportunity for significant savings in health care expenditures by reducing resource use at the most resource-intensive hospitals, particularly because there is some evidence (in this study and others) that systems using greater resources actually deliver lower quality care.

This new research reinforces a larger body of work documenting the inefficient overuse of certain services and calling for better alignment of incentives and local delivery system accountability for the cost and quality of care. (I’ve written about some of Fisher’s contributions before here.)

Cost control solutions such as increasing copayments in order to slow premium growth, as the Connector Authority is now considering, address short-term fiscal demands but are unlikely to have a great effect on costs and may hinder access. Read more…

We all know that cost management is important to the success of Massachusetts health reform and that there are a lot of ideas out there. One that nearly everyone agrees on is the need for greater health information technology (HIT) adoption, particularly electronic medical records (EMR) and computerized provider order entry (CPOE).

The New England Healthcare Institute released a report last week that showed that universal adoption of CPOE across Massachusetts would save $170 million a year and avoid 55,000 potentially serious adverse drug events. That means each physician could expect to avoid 9 adverse drug events a year and could prevent three life-threatening ones every five years. Only 10 of 73 Massachusetts hospitals have adopted CPOE at present. The promise is just as great with EMR and the adoption rate just about as grim. Read more…

The board of the Connector, on which I serve, is facing some difficult decisions about enrollee premiums and cost-sharing for the Commonwealth Care (CommCare) program. State finances are tight, CommCare enrollment is larger than expected, and health care costs and premiums continue to rise much faster than overall inflation or wages. All of these factors are combining to put financial pressure on the CommCare program.

Let’s be clear about the problem: The financial challenges facing CommCare result from covering more people than projected at this point in the program’s development. Spending per person is on target. Of course, this doesn’t lessen the need to deal with the finances of the program. But it does suggest that the problem results from something good: getting more people insured.

As one approach to moderating rising program costs, the Connector board is considering asking Commonwealth Care members to pay more, in the form of larger copayments for those above the poverty level and bigger premium contributions for program enrollees who have incomes above 150% FPL. We don’t yet know how much these proposed changes would save for the state or how much they would cost enrollees, and the Connector board, and the public, need that information before any vote on any proposed changes.

Some increase in cost-sharing for Commonwealth Care enrollees might be necessary. But as we seek to deal with the financial challenges of the program, we need to make sure that we distribute the burden fairly. Here are a few thoughts on this equation: Read more…

Can there be any value that comes from skyrocketing medical costs? Perhaps the medical cost trend will force an important debate about the role of health insurance.

Often, discussions about insurance lead to discussions about cost and affordability. Initially, health plans and insurers introduced the idea of managed care as a means to control medical costs and improve health. Now, the health care community recognizes the importance of performance and cost “transparency” as a prerequisite to engaging consumers and providers as part of the cost and quality debate.

We all recognize the value of transparency. But, because it’s a strategy that’s in its infancy, how do we know it will have enough “teeth” to help tame the medical cost beast that threatens to undermine our collective objective of access, affordability and quality?

Why not do more and take a page out of the auto and life insurance industries? Why not consider rewarding individuals who make healthy decisions and lead healthier lives? Read more…