As we look back over our shoulders at national health reform proposals, which continue to draw from the Massachusetts experience, we also continue to look ahead at improving Massachusetts health reform.

This week, for example, the legislature will be hearing a number of bills to strengthen both the quality and access threads of health reform.

On Tuesday, the Public Health Committee will be hearing three bills drafted by HCFA’s Consumer Health Care Quality Council. The Council gives a voice to people impacted by poor quality medical care. They have joined together to work for real improvements in our system. The bills are:

• An Act to Improve the Delivery of Healthcare (S. 878/H. 213), filed by Sen. Moore and Rep. Provost, directs the use of checklists in hospital procedures. The bill would reduce medical errors and infections in hospitals by requiring that a series of safety steps be explicitly checked off by healthcare providers to decrease patient harm for given procedures. Airline pilots always run through their checklist before takeoff, and when surgeons do it, death and complication rates reduce dramatically.

• An Act to Reduce Healthcare-Associated Infections (H. 2139), filed by Rep. Provost, calls for screenings of high risk individuals entering a hospital setting for the “superbug” MRSA, a highly-infectious bacteria that’s resistant to most anti-biotics. Two years ago, that CDC reported that more people in the US die from MRSA than AIDS. Read more…

Health Care advocates are urging Governor Patrick to veto a budget item that will cut 28-thousand legal immigrants out of the state’s subsidized health insurance program. Health Care for All’s Lindsey Tucker says this change in eligibility is unfair and unwise.

“This sends a very dangerous signal at a time when the nation is watching our progress on health reform and I think it is in our best interests and the nation’s best interests to maintain our program with all benefits and eligibility in tact.”

The Senate initially predicted that ending coverage for legal immigrants would save about $130 million next year. The final budget approved on Friday by the House and Senate restores $15 million for this group of people. Here’s a note from the Senate about how the money will be spent.

“The Conference Committee FY2010 budget eliminated certain legal immigrants from the Commonwealth Care program that were ineligible for federal reimbursement. To offset some of the costs of providing health care services to this population, the budget increased funding for MassHealth Limited by $15 M in FY10. This increase assumes that most of the population now ineligible for Commonwealth Care will be eligible for MassHealth Limited (generally adults making less than 133% of the Federal Poverty Level). The $15 M would cover, approximately, emergency services for up to 25,000 people. Read more…

Editors note: there are lots of stories out there about how insurance rates are rising much more quickly for small businesses than for larger companies…here’s one. There are many possible reasons for this. A small group of employees has little cushion if one or two members have a year of high medical costs… or if a few members age into a higher risk group…but the effects are still very hard to handle. Jon Hurst has more on this issue here.

My husband and I buy our health insurance through my husband’s office.
We pay in full, his company doesn’t participate at all. His company offers only Blue Cross Blue Shield plans. The only “benefit” we get is that it is a pre-tax expense.

Until July 2008 we had a plan called HMO Blue Value Plus with a monthly premium of $811.61. When faced with a renewal rate of $1117.01 we downgraded to HMO Blue $1000 in order to keep our monthly premium at $812.49. Of course the benefits changed and we had a $1000 deductible each.

Now the renewal rate for HMO Blue/$1000 is $1257.94, a 31.57% increase. We could hardly afford $812.49. We certainly cannot afford $1117.01. So once more we can downgrade to a plan called HMO Blue/$2000 with, as the name indicates, a $2000 deductible, and also the higher monthly premium of $931.71.

I want to mention that HMO Blue Value Plus,the plan we had until July 2008,has now a monthly premium of $1492.98 which represents a 83.95% increase. I find this fact to be not just astonishing but outrageous; but I don’t see much outrage among our elected officials. Am I the only one doing the math? Read more…

Recently the legislature held hearings on the need to address racial and ethnic health disparities. WBUR has covered this issue on several previous blogs.

As Boston Public Health Commissioners, we are given a a report every year on the “Health of Boston”. The 2009 version has just been released. It looks at the health of each neighborhood, rating them on the prevalence of major diseases or problems: infant mortality, Chlamydia, HIV infection, car crashes, kid’s asthma, diabetes, heart disease, and obesity. I took the ratings for eight major problems, and turned them into a map that shows the healthiest (light pink) to sickest (red) neighborhoods: Click here for an expanded view of this map.

I then used 2000 census data to break out neighborhoods based on how white/non-white the neighborhood is. This data is the most recent available data for Boston neighborhoods. Lightest green is for neighborhoods that are majority white, and the darkest green is for neighborhoods that are over 60% people of color:  Click here for an expanded map view.

Try flipping back and forth between these two maps. What you will notice is that the darkest red area (the highest level of medical problems) is nearly identical to the darkest green areas (those neighborhoods that are more than 60% communities of color). Read more…

Editor’s note: this is the 3rd of 3 posts on goals outlined by the Eastern Massachusetts Healthcare Initiative (EMHI), a group of major hospitals, health insurers and universities in Greater Boston.

As part of the Eastern Massachusetts Healthcare Initiative (EMHI), we established a Task Force of infection control chiefs and practitioners from each of our member hospitals to examine areas where hospitals were working on implementing effective prevention efforts to reduce healthcare associated infections (HAIs).

This Task Force includes at least one representative from all of our member hospitals: Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Children’s Hospital Boston, Dana Farber Cancer Institute, Lahey Clinic, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Tufts Medical Center and Winchester Hospital. Until recently, the Task Force was chaired by Dr. David Blumenthal of Massachusetts General Hospital and Partners Healthcare.

The group began its work by identifying “stuck points” – where the hospitals were encountering particular barriers to prevention initiatives in the following priority areas: hand hygiene, Methicillin-resistant Staphylococcus aureus (MRSA), central-line associated bloodstream infection (CLA-BSI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP). These “stuck points”, or areas of difficulty, were then addressed in the development of best practices focusing on the importance of effective strategies in the areas of management and measurement. While all of our member hospitals have implemented some of the best practices, Task Force members believe they are all important enough to strive for full implementation. The hospitals are now developing work plans to track that implementation. Read more…

Former State Senator Jarrett Barrios is resigning form the Blue Cross Blue Shield of Massachusetts Foundation to become president of the Gay and Lesbian Alliance Against Defamation. Barrios hopes his work at GLAAD will help achieve social equality for gays, lesbians and their families.

“It’s because of my love for my kids that I take this challenge on, to make a world a little bit better in future years, a place that’s better for them to live and for all of us to live in.”

Barrios’ resignation is effective in September.

Alexandra Dukakis

Editor’s note: this is the 2nd of 3 posts on goals outlined by the Eastern Massachusetts Healthcare Initiative (EMHI), a group of major hospitals, health insurers and universities in Greater Boston.

The American Recovery and Reinvestment Act of 2009 included extensive funding for health information technology programs. Funding includes $300 million to support regional health information exchange efforts and $17 billion in Medicaid and Medicare incentives for implementing “meaningful use” of certified electronic health records. This commitment to health information technology was reinforced by President Obama in his speech on health care reform to the American Medical Association this week.

As one of the first three major initiatives the Eastern Massachusetts Healthcare Initiative (EMHI) sought to tackle, health information technology interoperability holds hope for aligning care in a way that can reduce unnecessary tests, reconcile medications, and achieve other potentially cost-saving goals. More importantly, it can improve the quality of care.

To achieve this goal, EMHI completed a strategic plan phase, assisted by consultants at the Massachusetts Health Data Consortium that resulted in a recommendation that the group pursue a project around electronic communication of clinical data. Next, the collaborative entered into a scoping phase to examine what that work would mean for each EMHI organization, including determining individual institutional cost estimates based on the current sophistication of each of our organization’s health information technology systems. Read more…

Twenty-seven physicians who work in an emergency department at a Boston Hospital see each other every day, and often care for patients within earshot of each other. How can it be that they vary as much as eight-fold in their use of CT scans of the head?

The fact is that everywhere one looks in healthcare, there is tremendous variation that just might offer opportunities to improve efficiency – as well as quality of care. This variation exists between regions of the country, and between groups of providers within any region. And this variation also exists among physicians within a single medical practice.

As Martha Bebinger recently reported on WBUR, the Eastern Massachusetts Healthcare Initiative (EMHI) is making a major push this summer to help physicians understand variation in their practices – e.g., how physicians vary in their use of high cost medications or procedures such as endoscopy. EMHI is a collaborative that includes the area’s major health plans and provider organizations, and our hope is that insight into which groups and which individual physicians are high utilizers of these drugs and procedures might help control healthcare costs.

There is good reason for optimism. Read more…

While Massachusetts is way ahead of the rest of the country in health care reform, we certainly haven’t reached the finish line. At best, we’ve made it up Heartbreak Hill, with a lot of tough miles ahead. What’s been accomplished in three years is pretty amazing – 430,000 more people insured and a rate of uninsured that’s the lowest in the U.S. by far – but unless we address the urgent need to tame health care costs while also improving quality of care, the state’s gains in access and coverage will be in severe jeopardy.

Fortunately, the law’s success has generated a great deal of momentum and good will, and a quick glance across the health care landscape shows that numerous groups, agencies and institutions are already working on various pieces of the cost and quality puzzle. But the fragmented nature of the health care marketplace and delivery systems, plus the natural desire of groups to focus on their own best interests, can make it difficult for them to act quickly in concert with one another. That’s where Aligning Forces for Quality comes in.

Aligning Forces for Quality (AF4Q) is a comprehensive effort designed by the Robert Wood Johnson Foundation to lift the overall quality of health care in targeted communities across the country, and Greater Boston has just been chosen to participate. Read more…

As the debate on Capitol Hill about whether to let uninsured Americans buy into a government run health plan, like Medicare, becomes more polarized, some stakeholders are floating what they say could be middle ground options. A few days ago, Senator Max Baucus said his health care reform bill (due out this week), might establish an insurance cooperative instead of a public plan based on Medicare. An insurance co-op is run by it’s members. Trade and professional associations have used this model to increase the buying power of individuals. But these groups don’t always have the money or clout to bargain for lower insurance premiums.

House leaders say they are not interested in creating insurance cooperatives.

Another “compromise” option that is getting some attention would let uninsured residents buy into their state employee plan. In Massachusetts that would be the Group Insurance Commission where workers chose from several different private insurance programs. The GIC typically holds premium increases to half or less of the going rates for private health insurance. Read more…