Most of the state’s leading health insurers say profits were down last year…with the economy. Harvard Pilgrim was the exception…posting a small increase. Blue Cross Blue Shield lost members while Harvard Pilgrim, Tufts Health Plan and Fallon, added subscribers. Blue Cross Executive Vice President Steven Booma says he hopes investment income rebounds this year…but membership may not.
“I would see membership to be roughly flat, possibly declining some based again on the contraction of the employment base and the impact that has on folks buying health insurance.”
Income for insurer CEO’s rose…with Cleve Killingsworth of Blue Cross at $3.6 million…Charlie Baker with Harvard Pilgrim at $1.7 million…James Roosevelt, Jr. of Tufts at 1.1 million dollars and Eric Schultz of Fallon at $714,280.
The state’s health coverage law is getting a much needed shot in the arm. The cost of state providing state subsidized coverage next year is coming in lower than expected. Health plans that provide Commonwealth Care have agree to hold rates essentially flat next year. The savings are critical to keeping the law affordable for individuals and the state. But tamping down rates in one part of the insurance market may push up rates for residents who buy private health plans.
(story transcript follows)
A zero percent increase in health insurance rates sounds like an oxymoron. But health plans that provide coverage through the state’s subsidized health insurance program, Commonwealth Care, have submitted bids that would essentially hold rates flat for contracts that begin July 1st.
PATRICK HOLLAND: I think the plans have had more time to go back and revisit their provider contracts and potentially get a better deal.
Patrick Holland, the Connector Authority’s CFO, negotiated these lower cost contracts with 5 health plans that offer free and subsidized coverage. In addition to holding down payments to doctors and hospitals, Holland, says the health plans are also getting better at managing the cost of these newly insured residents…many of whom have chronic diseases. Read more…
There’s serious discussion in Washington around national health care reform. That’s a good thing because our current system produces inadequate clinical outcomes at an unsustainable cost. And, while the devil is most definitely in the details when it comes to health care reform, there’s growing consensus and a commitment among key stakeholders to take meaningful steps toward a solution.
There also is serious discussion around reducing funding to Medicare health plans (known collectively as the Medicare Advantage program) as a strategy for funding some of the national health care reform measures. For Massachusetts Medicare beneficiaries, that’s a bad thing.
As in so many things, Massachusetts was a pioneer in the Medicare program when it was among the first states to offer a health plan option to seniors. Today, Medicare Advantage is popular in the Commonwealth. Approximately 190,000 seniors (about 20% of all residents on Medicare) are enrolled in the program. There are good reasons for this popularity. These plans are high quality and low cost. And, the Massachusetts Medicare Advantage plans are ranked among the top health plans in the country by the National Committee for Quality Assurance for clinical quality and customer satisfaction.
According to statistics from the Henry J. Kaiser Family Foundation, most Medicare Advantage enrollees are lower income seniors (with incomes reported between $10,000 and $30,000). Read more…
The recently signed American Recovery and Reinvestment Act will deliver necessary relief from a dismal financial situation in Massachusetts. And it can be used to restore some on the massive cuts made to health care this year, and in next year’s budget.
The Administration’s FY 2010 budget tried to protect eligibility and benefits for low-income residents. They proposed some expansion of Medicaid and CommCare with the assumption that more residents will be in economic trouble this year.
Unfortunately, they also made dramatic cuts in payments to hospitals that serve the poor, freezing rates for most other healthcare institutions and nursing homes, and cutting public health and behavioral health programs.
The rest of FY 09’s health budget was balanced by using $533M (for three quarters) of financial assistance from the Recovery Act. This week, Massachusetts will be eligible for $594M for just two of the three FY09 quarters. Read more…
My name is Hannah Frigand, and I am a HelpLine Counselor at Health Care For All. I started working on the HelpLine as an intern January of 2006, and I began working full-time that fall. When I first started taking calls, it was before Health Reform passed, and we were receiving between 100-150 calls a week in English and Spanish. Currently, we receive over a thousand calls a week in English, Spanish and Portuguese and are looking to expand in even more languages. When I started working at the HelpLine, there were only two full-time counselors; now there are five.
In 2008, the HelpLine took a total of 37,472 calls and completed 1,870 health insurance applications over the phone. Behind each application is an individual or family who we have guided through the health care system. For each one of these clients, we have followed up individually and notified them of the status of their application and their next step. Our callers include those who need help making a doctor’s appointment or getting prescriptions filled at low- or no-cost; those who need assistance with medical debt or appealing a MassHealth decision; and those who have questions about private insurance or need assistance completing an application for the state programs.
The HelpLine calls have increased in the last few months, and we are hearing a lot of new stories from people who have never turned to the state for assistance before. Here are some of the changes:
– So far this month, the call volume has increased by 67% compared to same time-frame last year. Read more…
A recent meeting of representatives from the Special Commission on the Health Care Payment System hosted by the Massachusetts Medical Society allowed physicians the opportunity to share their ideas on the topic of payment reform. As one of those in attendance, I was impressed by the time and energy the commission has devoted to gathering input from all stakeholders as part of this challenging process.
While unanimous consent about payment reform – even among physicians — is unlikely, I think we can agree on certain key principles.
First, all stakeholders should practice “principled negotiation.” Dr. Elliott Fisher, Director of The Center for Health Policy Research and Professor of Medicine and Community and Family Medicine at Dartmouth Medical School, defines that as a willingness to collaborate and to frame issues in a way that everyone will interpret as valid rather than self-seeking.
I think all participants in the dialogue would also agree that a redesigned payment system could promote better coordination of care, preventive care, and chronic disease management. Shortcomings in these crucial areas adversely affect patient health and drive up costs.
However, those reforms could take several years to show a return on investment. Read more…
A few blogs ago, I stuck my neck out, and predicted that we could and would pass a national health care reform bill by the end of the year. Well, what a difference a stimulus package makes! The progress of the bill through the Congress has resuscitated a host of old scare tactics that I thought had been discredited and discarded during this first decade of the 21st Century. But here they are again. Comparative effectiveness research? How can a rational person be against trying to find out what works, without harming patients, and what works as well as, if not better than what’s already on the market? Have these alarm sounders missed all the highly publicized examples of drugs that turned out to have serious negative effects once they were distributed country-wide? And what about the dozens of drugs that are “new” heavily advertised, and expensive, but are really just “me – too” drugs that delay the roll out of generic substitutions. Read more…
One day the Pharisees and Sadducees came to test Jesus, demanding that he show them a miraculous sign from heaven to prove his authority. He replied, “You know the saying, ‘Red sky at night means fair weather tomorrow, red sky in the morning means foul weather all day.’ You know how to interpret the weather signs in the sky, but you don’t know how to interpret the signs of the times!
Matthew 16: 1-3 (New Living Translation)
Every Sunday morning I see the signs of the times, when I look out on to the faces of my congregation. Worry weighs upon their glorious faces and their eyes shout out a chorus of unanswered questions: Will I have a job tomorrow? How will I support my aging parents? How long can I pay the mortgage? Can I afford to go to college? Will we be able to pay our staff this month? The fear of what tomorrow might bring is robbing them of the joys of today. Amidst this seemingly endless song of worry is a life saving, beacon of hope: Massachusetts’ Chapter 58 Health Reform law! It has given a father the care he needs to recover from a stroke, a grandmother the emergency surgery that saved her life and a mother the prenatal care needed to protect her unborn child. For many, health reform has given them a safety net to survive in the midst of life’s storms.
The current times require that we not falter in interpreting the economic signs that surrounds us. Read more…
Most of us know the frustration of having to wait weeks to get a doctor’s appointment, and then waiting again when you finally get there but your doctor is rushed and running late. Well, imagine if there were no more waits for a doctor, and your appointment could last a leisurely 90 minutes. Turns out that’s actually happening, but there’s a catch: You have to be willing to share your appointment with a group of other people.
STORY
Gary Watson of Natick recently called the office of his primary care physician, Dr. Charlie Tracy. He wanted to get in to talk about his sleep apnea and some muscle pains.
GARY WATSON: “They said, ‘Wait a minute, can you get here at two-o-clock this afternoon?’ ‘Why?’ I said suspiciously. And they said, ‘We’re going to have one of these groups with Dr. Tracy.’ “
“These groups” are officially called shared medical appointments. A few hours later, he’s in a room with eight other patients for about an hour and a half. Most of them have different symptoms and health concerns.
NURSE: “I want you to really feel free to open up and share with each other. We have some cold drinks, hot drinks…”
A nurse helps Dr. Tracy. There’s also a medical assistant who takes patients one by one to a private exam room to check their vitals. No one has to get undressed in front of the group. There’s also a helper who takes notes as Dr. Tracy calls on each patient.
On February 19, the Division of Health Care Finance and Policy (DHCFP) will hold a public hearing on proposed regulations implementing an assessment on insurers to raise $33 million for the state’s general fund. The proposed regulations set a very low bar for determining how much insurers should keep in reserve in order to offer coverage safely to subscribers. This low bar should be concerning to everyone with a stake in maintaining the stability of our health care system.
All health insurers need reserves in order to pay claims in the event of an unexpected surge in health services, for example, a particularly bad flu outbreak. Some policymakers have appropriately asked whether reserves not needed for this purpose might be redirected for other public purposes. Read more…