Insurance

News on the state's largest health insurers; the effects of health care reform on coverage; rising premium costs.

RECENT POSTS

Second Opinion: Doc Says Blue Cross Opioid Policy Is Flawed

Amidst concerns over a massive national increase in the use and abuse of prescription painkillers, health insurer Blue Cross Blue Shield of Massachusetts instituted a new policy to reduce pain medication addiction and misuse.

This week The Boston Globe reports that as a result of the new policy, Blue Cross has cut prescriptions of narcotic painkillers by an estimated 6.6 million pills in 18 months.

But Daniel P. Alford, MD, an associate professor of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program at Boston University School of Medicine and Boston Medical Center, calls the policy “flawed and irresponsible.” Here’s Alford’s response:

By Dr. Daniel P. Alford
Guest Contributor

The Blue Cross Blue Shield of Massachusetts opioid management program was implemented to provide members with “appropriate pain care” and reduce the risk of opioid addiction and diversion.

In a recent Boston Globe report they claim “very significant success” with this program after 18 months because they have cut opioid prescriptions by 6.6 million pills.

Dr. Dan Alford

Dr. Dan Alford

Is this really a measure of success and if so, for whom? It likely saves Blue Cross money but has it successfully achieved their program’s stated goals? Does decreased opioid prescribing mean more appropriate pain care? Does decreased opioid prescribing reduce the risk of addiction or diversion, or does it decrease access to a specific pain medication (opioids) for treating legitimate chronic pain? Is the observed decrease in opioid prescribing evidence that opioids have been overprescribed, as Blue Cross claims, or is it proof that instituting a barrier to opioid prescribing (prior authorization) will decrease prescribing even for legitimate need? Are patients with chronic pain really benefiting from this program? I doubt it.

Adding yet more paperwork for physicians will not improve pain care, decrease addiction or the numbers of accidental overdoses from prescription opioids. Those physicians who are unwilling (or ambivalent) to prescribe opioids even when indicated will use the prior authorization requirement as an excuse to continue not prescribing. Those who are overly liberal in prescribing will figure out the most efficient way to satisfy the insurance requirements for approvals. Physicians who responsibly prescribe opioids – that is, prescribing them only when the benefits outweigh any risks — will be saddled with more administrative burdens to justify their well thought-out treatment decisions.

Some physicians may ultimately decide that prescribing opioids isn’t worth the trouble despite known benefits for some patients. Continue reading

Circumcision Boost: Study Cites Benefits, Notes Foreskin-Related Health Problems

New findings may offer a boost to proponents of newborn male circumcision: Researchers in the U.S. and Australia report that the health benefits of undergoing the procedure “exceed the risks by over 100 to 1,” and note that “over their lifetime, half of uncircumcised males will contract an adverse medical condition caused by their foreskin.”

The review, published online in the Mayo Clinic Proceedings, bolsters the position of mainstream physician groups, such as the American Academy of Pediatrics, which supports insurance coverage of the practice and full access for families who choose circumcision for their infants. But the new report is unlikely to silence critics of the practice, who have called it “insane” and a “disservice to American parents and children.”

Here’s some context, from the study, which shows a slight increase in circumcision among older men, but a decline among newborns:

Preparing for a circumcision

Preparing for a circumcision (Cheskel Dovid/Wikimedia Commons)

“The latest data on male circumcision in the United States show a 2.5% overall increase in prevalence in males aged 14 to 59 years between 2000 and 2010. In contrast, there has been a downward trend in neonatal circumcisions, with the present analyses finding that the true extent of this decline is 6 percentage points.”

And here’s more from the news release:

Whereas circumcision rates have risen in white men to 91%, in black men to 76%, and in Hispanic men to 44%, the study authors found an alarming decrease in infants. To get the true figures they had to correct hospital discharge data for underreporting. This showed that circumcision had declined from a high of 83% in the 1960s to 77% today.

There seemed to be two major reasons for the fall.

One is a result of demographic changes, with the rise in the Hispanic population. Hispanic families tend to be less familiar with the custom, making them less likely to circumcise their baby boys.

The other is the current absence of Medicaid coverage for the poor in 18 US states. In those states circumcision is 24% lower. Continue reading

Deadline Extended For Mass. Residents Bedeviled By Health Connector Site

State House News Service’s Matt Murphy reports that residents who had trouble signing up for health insurance through the state’s troubled Health Connector website now have a little more time to do so:

Massachusetts residents who have had difficulty signing up through the Health Connector for unsubsidized health insurance coverage will be given an extra two weeks to enroll under an extension plan to be presented Thursday, two days after President Barack Obama announced a similar reprieve for frustrated consumers on the national level.

Sarah Iselin, the special advisor who Gov. Deval Patrick put in charge of fixing the state’s dysfunctional health insurance sign-up website, plans to discuss the change to the state’s open enrollment process on Thursday when the Health Connector board meets.

Mass. Health Connector website

Mass. Health Connector website

Residents who have had trouble completing enrollment to due technical problems with the website will be allowed to shop online for unsubsidized plans through April 15, with payment due April 23 for coverage starting on May 1.

The open enrollment deadline was supposed to arrive on Monday, but the Obama administration announced this week that those who encountered problems shopping through the federal online marketplace would be given a similar two-week extension.

Murphy also reports that the Connector has been able to eliminate a massive backlog of paper applications from residents looking for subsidized health insurance:

After starting with a backlog of 72,000 applications in February and receiving an additional 1,000 applications a day, Connector staff, with the help of hundreds of workers brought on board through the consultant Optum, cleared the remaining 21,000 applications over the past week and officials are confident they can now keep up with new requests as they arrive.

Report: In Mass. Health Care, System Skewed So Rich Get Richer

A report released today by the Healthcare Equality and Affordability League (H.E.A.L.) — a partnership between the for-profit Steward Health Care System and the union, 1199 SEIU United Healthcare Workers East — finds that disparities in hospital costs and financing across the state are driving “a vicious cycle” of inequality in health care.

The result, according to this analysis, is that medical care is becoming less affordable for lower-and middle-income families in Massachusetts, and the disparities in hospital financing are “compromising the viability of community hospitals.”

The group is calling for new, and what they call more “fair” reimbursement rates so that poorer, community hospitals (with a greater proportion of Medicare and Medicaid patients compared to the higher-cost Boston teaching hospitals) can continue to serve the lower-income patients, among other financial recommendations.

David Williams, president of the Boston consulting firm Health Business Group, who was paid by H.E.A.L to research and co-author the report, says: “What hasn’t been demonstrated before is what impact these financing disparities have on communities and community hospitals.”

He notes: “The hospitals that have the highest percentage of publicly funded patients, they get paid less, but in addition to that, those hospitals also get the lowest commercial rates — because they’re not in as strong a position to negotiate — so that means that they’re doubly disadvantaged…it means that the hospitals serving middle-class and lower income communities don’t have the resources to compete effectively with those hospitals that get higher reimbursements.”

Clearly, the group’s recommendations would benefit the Steward-owned hospitals, Williams acknowledges, but, he adds: “it would also help with the state’s overall approach to cost containment.

I asked Nancy Turnbull, an associate dean at the Harvard School of Public Health, to take a look at the report and here’s what she had to say:

…This report looks to be raising critical issues regarding payment disparities. We’ve known for years, from the work of the [Attorney General], [Center for Health Information and Analysis] and others that these disparities exist and are, in many cases, getting worse. So far, we’ve done little to address them, and the effect these disparities have on lower paid providers and the patients for whom they care. However, I don’t think the solution is, in most cases, to just increase the rates of payment for poorly paid providers, although that is a needed action for some. We also need to talk about reallocation of existing payments, and about costs. I am supportive, to some extent, of giving consumers reasonable financial incentives, based on their income, to use lower cost providers—although lower paid is not the same as lower cost–but we also need approaches that are systemic. Consumers in tiered and high deductible health plans aren’t going to solve this problem without tough action by state government and other payers, including, in my opinion some regulation of rates of payment. And most tiered networks available so far are regressive — they impose higher costs on lower-and moderate-income people. They address one form of inequality by creating another.

Among the findings, according to the H.E.A.L press release:

“The rich get richer as highest cost hospitals attract a greater proportion of patients with commercial insurance, which have higher reimbursement rates than Medicare and Medicaid.”

(H.E.A.L report)

(H.E.A.L report)

–“Patient migration for routine care from community hospitals to high cost Boston teaching hospitals increases total medical costs and contributes to higher premiums for all individuals and families with commercial insurance (non-Medicare nor Medicaid). Additionally, low-income patients, forced to travel greater distances to receive routine care are more likely to forgo treatment until conditions become acute and require more expensive interventions.”  Continue reading

Mass. To Drop Contractor Behind Flawed Health Insurance Website

Massachusetts is negotiating an end to its contract with CGI, the Canadian vendor that built the state’s flawed health insurance website.

The site was supposed to be up last October, offering one-stop health insurance shopping for anyone in Massachusetts. But six months later, only a few functions work but have glitches, and a few are not usable at all.

Sarah Iselin, a special assistant to Gov. Deval Patrick hired to oversee the fixing of the website, has been working with a team of outside contractors from Optum to determine if the CGI project can be fixed.

“That assessment made clear that based on past performance and our current needs, parting ways with CGI is the right course for the commonwealth moving forward,” Iselin said Monday.

In a statement, CGI said it will “work with the Commonwealth to ensure a smooth transition to the next phase of exchange deployment, allowing for the best use of system capabilities already in place.”

Iselin and her team told the Health Connector board they are reviewing two possible remedies: hiring a new vendor to build on working parts of the current site or buying website elements from other insurance exchange sites. Iselin cautions that buying elements will be difficult because Massachusetts has many unique insurance rules, including 263 different factors that determine who is eligible for what type of coverage.

Continue reading

Despite Continued Health Site Troubles, Progress Made On Applicant Backlog

Massachusetts health care officials struggling to repair the state’s hobbled website are looking at the possibility of leasing or buying technology from states with functioning insurance sites.

Gov. Deval Patrick’s special assistant, Sarah Iselin, said Friday that looking for solutions from other states is just one of four options being weighed.

(Click to view the full Mass. health exchange dashboard update on Scribd)

(Click to view the full Mass. health exchange dashboard update on Scribd)

Others include forging ahead with the current website contractor CGI Group, looking for a new vendor that would build on the existing site, or scrapping the website and starting over.

Despite the website troubles, officials say they are making progress whittling down the backlog of people trying to sign up for health insurance, even though the number of applications for subsidized coverage has doubled since last week.

Residents who apply for help with insurance payments will receive temporary coverage which is good through June 30. There are now 62,000 people in this program and roughly 120,000 more people who must be moved from their extended Commonwealth Care plans into permanent coverage.

Confusing? Yes, and messy. The Connector is supposed to determine who is eligible for subsidies this year, and get everyone into a new insurance plan by the end of June. But the digital tool that looks for a match between all these people and the state’s 260 eligibility programs is still not working.

Continue reading

Connector Website On The Mend, But Many Applicants Still In Limbo

Good afternoon! This is your weekly update on attempts to fix the flawed Health Connector website. Sarah Iselin, a special assistant to Gov. Deval Patrick, is posting the latest numbers of people who expected to be able to enroll online without too much trouble but are in some kind of limbo because the website doesn’t work.

I’m reminding myself as I write this to look at the forest and not just the trees. There are lots of trees/numbers. I’ll start with them.

The Numbers

CLICK TO ENLARGE: From the Connector's Thursday update

CLICK TO ENLARGE: From the Connector’s update

1) The Connector has picked up the pace of processing a backlog of 72,000 applications for free and subsidized coverage. In two weeks, the backlog has dropped to 39,000, with help from Optum, the outside firm that has brought in 233 data entry folks so far. That number is supposed to rise to 318 by next Monday.

But 39,000 people that have applied for coverage may not have any, and haven’t heard anything about the status of their application. The Connector says it has tried to prioritize applicants who need coverage right away.

2) There are more than a thousand new applications coming in every day, so it will still be awhile before people get a timely response. The Connector has a new data entry tool that has cut the time it takes to process applications from two hours to 39 minutes, on average.

3) There are now about 55,000 residents in temporary coverage through the state’s Medicaid program. The Connector expects that these people will qualify for Medicaid, which is free coverage, or for Connector Care, which is subsidized insurance based on your income (up to 400 percent of the poverty line, or $46,680 for a single person).

4) These 55,000 people — and the roughly 120,000 folks who were already in a subsidized plan that has been extended — are in limbo. The Connector does not know exactly what they will qualify for because the online tool that verifies income, etc., and calculates eligibility, still doesn’t work.

5) The Connector says there are 21,000 low- and moderate-income residents seeking state coverage for the first time. This number probably includes low-wage workers who couldn’t afford their employer’s plan (especially if it was 50/50) but weren’t eligible for state subsidies because they had access to a work-based plan. The Affordable Care Act says those workers can apply for subsidized insurance.

The Bigger-Picture
Continue reading

Updates, But No Solutions, From Today’s Connector Board Meeting

If you have or have tried to sign up for health insurance through the Massachusetts Health Connector, you know the website is a mess. Last week, Gov. Deval Patrick brought in a special assistant, Sarah Iselin, and and IT oversight group, Optum.

Today we had the first of what are to be weekly updates, with graphics that map the problems many of you are having.

0213_connector-workaround

Click to enlarge this slide prepared the Massachusetts Health Connector

If you are expecting a quick fix, you can stop reading here. But there are some important updates that might be helpful:

1. If you are one of the 50,000 or so residents who submitted a paper application for subsidized insurance, hang tight. The state has several dozen people (adding another 36 this week) who are going through these applications by hand at the rate of about two hours per application. If you do the math you’ll see it may take a while to get to you. The state hopes to add software that will speed up this process.

2. If you are one of the 124,000 Commonwealth Care members whose coverage was extended through March, you might want to hang tight too. The state has clearance from the federal government to extend your coverage again, through June 30. Now the state must negotiate with your insurance plan.

Eric Linzer, with the Massachusetts Association of Health Plans, said “each plan will make its own decision about whether to participate in the extension. There have been financial challenges in continuing coverage at last year’s rates, but plans are committed to making sure these folks have coverage.”

And be prepared for another extension of your current coverage into the fall or beyond. Continue reading

Report Blames Mass. Health Website Troubles On Lack Of Skills, Leadership

In the months after President Obama signed the Affordable Care Act (ACA) in 2010, officials in Massachusetts started planning for a new Health Connector website that would be compatible with the new federal regulations. UMass Medical School, the Massachusetts Health Connector and MassHealth came together to work on the project. They hired a Canadian firm, CGI, to build the site which launched in October 2013, but “was not fully operational,” according to a report released Thursday by the technology firm MITRE. Residents who’ve tried to apply for insurance through the site use words like “disaster.”

The MITRE report, which was commissioned by the state, says CGI did not have the expertise to create or maintain the site. Functions were not tested. Data was lost. Tools to fix bugs were not in place. So who from the state should have spotted and corrected these problems? MITRE concludes that it was never clear which of the three state partners was in charge. Gov. Deval Patrick says the shared leadership structure would have been fine if CGI had done its job.

But, Patrick added, “It turns out that this vendor has required and will require a much, much shorter leash. And that’s hard to do by committee.”

The lack of clear authority created other problems, according to the report. The website never had a baseline set of requirements. There was no master schedule. Decisions were not explicit and were not communicated clearly. CGI received conflicting instructions and deadlines from the three parties in charge.

Continue reading

Can This Woman Fix The Health Connector? Please?

Screen shot 2014-02-06 at 11.27.38 AM

WBUR reports that Gov. Deval Patrick is appointing an executive from Blue Cross Blue Shield of Massachusetts to help fix problems with the state’s Health Connector insurance website, which has recently been plagued with technical and other glitches that have frustrated and infuriated users:

Blue Cross chief strategy officer Sarah Iselin worked for the state during the rollout of the 2006 health care law. In addition, the state will also hire a Minnesota-based health care systems firm to help with fixes to the Connector site.

The governor says Massachusetts residents who are on temporary health insurance coverage will know by next week if they can be moved to a permanent plan. (The temporary plans were needed because of technical problems with the Health Connector website.)

In addition, State House News reports:

The administration is also hiring Optum to advise them on short-term and long-term fixes to the site and to help clear the backlog of people who have tried to sign up for insurance but encountered technical barriers. Patrick was discussing the administration’s efforts to repair the site Thursday morning at the state office building at One Ashburton Place. Iselin is chief strategy officer of Blue Cross Blue Shield of Massachusetts and was previously president of the Blue Cross Blue Shield Foundation of Massachusetts. The Connector Authority on Thursday also released the findings of MITRE, a consultant hired to examine the site and ways for the authority to move forward.

WBUR’s Martha Bebinger was at the governor’s news conference and reports:

The Health Connector site is still not working properly four months after it was revised to meet new federal rules. Governor Patrick has hired a special assistant to guide the fix and an outside IT firm to review progress. Patrick apologized to everyone who has tried to sign up for coverage. He says he knows people are frustrated.

“We’re not going to let anybody go without insurance. It’s not going to happen,” the governor said. “We have a moral obligation and an obligation in the law and a commitment to doing so.”

Patrick says he doesn’t expect the state will need to spend more than the $69 million already budgeted. He says starting from scratch at this stage would be difficult.

Stay tuned for more developments. At 3 today, Radio Boston’s Carey Goldberg will try get into the details of how Iselin plans to tackle the Connector problems.