Nearly 30,000 legal immigrants from around the state face losing their health insurance at the end of August. State lawmakers erased the group from the state health plan, because of budget shortfalls, but are now considering a plan to cover non-citizens, at a reduced level.

Bazlul Wahab was born in Bangladesh. He studied engineering and developed skills attractive to American high-tech companies. He now lives in Woburn with his wife and children. Wahab’s been in this country 17 years. A few years ago, he became a U.S. citizen. One of the best parts of citizenship for Wahab, was that he could finally get his mother a green card and reunite his family.

“Obviously, I was very much interested to bring her here,” Wahab says while sitting on the couch in his Woburn home.

Wahab’s 62-year-old mother spends her days at home, where she helps watch Wahab’s children.

She suffers from diabetes and high blood pressure, but her health has has improved since she started seeing American doctors.

Wahab says care is better here, although way more expensive than in Bangladesh, where people pay out of pocket for relatively inexpensive doctors visits. Read more…

Join us on Thursday, at noon, for a live online chat about efforts in Washington, D.C. to overhaul health care. WBUR and Boston Globe will co-host the chat. Weigh in at wbur.org or boston.com tomorrow.

About a dozen years ago, there was a significant segment of the health care system that believed that the future of health care was going to change to be a system in which primary care providers held the key to all other services, with primary care “gatekeepers” managing the care of “covered lives” (i.e., patients) and ensuring lower cost, higher quality services. This group believed that insurance companies really just wanted to make money, and didn’t want to be in the business of determining what and how much health care would be allowed. So why not just turn the decision making (and a set dollar figure per patient) over to doctors and let them take the risks (and gain the rewards by managing care) with the insurance companies taking their share off the top?

Sound familiar?

In the 90’s, the system that is now being called a “global payment system” was largely represented in what was called “capitated managed care.” It required a transference of power from hospitals and specialists to primary care providers, and required primary care systems to invest in lots of technology and support services to effectively manage care and cut down on cost while ensuring quality care.

The problem with this type of system was manifold. Read more…

Most Americans are concerned about the rising cost of health care, eroding health benefits, and rising health insurance costs.  While a majority of Americans, and nearly all Massachusetts residents, have access to health care, it seems as though we keep paying more for health, but getting less care. Only ten years from now, if nothing is done at the national level, Americans can expect to pay 68% more than at present for health insurance and out of pocket costs of health care. Women, especially in a deteriorating economy, are more likely to be adversely affected by the cost of health care.

There are also a significant and growing group of our fellow Americans who have no health insurance, have inadequate benefits, or who are worried that if they lose their job, they will lose their benefits.  Estimates suggest that the number of uninsured in the U. S. will grow from the current 46 million to 65.7 million people by 2019 – ten years from now.  How health care is reformed nationally should be of direct interest and concern to all of us, especially to Massachusetts where significant reforms are already being implemented with 97.4% of our people already covered. 

The U.S. House of Representatives and U.S. Senate are now working feverishly to mark up health reform bills over the next few weeks that, if successfully reconciled and enacted into law, will make health care more affordable and reduce the cost of care.  Everyone – individuals, families, employers, taxpayers, health care professionals, insurers – has an important stake in the outcome of the growing debate.   It is President Barack Obama’s top domestic legislative priority.

We know from the media that the Obama administration and congressional leaders have made a very public commitment to build on the existing employer-based insurance system.   Read more…

Call it what you will – health promotion, wellness, prevention….it’s all of a piece. The idea is to avoid getting sick by staying healthy – and it’s an idea whose time has come.

Massachusetts already leads the nation in envisioning and delivering near-universal health insurance coverage. Now we need to expand the vision more broadly – by embracing health promotion and prevention.

Why? First of all, it’s only common sense that staying healthy is better for us than receiving medical care after we get sick.

Secondly, we’ve simply got to get beyond the distracting debate over whether prevention actually pays. Considerable research already exists on which prevention measures are effective – and we need to start promoting them. Health care costs nationally are nearly 18% of GDP and rising, and anything we can do that might rein them in is worth trying.

Thirdly, preventable chronic illnesses like obesity, diabetes and asthma cost $34 billion annually in Massachusetts alone Read more…

Last month, I got a call from a Fallon Community Health Plan member who wanted to speak with the CEO to express his dissatisfaction with the health insurance plan he purchased. Our conversation really brought home the importance of educating consumers in our increasingly complex health care system.

The caller was upset over having to pay a $1,800 MRI bill. He thought FCHP should have covered and paid for the test. In fact, the MRI was covered, but according to the plan he purchased — a $2,000 high-deductible plan — the service was subject to the deductible, which had not yet been met. So, the $1,800 was going to have to come out of his pocket. He was shocked, frustrated and angry.

Our conversation revealed that his decision to purchase a high-deductible plan was based, of course, on his desire to save money on the monthly premium. Many of us do this with our car insurance. We opt for a higher deductible because it decreases the premium. We gamble on not being involved in a car accident (and therefore not having to pay the deductible) so we can have a little more money in our pocket each month. But a gamble it is.

I posed a question to him: When he first decided to purchase a high-deductible plan, what was his contingency plan for covering the $2,000 deductible? Read more…

Massachusetts is about to write the next chapter of health reform.

The Payment Reform Commission, which was established as part of our local version of health reform, has just issued its recommendations. The core recommendation is the “what’s old is new again” idea of global payments. “Global payments” are a move away from the current “fee-for-service” system where there is a constant possibility of overuse or misuse of resources because providers can be paid more by ordering more visits and procedures, and a move towards a system that gives providers the resources that are adequate to take care of “the whole patient.” The new system should also include quality measures so that patients can have confidence that the decisions made in their care are patient centered and aligned with their desire to be healthy and are not driven by the desire to save money at the expense of their health. It is critical, in fact, to create a link between quality and payment.

We have great faith in the possibilities of global payment if it is combined with a focus on quality. Atrius Health, an alliance of five medical groups including Dedham Medical Associates, Granite Medical, Harvard Vanguard Medical Associates, South Shore Medical Center, and Southboro Medical Group, has experience with the benefits that global payments offers for patients. We know from years of experience with global payment as well as our current experience with fee for service payment that global payments can help providers better allocate our limited resources towards the care that will ensure the best health outcomes for all of us. Read more…

On health reform, Massachusetts deliberately tackled coverage first. But the harder “what to do about costs” question was always lurking just beneath the surface. Now with health care spending expected to nearly double over 10 years, and budget cuts threatening the coverage law, many state leaders say it is time to get serious about controlling costs growth. A special commission is sending the legislature a major overhaul that will affect virtually every resident in the state. It’s a return to managed care, but this time the incentives are to give patients more care…and earlier…as opposed to less. W-B-U-R’s Martha Bebinger begins our story with one example of how a visit to your doctor might be different in this new health care system.
(transcript)

Let’s say you’ve had a sore throat for a few days and finally decide it’s time to see the doctor. In the exam room you say, just give me an antibiotic and I’ll get on with my day. Your doctor’s rushed, so she says fine, feel better, and sends the insurance company a bill. Two days later, the antibiotic didn’t work, you’re back at the doctor. Now let’s replay that visit…but this time you’re covered by a global payment. That’s a budget. If the doctor sticks to it and keeps you healthy…she makes more money. That antibiotic, not appropriate, it would count against her. Read more…

Health insurance premiums for small business owners in Massachusetts routinely increase twice as fast as those for larger employers. On Beacon Hill, House and Senate health care leaders say they have a plan to end that pattern. It’s coverage that could be cheaper because it shifts more costs to patients and caps payments to hospitals and doctors.

(story transcript)
Quinta Andersen owns Andersen travel in Holliston. She has been absorbing double digit health insurance premium increases for years…

QUINTA ANDERSEN: But this one took me over the cliff. It was almost an immediate panic.

This year’s increase was 22%. Andersen called her 11 employees together and together they agreed on higher co-pays to help bring down the cost.

ANDERSEN: But I’m fearful of the next anniversary date.

Andersen hopes a bill unveiled at the State House yesterday will relieve her fears. It aims to help individuals and companies with 50 or fewer workers avoid insurance premium hikes next year. Senator Richard Moore says the bill would create insurance that is 17-22% cheaper than some of the least expensive plans available now. Read more…

On Thursday, a special commission on health care payments is expected to recommend dramatic changes that could affect almost 1/6th (16.3%) of the state’s economy. The commission wants to shift from paying providers based on the volume of tests or procedures patients receive…to a system where providers are rewarded for working within a budget by keeping patients healthy. There are a few health systems in Massachusetts that are already doing this…and doing it successfully according to the commission. One is Mount Auburn hospital in Cambridge.
(transcript of story)

RACHEL HAFT: I love vaccines. EILEEN: I do too. HAFT: Good for you (laughs).
EILEEN: I think medicine helps people.

Eileen, a patient who prefers we use just her first name, sits in a green print Johnny, her legs dangling off the edge of an exam table. She looks down at her primary care doctor, Rachel Haft, who is about to deliver one of those annual exam reminders most patients don’t want to hear.

HAFT: Alright, a colonoscopy, oh, ew, well, um

Eileen’s enthusiasm for medicine vanishes. Her message is firm. She’ll do it if she doesn’t have to drink that jug of gag you in the throat liquid.

EILEEN: I mean that’s really, really important to me.

Haft agrees to look for a gastroenterologist who uses one of the alternatives, a tiny bottle of liquid she says tastes like brine.

HAFT: We can call the endoscopy suite and find out who it is, but I really want you to get that test. It clearly saves lives, I’m sorry to be a nudge.
EILEEN: I need to be nudged on that one.

Increasing the rate of colonoscopies for patients over 50 is one of several prevention campaigns underway at Mount Auburn hospital. Read more…