When most Americans talk about fixing health care, according to polls they don’t prioritize helping older Americans or younger people with disabling diseases or injuries.

But, as key lawmakers in Congress look at what’s in and what’s out of a national health reform plan, long-term care is gaining attention.

Massachusetts Sen. Ted Kennedy says he won’t move a reform bill unless it includes a section on it.

At first glance, it looks like Terry Rickman is enjoying a cozy rainy afternoon on her living room couch — feet propped up under a fluffy pink blanket, one of her cats nestled in her lap.

But Terry is trapped here for hours on end every day. She was diagnosed with multiple sclerosis 23 years ago. At this point, Terry can’t walk, can barely see and has limited use of her arms and hands.

“I’m really confused about what my day holds anymore,” Read more…

The one thing we can all agree on when it comes to controlling health care costs is that payment reform is essential. Beyond that, there’s not a lot of consensus – or knowledge – about how to do it.

The Special Commission on the Health Care Payment System, which has been charged by the legislature with examining alternatives to fee-for-service payment in the Massachusetts health care system, is pursuing bold reform. It seems willing, for example, to endorse budgeted payment mechanisms that fundamentally change the incentives in our health care system. Such changes, if implemented correctly, will permit health care providers to enhance revenue not by simply increasing the volume of services they provide, but by providing better care at a lower cost.

But payment reform alone will not eliminate our cost problem or allow us to slow spending while maintaining or improving quality of care. To do that, we need better information systems to support provider decision-making and tighter linkages between providers to coordinate care and reduce waste.

And that’s where the Health Care Quality and Cost Council’s (QCC) Roadmap to Cost Containment comes in. Read more…

A recent Wall Street Journal (WSJ) editorial on federal health reform decried the Massachusetts version as recklessly out of control and warned the rest of the nation to avoid such liberal delusions. For those that missed it, the subtitle under the headline was “The Massachusetts debacle, coming soon to your neighborhood.” Chapter 58 was passed three years ago this month, and it’s clear the WSJ is voting thumbs down. It is worth looking at some facts on how things are going — given the federal health reform agenda the Massachusetts model will get a lot more attention, both good and bad.

There are 432,000 newly insured by the most recent estimate. That means 97.4% of Massachusetts residents are insured, more than any other state in the US and close to the levels in the Netherlands and Switzerland where universal health care coverage is the law.

The WSJ noted that only 21,000 of the newly insured had obtained insurance privately in the free market via the Connector products, but that 165,000 were insured via free or subsidized government programs. What they neglected to mention was that nearly all of the rest Read more…

As the tax filing deadline approaches…fewer residents are appealing the state penalty for failure to have health insurance. That’s a surprise to some state officials who expected a higher rate of appeals becaues the penalty was more than four times higher in 2008 than in 2007. But even though the number of residents filing early returns is up as compared to last year….the number of tax filers contesting the fine is down 30%. Navjeet Bal is the Department of Revenue Commissioner.

“It may be a reflection of the fact that more people have health insurance this time around than they did a year ago. So perhaps the penalties from a year ago had the desired affect which was to encourage people to get health insurance.”

A final tally on appeals won’t be available for several months. The Connector Authority set aside 2.7 million dollars to handle appeals this year, but does not expect it will need to spend that much.

Martha Bebinger

Our family had health insurance through my employer until I left my job to go to school, upon which my self-employed wife declared herself a business and obtained insurance through the Massachusetts SBA. Though we were insured, the premium was way over our budget.

About a year later my wife heard about the beginnings of Commonwealth Care on NPR. I submitted the application for what I thought was whole family coverage but when we received the insurance, my name was not included and thus, I was without health insurance. After many phone calls, it appeared that even though my data was on the application, only my wife and our children were insured. I was now a member of this country’s uninsured and it was quite scary. After many more phone calls and paperwork I was able to obtain insurance through Commonwealth Care.

Thankfully, our family has been able to keep our previous primary care providers and locations. We continue to receive excellent care and services, and are able again to save money for our and our children’s future needs.

We sincerely appreciate everyone who has enabled health care reform in Massachusetts.

Stuart Shapiro, Cambridge

As the country is poised for national health care reform there is increasing public discussion and interest in the topic of physician payment. To ensure that the right dialogue is taking place, we need to be explicit about the value of providers and payers sharing the same goal: alignment of financial incentives, which is based upon delivering the right care at the right time in the right place. One cannot have a conversation about alignment of financial goals, however, without addressing the opportunity to elevate quality standards for patients. It is my prediction that as national health reform comes closer to reality, we shall hear more about quality incentives in provider contracts the same way we are hearing about investment in comparative effectiveness research. This is good news for all of us.

Why is this conversation so important now? It is my belief that we are at a critical juncture as evidenced by the federal government’s attention on health care, the state’s payment reform initiatives and as part of that—the convening of the Commonwealth’s Special Commission on the Health Care Payment System, which seeks to evaluate the use of differing reimbursement models between payers and providers. Read more…

There is a sharp rise in requests for free and subsidized health coverage as the economic downturn continues. 10,000 residents applied for MassHealth this month as compared to 6,000 a month last Fall. The state’s Medicaid director, Tom Dehner offers one possible explanation.

I anticipate that this increased volume and higher enrollment numbers are going to be directly connected to people who lost employer sponsored insurance.

Dehner says, based on the numbers right now, the state has set aside enough money to handle the increase. The state’s Commonwealth Care program is seeing a more modest increase in enrollment.

Massachusetts may be a model for health care reform, but we’re losing our grip on one of the state’s most effective disease prevention programs: childhood immunization.

For years, Massachusetts has maintained some of the highest rates of childhood vaccination in the world. Now, our childhood immunization program is in crisis.

Vaccines are the most cost-effective public health interventions since clean water. According to the Centers for Disease Control, every dollar spent on immunization saves $18.40, producing aggregate savings from all vaccinations of $42 billion to US society. We’ve eliminated diseases like smallpox and polio and can prevent many others. We’ve been so effective that people don’t even remember how deadly these illnesses can be.

Effectiveness of a vaccination program is largely based on its ability to create “herd immunity.” Vaccinating a large proportion of children protects not only those immunized but non-immune individuals as well, both children and adults, because the illness cannot exist in such a highly protected population.

Recently, however, several factors have put Massachusetts’ children and communities at risk from vaccine-preventable illnesses Read more…

When community health centers were first introduced to the United States (the first in the U.S. was in Dorchester in 1965), they were created to deal with a health care system that didn’t meet the needs of the millions of low income people who increasingly made up American cities as the suburbs drew the middle and working classes out of them. To use my own health center community as an example, by the 1970s, there were still private physicians practicing in Codman Square, but the new residents, who were mainly African Americans largely uninsured or covered by Medicaid, were not welcome in most of those offices. Most of the doctors had closed their practices to new patients or refused to take new customers on Medicaid (and nearly all left the community by 1980). So the new residents had no place to go for services except the emergency rooms of local hospitals, which was considered very inefficient and costly, and bad care.

The Boston Department of Health and Hospitals, under enlightened leadership from people like Lewis Pollock, encouraged communities to start their own health centers. In addition, a number of urban hospitals, through the encouragement of the Sackett Plan (named for previous Health and Hospitals Commissioner Andrew Sackett), worked with community groups to help them start health centers. Availability of federal funding also encouraged the formation of health centers. Eventually 28 health centers were created in Boston (26 remain). Because of these different methods of formation, three different types of health centers emerged, all providing similar medical services but with different funding models. Read more…

In an effort to help the struggling Boston Globe, bloggers around he city are mounting a joint request for suggestions on how to keep the paper afloat.

President of Beth Israel Deaconess Medical Center and prominent Boston blogger Paul Levy has organized what he calls a “blog rally” to support the Globe.

Levy says dozens of Boston bloggers have agreed to align their messages for one day.

“We’re looking for the wisdom of the crowds, the public to make suggestions to help a newspaper that we think if very important to the community life and governmental functions in Massachusetts.”

The Globe’s parent, The New York Times Company, has threatened to close the Boston paper unless its unions agree to $20 million in concessions.

Paul Connearney