A well-kept secret in the arcane world of health care policy is an innovative program that is both taking better care of poor seniors and saving Medicaid dollars. That it’s a secret is the problem.

In 2004, Mass Health began offering poor seniors the option of joining a Senior Care Options plan (SCO). The objective was to provide a comprehensive care management plan that consolidated the benefits of Medicaid, Medicare Part D and, for those who qualified, Medicare Part A and B.

The anticipated outcome was less use of costly nursing home care, reduced acute care hospital stays and more economical home care and community-based services. Read my op-ed about the benefits of SCOs or that of Douglas Brown.

A recent study commissioned by MassHealth found that SCO members use nursing homes for long-term custodial care at half the rate of Mass Health beneficiaries on the Mass Health Standard. At present enrollment levels, Medicaid is saving $70 million in avoided nursing homes costs annually. The state’s share is one half of that. If the state were able to achieve 100 percent participation from the eligible population, the resultant Medicaid savings would be staggering. Read more…

The state payment reform commission has a vision of a new payment system for Massachusetts – a global payments system. The commission’s report is an important contribution to the debate over health care reform for Massachusetts, and for the country, as we strive to provide affordable care with reliably high quality. However, our state’s movement to such a model should be careful, deliberate and mindful of the errors of the past.

This new payment model would mean a dramatic change in how practices and hospitals organize themselves around patient care. Any business leader who has attempted a change of a similar scope will tell you that the process is slower, more difficult and more costly than initially expected. When you consider that we would be attempting payment reform at the same time that people are still becoming sick or injured, this task becomes even more daunting. It’s like trying to fix an airplane while it’s flying. You have to do this carefully – very carefully.

If physicians sound cautious about proceeding with this transition, it’s with good reason. Like everyone else, we have long memories. We remember past failed experiments, like capitation in the 1990s, which was rushed into implementation without proper safeguards, checks and balances. Read more…

Aides to House and Senate leaders say there’s a deal to provide $40 million dollars for continuing health coverage for legal immigrants. Governor Patrick had asked lawmakers to restore $70 million for this effort in the budget. But lawmakers are reluctant to go that far because state revenue are still coming in short of expectations. Some advocates are praising legislative leaders for carving out at least $40m. Others say it’s not enough, and it seems the administration agrees. Spokeswoman for Administration and Finance Cyndi Roy says, “while we appreciate this statement of support, our analysis shows that the level of funding appropriated is not sufficient to maintain meaningful coverage or to develop a scaled back program.” $40m is less than one third of what the state currently spends on subsidized coverage for these residents. The House and Senate are scheduled to debate this issue tomorrow.

Martha Bebinger

Yea, though I walk through the valley of the shadow of death, I will fear no evil: Psalm 23:4 (King James Version)

Perhaps no other Scripture of sacred text better describes these perilous times in which our Commonwealth finds itself on this very day. His Eminence, Cardinal Sean O’Malley, eloquently describes this dangerous economic valley through which we are traversing in his July 24 blog: “The Governor and the Legislature in the commonwealth face excruciatingly difficult choices this week. Final decisions about the budget bring together the fact of an economy in deep recession, declining state revenues and multiple human needs among the citizens of the commonwealth.” The Cardinal continues, “A particular issue of concern to me is the possibility that funding for health coverage for 28,000 legal immigrants may be cut in whole or in part….The commonwealth has done a very commendable job of providing health care to the citizens of Massachusetts. It would be a tragic mistake to let these 28,000 members of our community lose access to the precious good of health care.”

“Yea, though [we] walk through the valley of the shadow of death. . .”

“A tragic mistake” the Cardinal says. I would, respectfully, like to expand on the Cardinal’s accurate assertion, “a tragic mistake.” I would go a step further and say a “catastrophic mistake.” With the bottom out of our economy, our state political leaders are faced with many horrific challenges. Tremendous cuts in every area – disabilities, mental health, elderly, public safety, HIV&AIDS, public education and the list goes on and on and on! Indeed, the implications of many of these cuts are captured by the word, “tragic.” But to cut 28,000 legal immigrants access to health care is beyond tragic – it is a catastrophic mistake. Here is why. Read more…

Here’s the notice from Boston Medical Center.

We had some web wobbles today at WBUR. We lost a few posts and some comments. I will reinsert the posts, but don’t have a list of the comments that have disappeared. My apologies to anyone whose comment was erased.

Martha Bebinger

Earlier this month, the Special Commission on the Health Care Payment System recommended that the Commonwealth move to a global payment system. The recommendation has given us all reason to step back and imagine how health care might look different than it does in today’s fee-for-service world.

Our current fee-for-service system imposes an artificial, anarchistic structure on the relationship between doctors and patients. In that artificial structure, care must happen in the office. Coordinating treatment among multiple clinicians does not count as care. E-mail, in most cases, does not count as care. Specialty care is worth more than primary care. Treating disease is worth more than preventing it. Intensive procedures and high-tech care are worth more than a conversation between a doctor and a patient. And on and on until good care often is being delivered in spite of, rather than because of, the health care system.

Under global payment, this artificial structure is gone. We are hearing from the physicians and hospitals in our new Alternative Quality Contract that the global payment has liberated them from the fee schedule and all its unintended consequences. Under global payment, they are free to deliver care in the ways that work best for patients and their doctors.

Dr. Barbara Spivak, president of the physician group affiliated with Mt. Auburn Hospital, Read more…

We are starting to see fractures in the national health reform coalition. Among the defectors are the nation’s governors, who weighed in on the plan last week during their annual summer meeting. It seems support for reform among this group is at best tepid. This is a shame. Health care reform, if done right, should appeal to most states’ top politicians. Meanwhile, backing from the nation’s governors is critical for the successful implementation of any reform plan that comes from Washington.

Under the right kind of national health care reform, states would have much to gain:

• Fiscal relief. Medicaid made up 21 percent of the average state budget in fiscal year 2008. This includes both state and federal funds, and the federal share has increased temporarily under the federal stimulus bill. Nonetheless, increasing medical care costs, particularly when combined with caseload increases due to an economic downturn, crowd out other priorities and force very difficult choices in state capitols in terms of coverage, eligibility, and provider payments. Health care reform could provide badly-needed relief for states by supplying federal funding for low-income subsidies, stemming the erosion of employer-sponsored insurance and any associated increase in Medicaid caseloads, and buffering states against economic downturns by increasing federal matching rates during recessions. Of importance for Massachusetts, it also could level the playing field between our employers and those in other states by imposing national requirements for employer coverage.

• Long-term care reform. Read more…

Wednesday morning, June 24th I left Boston on my way to Washington DC and after that Bethesda Maryland for a few days. In DC in the morning I was one of eight people from Massachusetts, who believe “Massachusetts is not the model”, to meet with some of the people that were going to be in the White House that evening for President Obama’s town hall meeting on national health reform which aired on ABC to talk about health reform in Massachusetts. I gave them my morning copy of the Globe I picked up at Logan and read on the way down. The front page story (above the fold) was about the projected cuts of $115 million from the state’s health care budget. The front page of the Metro section (again above the fold) was a story on the State Treasurer saying that the Massachusetts experiment in “health reform was too pricey.” In the afternoon I took the Metro to Bethesda to attend a conference of the Agency for Healthcare Research and Quality (AHRQ) to discuss the role of primary care practice based research networks in helping move the AHRQ agenda promoting and funding in the area of comparative effectiveness research, a necessary strategy in national health reform aimed at getting a better return on investment of the health care dollar in regard to efficacy and quality. That night I watched the President on ABC.

The next day, Thursday, I attended a rally organized by Health Care for America Now (HCAN) at the Capitol and was hyped by the overwhelming display of support for health reform from communities, organizations, and workers from across the country. I spent the day talking with legislators, staff and policymakers, including our own John McDonough who came out of a Senate committee mark up session to meet with us. Read more…

Join WBUR’s Martha Bebinger and Boston Globe reporter Lisa Wangsness for a discussion of President Obama’s efforts to overhaul health care. You can read a wrap-up of Mr. Obama’s prime-time news conference from NPR’s Liz Halloran or see the White House transcript of Mr. Obama’s remarks (links open in new windows).