There’s a birthday party for the National Health Service Tuesday at Wembley Stadium in London. Dr. Don Berwick, president of the Institute for Healthcare Improvement in Cambridge (MA), delivers the keynote on the theme of the day “Energising Innovation.” Berwick was appointed an honorary Knight in 2005 for his “distinguished service to healthcare improvement in Britain’s National Health Service.”

Dr. Berwick’s address is scheduled to begin at 8:15 AM (EST). Click here to register.

For a couple of different perspectives on the NHS at 60 here’s a physician in The Guardian arguing against a move towards more private health coverage and then a more celebratory view here.

I was fortunate to have begun my tenure as Commissioner of the Massachusetts Department of Public Health just about the time that health care reform was going into effect. I spent much of the first few months in the job reviewing health data of Massachusetts residents and traveling around the state for a series of health dialogues to identify a short list of public health priorities.

What was repeatedly reinforced during that experience is that health care reform is directly related to improving the health status of thousands of people, increasing the public’s safety on a population-wide basis, and reducing health care tragedies and premature deaths.

Health care reform in Massachusetts is still in its infancy, but we’re already seeing some impressive results.

1. According to the Division of Health Care Finance and Policy, more than 330,000 people have enrolled in private or subsidized insurance programs since the implementation of this groundbreaking initiative.

2 This influenza season we saw a dramatic increase in the number of adults in Massachusetts who received a flu vaccine. Read more…

It is an accepted fact that health reform will succeed only with focused attention on cost control. All stakeholders seem to agree that we will not be able to afford universal coverage unless health care costs are brought under control, and there are many worthwhile ideas about how best to meet this goal. Unfortunately, there are just as many, if not more, ideas that would increase costs.

When it comes to coverage, Massachusetts’ health insurers are heavily regulated. The rules were established with the best of intentions, but each new rule adds to the cost of coverage, either by requiring coverage for specified services or by making it more difficult for health plans to manage care.

The Health Reform Act recognized the impact of such requirements on the cost of coverage. It imposed, for instance, a moratorium on new mandated benefits until the Division of Health Care Finance and Policy completed a study of the cost impact of existing mandates. The Division has not yet released this important report.

Against this backdrop, it is surprising that some of health reform’s staunchest allies are supporting laws that would expand benefits further. Read more…

Yesterday we announced the launch of the health information exchange in the greater-Newburyport community. The HIE is called WellportSM. It’s the culmination of an enormous and very successful collaboration among many parties, including MAeHC, our technology partners, and—most notably—the medical professionals and patients of the Newburyport community itself. Preparing to launch an HIE begins years in advance and involves a tremendous amount of work at many levels. It’s particularly challenging when you build it with a focus on putting patients first. Wellport is permission-based, meaning that patients choose whether they want their information shared among their care providers across the community. MAeHC and the Newburyport medical community strongly believe that having a more complete picture of a patient’s health profile available to caregivers at the point of care will provide better, more affordable care, but we also strongly believe that patients themselves need to be the determinants of who sees their medical information. With 90% of patients agreeing to participate to date, we are proud that Wellport is a system that is trusted by patients and physicians alike.

The launch of Wellport follows on the launch of the North Adams eHX, our first HIE, which now has over 25,000 patients participating in the network.

It’s our mission at the Massachusetts eHealth Collaborative to transform the delivery of healthcare and to enhance the quality, efficiency, and safety of care in Massachusetts. We are beginning to see this transformation at every level. Read more…

The other day I was asked, why I was taking a somewhat conservative approach to suggestions that eligibility for CommCare be expanded now. The excellent analysis presented to the Connector Authority (I am pleased to add that it was written by Bob Carey, a former GIC policy director) raised a number of questions about the fiscal implications of expansion, and the decision was made that the issue demanded further investigation and analysis — a sensible decision, in my view.

I’ve been giving this matter a lot of thought and it seems to me to present even larger policy issues. The distribution of state tax dollars across state sponsored programs, as we know, has changed over the years of health care inflation coupled with health insurance coverage expansion, be it Medicaid, state employees, or the creation of CommCare itself. And, while it is a matter of justifiable pride that we have covered so many of our fellow citizens with insurance that they didn’t have before, we need to keep our eyes on the other state needs that are competing for those dollars. The Governor’s new and exciting education program is just one example. As the administrator of one of the Commonwealth’s health care agencies — the GIC — and as a board member of another — the Connector Authority — I know I can support and feel very good about the health services that we can provide with every additional dollar we are given. But as a citizen of this Commonwealth, standing back and looking at all of the needs of our Commonwealth and its people, it is the obligation of every one of us to look long and hard at every expansion proposal that comes before us to make sure that it is well thought out, carefully costed out, and every alternative to saving dollars seriously considered. Read more…

The WHO will use a surgical checklist developed by Dr. Atul Gawande (HSPH) in a “major drive to make surgery safer around the world.” You can see the checklist here (you may have to enter an e-mail address to download); or read this brief overview from the HSPH press release:

The global checklist project is an outgrowth of more than a decade of work at HSPH on patient safety and prevention of medical error by addressing health systems errors and solutions. Before anesthesia, for example, the surgical checklist requires confirmation that the patient has a safe airway for anesthesia and has proper intravenous lines for resuscitation. Before making a skin incision, the surgery team must check off that it has verbally confirmed the patient’s name, the site and the procedure, and administered an antibiotic to prevent infection. At the end of surgery, nurses must check off that instruments, sponges and needles have been counted, specimens labeled properly and equipment problems addressed.

Countries that have already announced their intention to implement the checklists nationwide are Ireland, Jordan and the UK. The Safe Surgery initiative has been endorsed by scores of professional medical associations worldwide.

Dr. Gawande and colleagues estimate there are 234 million major surgical procedures worldwide every year. Senator Edward Kennedy was scheduled to speak at the conference, but sent this letter to Dr. Gawande instead.

PhRMA, the pharmaceutical industry trade group, is finalizing new gift restrictions that some state lawmakers say would make a proposed ban on gifts to doctors unnecessary. State Representatives meeting to revise a ban that has passed the Senate are getting calls and letters from PhRMA. Representative Peter Koutoujian says CEO Billy Tauzin told him that PhRMA plans to ban gifts, expect those for educational purposes, and will stop paying for meals outside a doctor’s office. Meals in the office would still be allowed. Koutoujian says with these changes, he doesn’t think a state ban is needed; and that the bill has already worked to tighter PhRMA gift rules.

I’m assuming, just by the timing of this proposal that they seem to be concerned and respectful of the role the legislature was taking right now in deciding whether to take action.

Other House and Senate leaders say the state must impose some restrictions to curb unfair marketing of drugs. A PhRMA executive says the changes are not a knee jerk reaction to any particular bill or event. PhRMA expects to release a revised ethics code early next month. Read more…

Last week we learned that the Connector had a major mess on its hands. Apparently, thousands of notices (affecting as many as 16,000 people) were not sent out on time to Commonwealth Care members and applicants. As a result, these people may have lost or will be losing coverage, through no fault of their own. We discovered the problem when our Helpline got dozens of these notices on the same day. We quickly got on the phone with other groups doing enrollment work, and figured out that something went wrong.

The Connector is trying to find a solution to the problem. We draw three lessons from what’s happened so far:

1. The continued need for outreach and education: The state now provides modest grants to 45 non-profit community groups to fund outreach and education efforts statewide. For the past two years, much of their work has been oriented towards getting people to sign up. Now, the focus is helping people stay enrolled, with continuous access to care. Read more…

This week, a team from Massachusetts will travel to Chicago for the initial meeting of the State Quality Improvement Institute. The Institute is a program of Academy Health and the Commonwealth Fund to assist several states, including Massachusetts, to improve the quality of health care. Our team, led by Health and Human Services Secretary JudyAnn Bigby, MD, will have the opportunity to brainstorm on possible solutions to several important issues with national experts on those topics. This intense review will assist the Commonwealth to better conceptualize quality improvement strategies, analyze potential tradeoffs, and consider possible implementation tools.

The Commonwealth Fund, which is the sponsor of the State Quality Institute, issues an annual report card on state health system performance. Massachusetts currently ranks #8 in this assessment, and we hope that what we learn through the Institute will be put to use to improve our ranking and the quality of care offered to Massachusetts residents.

Why should we care about our ranking? Well, it’s not about ego or bragging rights. Read more…

The state is in the final stages of negotiating a new 3 year deal with the federal government that leverages more than a billion dollars for health care in Massachusetts. The funding is critical for many hospitals, clinics and coverage of the uninsured under the state’s health coverage law. Governor Deval Patrick, Secretary JudyAnn Bigby, aides and several legislators met with US Health and Human Services Secretary Mike Leavitt today. Several people who attended the meeting say Secretary Leavitt confirmed the administration’s support for the law. Senator Ted Kennedy, a key force in securing this federal funding in the past, spoke to Sec. Leavitt by phone yesterday. You can read Sec. Leavitt’s blog entry on his conversation with the Senator here. Read more…