First it was doctors…now it’s hospitals. Starting in July, more than 300,000 residents who get health coverage through the Group Insurance Commission will pay more to go to some hospitals than others. Putting hospitals in one of three tiers, based on the cost and quality of their care, is part of the latest effort by the GIC to hold down health care costs.

Here’s how this will work. If you’re a state employee, your health plan will develop a rating system for hospitals that is supposed to be based on the cost and quality of their care. At a tier one hospital, your co-payment for an in-patient stay would be in the range of $200. But going to a tier three hospital would cost you $750 or so, depending on your plan. The Group Insurance Commission started a similar system for doctors several years ago. And although the Massachusetts Medical Society has sued the GIC over the program, GIC director Dolores Mitchell says its time to expand the practice to the hospitals where physicians work.

DOLORES MITCHELL: We are paying an enormous amount of money to cover our enrollees and we know that there is enormous variability in the quality of care delivered in these institutions. It seems to me it’s incumbent on us to try to get a handle on that.

JOE KIRKPATRICK: Patients should know the difference about the costs for hospitals and select those that are most cost effective.

Philosophically, says Joe Kirkpatrick with the Massachusetts Hospital Association, hospitals agree with the idea of tiered co-payments. But the MHA has problems the GIC plan. Read more…

While most employees are paying at least 9-10% more for health insurance this year, the state’s Group Insurance Commission is holding rate increases to just over 3%. The GIC is holding down premiums by keeping administrative expenses essentially flat, finding more ways to manage patient care and by increasing or beginning co-payments for a range of services. GIC director Dolores Mitchell says she hopes the changes make patients more aware of how much health care costs.

“That’s part of what co-pays and deductibles are intended to be. To raise people’s consciences that they are getting very expensive services and to at least think about it. But I don’t want to make it a barrier that keeps people from getting the care that they should get.”

The GIC covers more than 300,000 state employees and their dependents. There’s a push from some municipal leaders to save money by moving their workers into the program.

The Massachusetts health care reform law was enacted 3 years ago this month. Much credit for the law’s passage was given to the balance struck among various interests, and to the concept of “shared responsibility” for financing the expansion of health insurance coverage. Since April of 2006, over 400,000 more people in Massachusetts have health insurance, but there has not yet been a full assessment of whether the goal of shared responsibility is being realized.

Our analysis, being released today by the Blue Cross Blue Shield of Massachusetts Foundation, suggests that it is, at least at this early stage of reform. We took a comprehensive look at who was paying the premiums and other costs of private and public health insurance among employers, consumers, and government in 2005, the year before the law, and in 2007, the first full year after. We also looked at the distribution of spending on uncovered services, since an explicit goal of reform was to see these payments reduced as coverage increased.

Overall, we found that the shares of spending on coverage and uncovered services remained essentially the same between 2005 and 2007: employers and union health plans accounted for about 45 or 46 percent of total spending, government contributed about 30 percent, and individuals the remaining one-quarter. Embedded in these overall findings were some interesting dynamics. Read more…

This is not a summary of the 4+ hour long meeting of the Special Commission on Payment Reform on Friday. Health Care for All has some of that here. I’m focusing on a couple of issues or questions that are beginning to make these all too congenial meetings more interesting.

There is a tension developing about what can be done NOW to reign in health care spending, what is the longer term plan, and whether those two stages might be at odds.

Board members who represent state government are urging the commission to take immediate cost control steps. A and F Secretary Leslie Kirwan and Group Insurance Commission director Dolores Mitchell spoke several times on Friday about the need for bold action that will hold down health care spending and relieve some pressure on the state budget (about half of which is spent on health care). Ms. Mitchell’s budget at the Group Insurance Commission is $60-million short this year.

Harvard School of Public Health professor Nancy Kane suggested the state redistribute money more equitably among providers or look at freezing the rates it pays to both save money and push providers to try something new (global payments are the preferred option, but there is no decision yet on what the commission will recommend). Read more…

By Abigail Beshkin (WBUR)

A Suffolk Superior Court ruling on Thursday says a suit over how the state’s health insurance ranks its doctors may go forward.

The health insurance system for state workers divides doctors into three tiers. Patients who receive care from higher-ranked doctors pay lower co-pays.

But the Massachusetts Medical Society accuses the state’s Group Insurance Commission of using arbitrary measures to grade the doctors.

Massachusetts Medical Society’s Bruce Auerbach says among other things, the GIC often grades doctors on procedures they don’t do.

“We are not afraid to be measured,” Auerbach says. “We are not afraid to have people looks at how we do things. We just want it done right.”

The GIC calls its system a fair way to control costs, and says it developed the ranking system with doctors’ input.

No one can predict whether President Obama and the Congress will be able to forge an agreement on national health care reform, but there is one thing everyone seems to agree on: we need to receive far more value from our health care system – in other words, more quality and better outcomes for each dollar spent.

As readers of this blog know all too well, efforts to manage costs and improve quality have been ongoing for decades, but they are too often stymied by the way U.S. health care is organized, financed and segmented. There’s an emerging consensus, however, that health-care stakeholders need reliable, transparent quality and cost data in order to close the value gap. If it can’t be measured and reported, it can’t be improved.

For the past five years, Massachusetts Health Quality Partners (MHQP) has been measuring and publicly releasing quality data comparing how well primary care medical groups perform in meeting national standards for providing preventive care, helping patients manage chronic conditions such as diabetes, and avoiding the overuse of certain medications and tests. Our latest Quality Insights report on the performance of 150 medical groups from across the state has just been posted here.

Overall, Massachusetts physicians performed better than the national average Read more…

Many of us have known someone who loses a spouse or child and just never seems to get over it. Some researchers say that is not just folklore but a diagnosible mental illness they call “Prolonged Grief Disorder.” As the American Psychiatric Association considers establishing this new diagnosis, we survey divided opinion on how to deal with prolonged grief.

"Time Will Tell: Pathways to Prolonged Grief, Pathways to Acceptance" By Holly G. Prigerson, Harvard Medical School (click the picture for the full presentation)

Joyce Lopes met her soul mate at a bowling alley in Fairhaven in 1988. Ten years after a whirlwind romance and marriage, Tony was diagnosed with cancer of the esophagus.

He died six weeks later.

Joyce fell apart. She couldn’t go back to work and only got out of bed to deal with her 6-year-old daughter’s basic needs. She held out hope that her blanket of despair would lift if she could make it to the one-year anniversary. Read more…

A report out today says the state spent almost $794 million last year on health insurance for residents employed by large companies.

Massachusetts has one of the highest rates of employer coverage in the country…but 532,000 employees of larger firms and their dependents are in government subsidized insurance programs. Some are part-time, seasonal or contract workers…others can’t afford the premium. Division of Health Care Finance and Policy Commissioner Sarah Iselin says this is an expense the state is willing to bear.

“This is not surprising and really does line up with all of those enrollment numbers and success that we’ve seen and achieved with reform”.

Walmart, Stop and Shop and the Commonwealth top the list of large employers whose employees get state funded health coverage. Read more…

“One way or another, it’s time to look more critically at what we are getting for our health care dollars and identifying which providers serve us better with both skill and efficiency. In the last analysis, giving patients information is the best consumer protection – and the best road to lasting health care reform.” Dolores Mitchell Sept 4, 2007 – Commonhealth blog

As I understand it, the Massachusetts Commonwealth Group Insurance Commission, had a mission. They needed to come up with an effective way to reduce health care costs. Their choice was to partner with a few consulting firms (Mercer Consulting and Resolution Health) to generate a platform- a “methodology”- by which they could use physician claims data to rate physicians on quality and cost efficiency. The internet is ripe with articles, blogs, and case studies about the efforts and “successes” of this GIC endeavor. They have used claims data, not clinical data, as the basis for this approach, also known as tiering. Each insurance company contributes its claims data to GIC and to the data mining firms. This data once run through software and analysis is sent back to the insurers to be used as they see fit. Some have used it to develop threshold levels to rank physicians as Tier 1 (excellent), Tier 2 (good), and Tier 3 (standard.) The tiers are then attached to a different co-pay, the physician is listed on the insurer website as a “Tier 1-2 or 3″ quality doctor and patients and their families are required to pay a higher copay, the lower the tiering.

As a pediatrician in the state, my “tiering,” has resulted in being among the group rated as Tier 2. Read more…