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…

April is National Minority Health Month, a time to examine the health of communities of color both nationally and in Massachusetts. While there is great excitement for national healthcare reform and pride in the state’s coverage accomplishments, not enough attention is paid to the pervasive racial and ethnic health disparities that persist across the country and the state.

People of color continue to live shorter and sicker lives in Massachusetts and the United States. Even when insurance status is equal … access, treatment, and outcomes are not. As we work to ensure the success of healthcare reform in the Commonwealth and vision a nation with universal coverage, we must also increase our focus on eliminating these inequalities. These differences, inequalities and disparities in outcomes become inequities because they are “avoidable, unnecessary and unfair.”

There is some good news for Massachusetts. Several efforts are in progress to achieve health equity and improve community health for everyone. Read more…

The report released this month, Health Insurance Coverage in Massachusetts: Estimates from the 2008 Massachusetts Health Insurance Survey, shows that more than 97% of Massachusetts residents have health insurance, marking yet another milestone for Massachusetts health reform. While we should be proud of what we have achieved, universal health insurance coverage is not the panacea for a health care system that provides such a poor return on investment…ranking lower in health status and life expectancy than nearly every developed country; has an infant mortality rate comparable to underdeveloped countries; and accepts persistent disparities and inequities in the health of its racial and ethnic minority populations. The current realities of uncontrollable health care costs and the state’s budget crisis, begs the question, will Massachusetts health reform survive its fiscal storm?

Adding to these realities are reports in the Boston Sunday Globe of significant increases in the number of unemployed Massachusetts residents applying to the state’s Medical Security Program. A remnant of universal coverage from the Dukakis era, the Medical Security Program, provides assistance to middle and low income residents who are collecting unemployment by paying up to 80% of their health insurance premium. Read more…

“Quality is job one” became the advertising mantra of the Ford Motor Company in the 1980’s following the surge in foreign car sales that began to exceed that of manufacturers in the United States as American consumers began to demand fuel efficient and better quality automobiles. The focus on quality came too late for a full recovery, and two decades later the patient’s health continues to decline and the prognosis is not good.

On September 16, 2008, Charles Kenney, former journalist at The Boston Globe, introduced his new book, The Best Practice: How the New Quality Movement is Transforming Medicine, to the health care establishment of Boston, touting such ideas and concepts as the introduction of the principles of quality in the Toyota Production System being employed at the Allegheny General Hospital. The forum was sponsored by Blue Cross Blue Shield of Massachusetts and hosted by its Chairman and CEO, Cleve Killingsworth, writer of the foreword to the book, who issued a “call to action” for transformation of the system to improve quality, and promote affordable patient centered health care.

A quick scan of the room and of the table full of name badges, I determined that the forum drew 350+ people from the major teaching hospitals, medical schools, networks and health plans all interested in identifying ways of improving quality and increasing productivity while also keeping health care affordable. Read more…

The singular measure of the success of Massachusetts health reform, defined as universal coverage, should be whether we achieve health equity for all residents of the Commonwealth. The challenge is whether we can eliminate the persistent disparities in health and health care experienced by significant segments of the state’s population.

One step toward achieving that goal was realized when the Massachusetts State Legislature passed legislation that authorized the creation of a new statewide Office of Health Equity to lead efforts within the Executive Office of Health and Human Services and across the other Secretariats to coordinate efforts that would lead to the elimination of disparities in health in Massachusetts. The statewide coalition of advocates representing over 70 groups and organizations comprising the Disparities Action Network (DAN) who worked with this as their chief policy agenda and pushed it thorough the legislature sincerely thank Representative Rushing and Senator Wilkerson for their leadership on getting this initiative through the State budget process and as Co-Chairs of the Health Disparities Council established under Chapter 58. Read more…

On behalf of the 65+ organizations statewide, that have worked together for more than 2 years as the Disparities Action Network (DAN) to craft legislation that would provide for an Office of Health Equity to be located in the Executive Office of Health and Human Services, as Co-Chair I wish to express our great disappointment in the House budget released last week for its failure to support this provision as it was contained in Governor Patrick’s budget proposal.

As we get ready to “celebrate” the second anniversary of the Massachusetts health care experiment, the message in the House budget is clear; there is no political will or budgetary authority for addressing the most challenging issues for true health reform. Read more…

When we get our checks from the Fed this summer to spend on consumer goods and services to try to resuscitate the struggling US economy, let’s all spend it on health care! Let’s join together in a collective strategy to suppress health care inflation in the Commonwealth, to ensure the success of the Massachusetts model of health reform. The Connector has already thought of this considering recent proposals that would jack up premiums… and shift more cost to consumers. These are short term budget fixes, not reform.

From my previous entries on this blog, you know I have not been enamored with the promise of reform in Chapter 58. The real opportunities for reform take a backseat to increasing access by expanding coverage and simply pumping more dollars into a system that is almost irreparably broken. Read more…

A couple of weeks ago, my class of health science majors (pre-med, public health, possibly nursing, pharmacy or physical therapy) in Bouvé College of Health Sciences at Northeastern University were privileged to have a presentation by Lindsey Tucker, Health Reform Coalition Coordinator at Health Care for All about Chapter 58, often mistakenly referred to as “Massachusetts health reform” and the availability of affordable health insurance for them as one of the key target populations, young adults ages 19-26. Partly motivated by another contributor to this blog this week I decided to follow-up with a class survey, and while “of course I’m not a researcher or a scientist” it’s subject to criticisms regarding scientific rigor, validity and reliability. Nevertheless, I think there are some interesting findings.

I’m pleased to report a 100% response rate and that 100% of the students responding to the survey are insured: 88% on their parents plan with 6% on Medicaid and another 6% that purchase the plan offered by the University. As future health professionals a substantial majority, 78% report that having health insurance is very to very, very important to them mostly for security as a way “to ensure payment for a catastrophic event or illness.” Only 30% reported feeling they understood enough about health insurance, coverage and benefits to make an informed decision in selecting from among the “too many” Commonwealth Choice(s). Many, 66% were discouraged by the complexity and lack of information available. Try here. Read more…

In the year since enacting Massachusetts’ comprehensive plan for expansion of health insurance coverage to all citizens of the Commonwealth (what many mistakenly promote as health reform) two seminal reports have been issued this summer providing recommendations to address the persistent racial and ethnic disparities in the health and health care of its citizens of color. One, issued in July, the Pay-for-Performance to Reduce Racial and Ethnic Disparities in Health Care in the Massachusetts Medicaid Program, contains recommendations from the Massachusetts Medicaid Disparities Policy Roundtable, convened and supported by the Massachusetts Medicaid Policy Institute and the Metrowest Community Health Care Foundation seeks to establish Medicaid rates based on performance on certain measures of quality, including reducing racial and ethnic disparities in health care. The second, issued earlier this month, is the long awaited final report of the legislative Commission to End Racial and Ethnic Health Disparities, chaired by Senator Dianne Wilkerson and Representative Peter Koutoujian with its own set of recommendations emanating from a three year process that began before discussions of health reform in the state.

Chapter 58, the Massachusetts health reform legislation introduced the notion of “pay-for-performance” (P4P) by tying increases in hospital reimbursement rates to measures of quality performance. Unlike other pay for performance programs implemented in other states, Massachusetts for its Medicaid program, given the populations covered in the state, is including measures for the reduction of racial and ethnic health care disparities, hoping that such efforts will contribute to reducing disparities in the health of those covered by MassHealth. They are not only testing the pay for performance model but also testing the relationship between health care disparities and health disparities; looking at the process of health care delivery as a determinant of health outcomes. The Chronic Disease Collaboratives of the Health Resources and Services Administration working with community health centers to better manage chronic disease care among their patient populations may be a model with some important lessons learned.

The concern with P4P in MassHealth is that it has the potential of possibly making disparities in health worse for this population. Read more…

So, the anniversary of the first year of health reform, as we perceive it, has come and gone, and going into year two we have significantly increased the number of “insured” residents in the Commonwealth. We should and do take great pride and praise for being the first state in the nation to make a commitment to “health care for all” of its residents. Through expansion in entitlement to MassHealth and the “safety net plans” for classes of people too poor to afford market health insurance through Commonwealth Care and the affordable options of Commonwealth Choice we have moved ahead in increasing coverage. However we have done nothing, that even misconstrued, can be considered by any rational person to be health reform. So let’s call it what it is! Or is it what its not?

It is expansion of health insurance in its various iterations, employer based, individual and group, and government sponsored, to uninsured residents of Massachusetts. It is not health reform, and that’s the problem. It is increasing dollars spent on a broken system. It is not changing the system. It is giving people access to care. It is not improving care. It is investing more money with no return on that investment in terms of decreased cost, improved quality or increased accountability. Read more…