Christine Keeves, MPH, and the Oral Health Communications Coordinator at non-profit Health Care For All, says state budget cuts could mean no more critical oral health care for some of the state’s most vulnerable residents:

In recent years, Massachusetts has led the nation by creating a new system to address our state’s health care needs. As we are increasingly used as a model for improving health care throughout the country, we must ensure that we protect some of the most critical pieces of this system, including oral health care.

With access to simple, cost-effective preventive care, we can keep our state and our nation healthy. Protecting these benefits is imperative for several reasons:
· Oral health is an essential part of overall health. Chronic oral infections are associated with complex health problems such as heart disease, stroke, diabetes, low-birth weight, and premature infant births.
· Lack of preventive care causes the state to waste millions in extensive and costly services in emergency and inpatient hospital settings.
· Lack of comprehensive and consistent dental care prohibits many adults form entering or remaining in the workforce. Currently, 164 million hours of work are lost in US each year due to dental disease.

By law, the governor must balance the state budget, and on Thursday announced a $600 million deficit. Currently, Governor Patrick can only make up these deficits by cutting from certain types of programs, including public health. Read more…

Last week the American Board of Internal Medicine Foundation convened a four-day meeting on physician payment reform. The title of the gathering was “Achieving Equity, Affordability and Quality, The Indispensible Role of Payment Reform” and it attracted an esteemed group of experts, medical professionals, academicians, consumers and payers. The goal for this forum was to establish a guiding set of principals for national payment reform.

Early in the meeting speakers identified competing pressures that will challenge the adoption of a different payment system. Speakers and meeting participants spoke of the need to maintain patient centered care, patient and doctor autonomy, while being mindful of limited resources in the face of unlimited need. There was near unanimous agreement that most physicians don’t actually know what things cost, and some very funny anecdotes about trying to find out cost information. (One doc asked a lab manager what a panel of tests cost only to be told that the manager was prohibited from sharing that info. When pushed, the manager suggested that the doc couldn’t handle the truth.)

Dr. Harvey Fineberg, the President of the Institute of Medicine gave the keynote address and opened his remarks by polling the physicians in the room about how they are paid. Read more…

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…

The Division of Health Care Finance and Policy (DHCFP) has proposed regulations which would require schools to report more comprehensive information on their health plans’ benefits and performance. The ACT!! Coalition will voice our perspective on these regulations at DHCFP’s public hearing tomorrow. The ACT!! Coalition strongly supports the proposed regulations increasing disclosure and reporting requirements. We appreciate the DHCFP’s commitment to analyzing student health insurance plans and requiring that students are provided with transparent information about their plans. As Massachusetts leads the nation in guaranteeing that our residents have access to quality health insurance coverage, we commend DHFCP for ensuring that students do not fall through the cracks.

ACT!! has significant concerns with student health plans, particularly the lack of comprehensive coverage and unaffordable cost-sharing. The skinniest of the skinny, student health plans often do not cover basic services such as prescription drugs and surgery. Read more…

My name is Hannah Frigand, and I am a HelpLine Counselor at Health Care For All. I started working on the HelpLine as an intern January of 2006, and I began working full-time that fall. When I first started taking calls, it was before Health Reform passed, and we were receiving between 100-150 calls a week in English and Spanish. Currently, we receive over a thousand calls a week in English, Spanish and Portuguese and are looking to expand in even more languages. When I started working at the HelpLine, there were only two full-time counselors; now there are five.

In 2008, the HelpLine took a total of 37,472 calls and completed 1,870 health insurance applications over the phone. Behind each application is an individual or family who we have guided through the health care system. For each one of these clients, we have followed up individually and notified them of the status of their application and their next step. Our callers include those who need help making a doctor’s appointment or getting prescriptions filled at low- or no-cost; those who need assistance with medical debt or appealing a MassHealth decision; and those who have questions about private insurance or need assistance completing an application for the state programs.

The HelpLine calls have increased in the last few months, and we are hearing a lot of new stories from people who have never turned to the state for assistance before. Here are some of the changes:

– So far this month, the call volume has increased by 67% compared to same time-frame last year. Read more…

Last summer, the Massachusetts legislature passed Chapter 305, a comprehensive cost control and transparency bill. As one of its central pillars, the bill directed the Department of Public Health (DPH) to draft regulations establishing a Code of Conduct and payment disclosure requirement for the pharmaceutical and medical device manufacturing industries. This component of the bill is one of the keys to the health care cost control Massachusetts so desperately needs.

Prescription drugs are central to modern health care. Medications are the first line of defense in preventing and combating disease. The prices of the most widely used brand-name prescription drugs rose nearly 50% between 2000 and 2006, more than twice the rate of inflation. Research has shown that gifts and fees paid to prescribers influence their prescribing behavior and cause more brand-name drugs to be prescribed when cheaper, generic drugs are as effective. The billions of dollars spent annually place a huge financial burden on the entire health care system. According the Congressional Budget Office, disclosing industry payments could lead to health cost reductions. Read more…

The economic downturn and resulting decreased revenues have forced Governor Patrick into difficult decisions. The result has been significant, and often dramatic, cuts to state health programs – even those designed to serve individuals and families in the most need.

Across the country, other states are similarly feeling the pinch, and Congress has been considering options to help. One potential opportunity to lessen the impact of budget cuts on the health care system is a short-term increase in the Federal Medical Assistance Percentage, or FMAP. FMAP is the percentage that the federal government reimburses to the states for Medicaid expenses. Because Massachusetts is one of the richer states, we receive the minimum – 50%. Read more…

Last week we learned that the Connector had a major mess on its hands. Apparently, thousands of notices (affecting as many as 16,000 people) were not sent out on time to Commonwealth Care members and applicants. As a result, these people may have lost or will be losing coverage, through no fault of their own. We discovered the problem when our Helpline got dozens of these notices on the same day. We quickly got on the phone with other groups doing enrollment work, and figured out that something went wrong.

The Connector is trying to find a solution to the problem. We draw three lessons from what’s happened so far:

1. The continued need for outreach and education: The state now provides modest grants to 45 non-profit community groups to fund outreach and education efforts statewide. For the past two years, much of their work has been oriented towards getting people to sign up. Now, the focus is helping people stay enrolled, with continuous access to care. Read more…