Enrollment in the state’s subsidized health insurance plan, Commonwealth Care, is rising for the first since last Fall. The plan has added nearly 8,000 members in the last 2 months. The new total is just 3,000 members short of the 180,000 members on which next year’s state budget is based. The number of residents seeking free coverage through the Medicaid program, MassHealth, is also up.

Martha Bebinger

A new national report that examines disparities in health care finds that minority women in Massachusetts have higher rates of diabetes and HIV/AIDS than white women do.

The study compares the health of white women and women of color for illnesses including heart disease and cancer.

The Kaiser Family Foundation report also looks at whether the two populations have comparable access to care, such as insurance coverage and health screenings. In Massachusetts, the study found that minority women get diabetes twice as often as white women do, and get HIV or AIDS 13 times as often.

The Kaiser Foundation’s Cara James calls these disparities an economic concern as well as a health issue.

“The cost to the health care system of having women who have problems with diabetes, heart disease, smoking — the toll that that takes in terms of care that they need is costly,” said James, the study’s lead author.

James says the study could help Massachusetts decide where best to spend its health care dollars.

Sacha Pfeiffer

Here’s the list of stakeholders invited to a roundtable hearing on Senator Kennedy’s health reform bill. HELP avoids the theater of Finance committee hearings last month with the first guest:

Margaret Flowers, M.D., Maryland Co-Chair, Physicians for a National Health Program, Chicago, IL

Ron Williams, CEO, Aetna Inc., Washington, DC

Randel Johnson, Vice President for Labor, Immigration, and Employee Benefits, U.S. Chamber of Commerce, Washington, DC

Mr. William Dennis, Senior Research Fellow, National Federation of Independent Business, Washington, DC Read more…

Ask anyone how long they have to wait for an appointment with their primary care doctor, and you’ll likely get a roll of the eyes and an exasperated sigh. Their frustration reflects a national trend: Primary care delivery is in a state of crisis. The problem is even more pronounced here in Massachusetts, where an increased number of insured patients are flooding doctors’ offices since health reform was passed three years ago. According to a recent study by Merritt Hawkins and Associates, of 15 cities surveyed, Boston had the longest wait time for a primary care appointment – a staggering 49.6 days. The wait is partially the result of doctors’ offices refusal to take on new cases: A full 35 percent of Massachusetts family medicine practices are closed to new patients.

The problem couldn’t come at a worse time for the Commonwealth. Unhealthy behaviors are fueling a rising tide of chronic disease; self-reported diabetes in Massachusetts increased by nearly 40 percent in a decade, exceeding seven percent of the population by 2005. And diabetes, heart disease and other chronic illnesses hurt our economic well-being in addition to our health: The Milken Institute estimates that the total impact of chronic disease on the Massachusetts economy is $34 billion per year. Read more…

Regular readers of the WBUR Commonhealth blog know that I have complained long and loud for years now that the clear shortcoming of health care reform in Massachusetts has been the lack of equal rights, opportunities, and insurance pricing under the law and in competitive markets for small employers versus what exists for the big business and big government. We remarkably have a health care mandate law pushed for by the receivers of our health care dollars—such as Blue Cross/Blue Shield of Massachusetts and Partners–which requires coverage, yet which does not allow small businesses and small non-profits the same ability to group buy or to seek discounts from providers that large purchasers enjoy. Without that ability, insurers are free to take money from the small purchasers in order to give all the discounts to their big groups. Kay Lazar of the Boston Globe examined this issue very recently.

We all know about the hundreds of millions of dollars cities and towns would save by joining in on the buying clout of the Group Insurance Commission. The GIC has been very effective in keeping their recent increases in the 3-5% range. Read more…

The number of bankruptcies tied to medical costs in the United State is on the rise.

A Harvard University study out today shows a 50 percent increase in such bankruptcies between 2001 and 2007. The vast majority of the 2,300 bankruptcy filers surveyed had health insurance when their medical problems began.

Study co-author Steffie Woolhandler, an associate professor of medicine at Harvard, spoke with WBUR’s Delores Handy about the findings.

The President sent this letter to Senators Ted Kennedy and Max Baucus today. A few highlights:

1) President Obama says he’s open to the idea of “shared responsibility” including an individual mandate.
2) He reaffirms support for a public health plan option.
3) He talks about giving a Medicare Advisory Commission greater authority to impose health care cost controls.
4) He mentions encouraging physicians to join networks that can coordinate and manage patient care (this idea is in recommendations pending from a special state commission on health care payments)

Here’s a response from Senate Finance chairman Max Baucus:

“It’s clear that President Obama and I are in lockstep in our view that we must act quickly to drive down the growth of health care costs and ensure that all Americans have access to quality, affordable health care coverage. Working together will be crucial throughout the health care reform process and that is a sentiment echoed by the President today. Health care reform is my top priority and I will stop at nothing to deliver a health reform bill that works for families and businesses to the President this year.”

Martha Bebinger

With all the reminders lately to wash your hands to prevent the spread of flu, you might feel like you’re back in grade school. But it can be so hard to get people to follow proper hand hygiene that even many doctors and nurses don’t do it correctly.

That contributes to 1.7 million hospital-acquired infections each year. So several Boston hospitals have launched hand-washing campaigns, including some that involve rap music videos and undercover surveillance.

Everywhere you look at Massachusetts General Hospital, there seems to be a dispenser of hand sanitizer. Read more…

Managing health care costs by changing the way providers get paid is a hot health care reform topic. Proposals for doing so are plentiful. What if we could improve care for the sickest of our patients and also reduce costs?

Last August, I used this space to describe a demonstration project underway at MGH. Working with the federal Centers for Medicare and Medicaid Services (CMS) we have been testing whether we could better manage the care of 2,500 of our sickest Medicare patients, avoid hospitalizations and save money. Almost three years into the program, it looks like we have and CMS has asked us both to extend the program for three more years and to replicate our results at another site.

These patients and their physicians are coping with multiple complicated problems. In addition to their medical issues, half have a psychiatric diagnosis, like dementia or depression, and nearly a quarter are near the end of life and die each year. Over the course of this demonstration, we have reduced their emergency room visits, hospital stays and readmissions to the hospital. It’s not uncommon for our care teams to hear that the program has “transformed” a patient’s life. We have also covered our costs and produced net savings compared to a rigorously selected matched control population. Read more…

As the debate about how to control rising health care costs reaches the next level in Massachusetts, two new groups that include the most powerful players in Greater Boston are staking out their positions. One includes major hospitals, health insurers and universities. The other is a coalition of employers. The groups have overlapping members and goals…which highlights a conflict Massachusetts faces as it tries to control the rising cost of one of its most important industries.

The group of top level hospital, insurance and university leaders has been meeting quietly for more than four years now. They called in an anti-trust lawyer to make sure their plans and even their conversations did not violate federal regulations. This group, whose members are often at odds over how or when to spend money, found some common ground on how to curb rising health care costs.

STUART ALTMAN: Which was to improve quality. Its much easier to get the groups to work on quality improvement than it is to work on sort of slashing their own.

Stuart Altman, professor of health policy at the Heller School at Brandeis University, is shepparding this group that calls itself the Eastern Massachusetts Health Initiative (EMHI). It is announcing three goals: to eliminate hospital acquired infections in 5 years, to connect electronic health records at all hospitals and to reduce broad differences in the way Boston area hospitals treat patients. Read more…