Insurance

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

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New Concerns About Coakley-Partners Deal

There are new concerns about an agreement Attorney General Martha Coakley negotiated to try and control the prices and market power of Partners HealthCare. The implication, from a commission created to help reduce health spending, is that the deal does not go far enough.

“Without lasting change to the market structures,” the Health Policy Commission (HPC) writes in comments to be filed in court, “price caps may not be effective in keeping costs down.”

Price caps?

The commission dug in on a portion of the deal Coakley reached with Partners — the part that says network prices could not rise faster than inflation for six and a half years.

“Prices themselves, they are important,” said commission chairman Stuart Altman, “but they’re not the end of the game.”

To explain why, picture a colleague, neighbor, maybe your grandmother — someone who’s had hip replacement surgery. Now picture two hospitals.

“In one place,” said Altman, “a hip costs $10,000 to replace. In another, it’s $15,000.”

Under Coakley’s deal, prices at each of these Partners hospitals would rise slowly. But there’s nothing to keep Partners from sending more patients to the $15,000 facility. If more patients have hips replaced at the higher-cost hospital, then total health care costs would go up, even if prices don’t.

“Total medical expenditures, when we finally figure it out, is going to up by a lot, but yet the price increases were fine,” Altman said.

Coakley would have someone monitoring Partners, who could, in theory, intervene if a significant number of patients shift from lower- to higher-cost hospitals. But that monitor would only have access to spending for patients covered by a global budget, which Partners says is about 25 percent of its business.
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Judge Delays Review Of Partners HealthCare Deal

Update 6:35 p.m.: A judge has granted Attorney General Martha Coakley’s request for an extension. The comment period will now close Sept. 15, and Coakley will have until Sept. 25 to file comments from her office after seeing the full Health Policy Commission report. A new hearing has been set for Sept. 29.

Our original post continues:

BOSTON — Massachusetts Attorney General Martha Coakley is asking a judge to postpone reviewing a settlement between her office and Partners HealthCare that would allow the hospital network to acquire three new hospitals.

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Coakley’s motion asks a judge to wait until September to hold a hearing on the deal, which aims to limit the market clout of the state’s largest hospital network in exchange for allowing it to acquire South Shore Hospital and Hallmark Health.

A spokesman for the attorney general says Coakley has seen findings from a preliminary review of the deal from the state’s Health Policy Commission, and she believes the court should consider the full report.

The statement reads in full:

Our office always retained the option to seek to renegotiate portions of this agreement as it relates to Hallmark following a Final Report by the Health Policy Commission.  After reviewing the preliminary findings by the HPC, we believe it is in the interest of the public and the parties involved to wait for the final report before any final consent judgment is considered by the court.

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Cautious Optimism That New State Insurance Site Will Work

connector

An image from a previous interface for the Connector.

The first test of a new Massachusetts health insurance website was a success, a top state official says, leaving him cautiously optimistic that it will be up and running for a critical Nov. 15 deadline. That’s Opening Day for anyone who plans to buy insurance through the Health Connector, or is seeking free or subsidized coverage.

But Maydad Cohen, a top aide to Gov. Deval Patrick, says he’s not sure yet if the site, developed by hCentive, will be ready. So the state will continue to build out both a state and federal option for one more month. If the hCentive site clears a second test in early August, Massachusetts will drop plans to merge with the federal HealthCare.gov for 2015. Work would continue on the state site so that it would be ready for 2016.

Cohen is scheduled to update the Connector board Thursday morning, two months after the state gave up on the idea of trying to fix a site built by Canada-based CGI that never worked.

Some 230,000 residents who could not sign up for insurance online were placed in a temporary coverage plan because the state could not figure out what, if any, insurance assistance program they might qualify for. Each of those men and women will have to a reapply through a new site this November. And 101,000 residents who qualified for subsidized coverage last year, and whose plans have been extended this year, will also have to apply again.

Cohen says the cost of building out two options will be less than the original $121 million estimate, but he can’t say how much. An update on how much the state is spending to keep 230,000 people in temporary coverage is expected at Thursday’s board meeting.

AG Deal With Partners Filed In Court: Restricts Growth, Costs

Massachusetts Attorney General Martha Coakley on Tuesday reached an agreement with Partners HealthCare that she says will alter the hospital network’s negotiating power for years to come.

The deal would resolve an antitrust investigation by the attorney general’s office and ultimately allow Partners to acquire South Shore Hospital.

“Our office was the first to shine a light on the ability of Partners to charge higher prices based on its negotiating power,” Coakley said in a statement. “Today’s resolution is the first action of its kind to directly address that market dysfunction.”

But many in the health care industry say they’re frustrated and angry about the process.

The Rev. Burns Stanfield, president of the Greater Boston Interfaith Organization, says the group is disappointed the agreement bypassed the state’s Health Policy Commission

“A proper review would need to have the agreement available before it is submitted to the judge, and for the Health Policy Commission to be invited to weigh in,” he said.

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A New Way To Shop For A Primary Care Doctor In Mass.

A screenshot of MHQP's new Healthcare Compass website.

A screenshot of MHQP’s new Healthcare Compass website.

Massachusetts Health Quality Partners is launching what it hopes will be a more user friendly way for the public to use information it has gathered on primary care doctors’ offices for years.

MHQP has been publishing reports for almost a decade that compare physician groups based on the experience of their patients as well as how well they treat depression, asthma, diabetes, heart disease and screen for cancer. But the reports, which gather information from 65,000 patients and commercial insurance records, did not get a lot of attention from patients.

On Healthcare Compass, MHQP’s new website, patients can search for a primary care doctor by ZIP code or a physician’s name. But keep in mind, the site rates practices, not individual physicians.

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Health Care Leaders Call For Closer Scrutiny Of Partners Deal

In an unusual, perhaps unprecedented move, leaders from across the health care industry are calling for closer scrutiny of a deal that would cap prices for Partners HealthCare in the short term but would let the state’s largest hospital network add four more hospitals.

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

The deal that is fueling letters, analysis, statements and meetings is between Partners HealthCare and Attorney General Martha Coakley. She says it will limit Partners’ clout and the health care “Goliath’s” (her word) ability to drive up costs. That might be true. But no one has seen any details. The only thing made public is a press release. The public deserves to have more information about such a significant health care industry transaction, says Health Care for All director Amy Whitcomb Slemmer.

“There are a number of unknowns that have a direct impact on the care that will be delivered in Massachusetts and on costs, particularly, the impact to people’s pocketbooks,” Whitcomb Slemmer said.

Coakley has said that the details would be available when the agreement is filed in court. That was supposed to be next week. But Health Care for All, the Massachusetts Association of Health Plans, the National Federation of Independent Businesses/Massachusetts, the Retailers Association of Massachusetts and the state’s largest employer group, Associated Industries of Massachusetts, are all calling for a delay that would allow time for a public review.

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Latest Look Finds Mass. Near Zero Percent Without Health Insurance

When Massachusetts passed its landmark health coverage law under Gov. Mitt Romney in 2006, no one claimed the state would get to zero, as in 0 percent of residents who are uninsured. But numbers out today suggest Massachusetts is very close.

Between December 2013 and March of this year, when the federal government was urging people to enroll, the number of Massachusetts residents signed up for health coverage increased by more than 215,000. If that number holds, the percentage of Massachusetts residents who do not have coverage has dropped to less than 1 percent.

Click to see the full enrollment trends document from the Massachusetts Center for Health Information and Analysis.

Click to see the full enrollment trends document from the Massachusetts Center for Health Information and Analysis.

“We’re thrilled that we are getting this close to universal health care access,” said  the Rev. Burns Stanfield, president of the Greater Boston Interfaith Organization.

Stanfield says a report out last month that found mortality rates dropped in the first four years of expanded coverage, coupled with the insurance numbers, show that “our statewide move to universal access is working, and it’s a powerful witness to the nation.”

You won’t hear that kind of enthusiasm from the state, at least not on the record yet.

“These numbers are a sign that we are moving in the right direction, but there is still a lot of uncertainty about what they will ultimately mean to the total level of health insurance coverage in Massachusetts,” said Aron Boros, director of the Center for Health Information and Analysis, the state agency that tallied the latest insurance figures.

Uncertainty might be an understatement. One insurance insider says there is chaos behind the scenes. Most of the new enrollees are in a temporary coverage plan because the state, with its failed website, has not been able to figure out if these people qualify for free or subsidized care.

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AG Inks Deal To Rein In Partners HealthCare, But Does It Go Far Enough?

If you check in to a hospital or see a doctor connected to the Partners HealthCare network, your care will almost certainly cost more — sometimes a lot more — than at any other hospital in the state.

Brigham and Women’s, a Partners hospital, might get $1,500 for an MRI, while the same health insurance plan would pay Beverly Hospital roughly half that amount for the same test.

A deal reached Monday between Partners and Attorney General Martha Coakley aims to address that disparity in exchange for allowing the network to acquire Shore Shore Hospital and Hallmark Health.

“[Partners is] a Goliath in a market that has used its dominance to drive up costs,” Coakley said at a press conference Monday. “Those higher prices have led to an increased burden for families, for businesses, they’ve drained taxpayers … and they have contributed to the difficulties that many of our community hospitals have had to compete and to stay in business.

“How to address the Partners problem has been an issue in our commonwealth for years,” Coakley added. “But with this agreement, I believe we move from just documenting that problem to solving it.”

Coakley and the U.S. Department of Justice have looked for several years at whether Partners’ use of market clout violates antitrust laws. When Partners’ plan to acquire South Shore Hospital landed on Coakley’s desk for review last spring, South Shore became leverage for an agreement in principle that Coakley and Partners representatives signed Monday.

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The Rising Cost Of Massachusetts’ Failed Insurance Website

The cost to launch and maintain a website where Massachusetts residents can sign up for health insurance is estimated at $121 million through the end of next year. The actual price could be plus or minus 20 percent of that figure. Gov. Deval Patrick’s special assistant, Sarah Iselin, outlined the plans and expenses at a Health Connector board meeting Thursday.

“That’s shockingly high,” said Erika Beahr, a consultant from Waltham who buys health insurance through the Connector. “The state has to have a working website, but it’s hard to understand why it should cost so much in this day and age.”

Part of the reason for the high cost is that the state will spend a few months, at least, building toward two websites, as first outlined Monday. Iselin defended that decision Thursday.

“We’re really making the best of a bad situation.”
– Sarah Iselin,
special assistant to the governor

“It’s not as though there were other things that were viable that we rejected,” Iselin said. “We could spend 30-40 percent more and try to fix our existing exchange, and be in the same position we were in last fall.”

Iselin says she and her team looked at importing a site built by another state, but concluded that customizing it to fit Massachusetts could not be done in time for the next open enrollment, in November.

“I wish that we were in a different situation, but we’re not and we’re really making the best of a bad situation,” she said.
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Mass. Health Coverage Law Linked To Lower Mortality Rate

In this April 12, 2006, file photo, then-Gov. Mitt Romney is seen with lawmakers and staffers after signing the state's universal health coverage law at Faneuil Hall in Boston. A new report finds that the state's mortality rate has decreased almost 3 percent since the law was implemented. (AP File)

In this April 12, 2006, file photo, then-Gov. Mitt Romney is seen with lawmakers and staffers after signing the state’s universal health coverage law at Faneuil Hall in Boston. A new report finds that the state’s mortality rate has decreased almost 3 percent since the law was implemented. (AP File)

Three-hundred and twenty. It’s estimated that is the number of deaths prevented each year as a result of the 2006 Massachusetts health care law, a Harvard School of Public Health report says.

The decrease in the state’s mortality rate is the most concrete proof that Massachusetts’ health insurance mandate is improving people’s health.

When people have health insurance, they are more likely to get preventive care, go to the doctor when they become ill, and live longer. At least that was the expectation when Massachusetts passed the health coverage law back in 2006.

Now, there’s evidence of that link, in the study out Monday in the Annals of Internal Medicine.

It found that in the first four years of mandatory health insurance, the state’s death rate dropped 2.9 percent  TWEET , as compared to similar counties outside Massachusetts that did not expand health coverage.

“We already had a large body of research that showed the uninsured rate had dropped, people were able to access services, and that they felt better. This adds another important piece to that, which is that people are living longer,” said Dr. Ben Sommers, the Harvard report’s lead author.

Sommers said the most significant declines were in “things like cancer, infections, heart disease and other conditions that medical care might either prevent or treat or at least reduce the risk of death from. Meanwhile in some other causes of death that are less amenable to health care, such as car crashes, homicide, suicide, we didn’t find any statistically significant changes.”

That 2.9 percent decrease is for everyone in the state. White residents are living longer, but the biggest improvement is for blacks, Asians and Latinos, whose death rates dropped 4.6 percent.
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