Insurance

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

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Mass. AG Shifts Health Care Costs Conversation To Behavioral Health

If you have ever tried to get more than a doctor’s appointment for deep depression, alcoholism or a drug addiction, you already know that figuring out where to get care and who will help cover the cost is messy.

Now, that struggle is spelled out in the first health care cost trends report from Attorney General Maura Healey. It takes stock of behavioral health benefits and the low health insurance pay rate for these services in Massachusetts. Healey is shifting the focus of her office’s health care cost report after several, under former Attorney General Martha Coakley, that highlighted the wide gaps between payments made to high- and low-cost hospitals.

Attorney General Maura Healey speaks during a press conference at the State House in June. (Jesse Costa/WBUR)

Attorney General Maura Healey speaks during a press conference at the State House in June. (Jesse Costa/WBUR)

Healey says she’s changing gears because “it’s really important to look at the whole health of the patient.”

“We need to get to a place where we treat people who’ve got mental health, substance abuse issues in the same way we treat patients with diabetes or with cancer or with broken bones,” Healey says.

Seventy-nine percent of Massachusetts residents enrolled in MassHealth or ConnectorCare have coverage that separates general medical care from mental health and substance abuse. For members of commercial health plans. that number is much lower but still significant: 31 percent.  Healey’s report does not say that the separation is necessarily bad, but that the state needs a better system of sharing patient information between medical and behavioral health providers, and more coordination of care.

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MassHealth Squandered More Than $500 Million, Audit Finds

The state Medicaid program squandered more than $500 million through unnecessary payments or missed savings opportunities in its managed care program, according to an audit released Tuesday.

The review by State Auditor Suzanne Bump found MassHealth, the state Medicaid program, made $233 million in unnecessary payments for medical services that should have been covered by managed care organizations between October 2009 and September 2014. The audit also says the state could have saved $288 million more through more detailed structuring of managed care contracts.

Bump said that during the five years covered by the audit, MassHealth paid managed care organizations about $12 billion to provide health services to 1.6 million members. Managed care organizations are private health care insurers that agree to fixed, per-member rates to administer and pay for specific categories of health care claims on behalf of MassHealth.

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Mass. Health Connector Website Costs Rise To $281 Million

The cost of setting up the Massachusetts health insurance website under the rules of Obamacare is rising again, this time by $47.2 million.

Additional fixes bring the total price tag for the Connector site that failed two years ago and the new flawed replacement to $281 million. And this isn’t the final bill.

Connector leaders are considering two significant changes — a new payment tool and an easy physician search option — which could push the costs over $300 million. Continue reading

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Your Doctor, Always Available, For A Monthly Fee

For 10 years, Jeff Gold showed up to a job he wanted to love: being a family doctor.

“I was busy as a bee,” says Gold, 39, with up to 2,500 patients, seeing 20 or so a day.

Dr. Jeff Gold runs a direct primary care office in Marblehead. (Martha Bebinger/WBUR)

Dr. Jeff Gold runs a direct primary care office in Marblehead. (Martha Bebinger/WBUR)

Rushing from one patient to the next, calling insurers who wouldn’t approve prescriptions, filling out paperwork that didn’t seem relevant to his patients, Gold kept asking himself, is this what I signed up for?

“I thought I was gonna help everybody and spend time with everybody and it’s impossible to do,” Gold says.

So Gold quit, wrote a business plan to be a doctor who does not take insurance, hired one staff member (a nurse), and borrowed almost $400,000 to outfit a two-exam-room office next to a candy shop and café in Marblehead.

Gold may be the first physician in Massachusetts practicing under a model called direct primary care. For a flat monthly fee, Gold offers patients one-hour same-day appointments, no wait. The doctor is available 24/7 in person, at the office, at the patient’s home, via text, email or Skype. Continue reading

Boston Medical Center And Tufts Medical Center End Merger Talks

(Kalman Zabarsky/BU)

(Kalman Zabarsky/BU)

Boston Medical Center and Tufts Medical Center announced Wednesday that they are ending merger talks.

The two nonprofit hospitals, which had been in talks since last year, said in a statement that both sides “determined that at this time it is best for our medical centers to remain separate.”

Here’s the full statement from BMC President Kate Walsh and Tufts President Michael Wagner:

Over the last several months, Tufts Medical Center and Boston Medical Center have carefully considered how we might combine our two organizations. We have had thoughtful conversations and considered different options for tackling the complex task of integrating two vital, but different, academic medical centers. After much consideration, we have determined that at this time it is best for our medical centers to remain separate. We conclude these discussions with great respect for each organization’s mission and remain open to future opportunities for collaboration as neighboring institutions.

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Feds Seek Massachusetts Health Exchange Records

Federal authorities have subpoenaed records related to the Massachusetts Health Connector, including a period covering the breakdown of the health exchange’s website, The Associated Press has learned.

“The administration received a subpoena regarding the Health Connector’s difficulties dating back to 2010 and we are fully cooperating with the Department of Justice,” Elizabeth Guyton, a spokeswoman for Gov. Charlie Baker, said in a statement.

The administration said the subpoena came from the U.S. Attorney’s Office in Boston shortly after Baker took office in January. No details were immediately available, and it was not clear what information was being sought from the agency.

The U.S. Attorney’s office did not immediately return a request seeking comment.

Massachusetts’ first-in-the-nation universal health care program served as a model for President Barack Obama’s Affordable Care Act. But the state’s transition to the federal program in 2013-2014 proved disastrous, forcing the administration of former Gov. Deval Patrick to place hundreds of thousands of residents into temporary Medicaid coverage.

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Report Finds Stark Gaps In Mass. Addiction Care

The math is simple and starkly clear.

There are 868 detox beds in Massachusetts, where patients go to break the cycle of addiction. They stay on average one week. Coming out, they hit one of the many hurdles explained in a report out this week from the Center for Health Information and Analysis on access to substance abuse treatment in the state.

There are only 297 beds in facilities where patients can have two weeks to become stable. There are 331 beds in four-week programs.

As the table below shows, there are almost four times as many men and women coming out of detox, with its one-week average, as there are from a two- or four-week program.

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

Patients who can’t get into a residential program right away describe a spin cycle, where they detox and relapse, detox and relapse. Some seek programs in other states with shorter wait times.

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John Hancock Taps Fitness Trackers To Breathe New Life Into Insurance Industry

John Hancock Financial is the first U.S. insurer to offer discounts to policyholders who wear Internet-connected fitness trackers, like the ones pictured here. (Richard Drew/AP)

John Hancock Financial is the first U.S. insurer to offer discounts to policyholders who wear Internet-connected fitness trackers, like the ones pictured here. (Richard Drew/AP)

Could 15 minutes of exercise could save you 15 percent on your life insurance?

John Hancock Financial on Wednesday became the first U.S. insurer to offer discounts to policyholders who wear Internet-connected fitness trackers. Sign up for a new life policy today, and the company will send you a Fitbit, one of those bracelets that tracks your steps.

The more you exercise, the bigger discount you get on your insurance premium, up to 15 percent.

Company President Craig Bromley says the policy will also incentivize healthy behavior with “fun sort of rewards” to get policyholders to the gym, like gift cards, discounted hotel stays and leisure travel.

Delaying a death benefit “would obviously be good for us, but also good for them,”  TWEET Bromley said. “You know, other companies are not really helping people to live longer.”

It’s not just about customers living longer. By leveraging wearable devices and promoting wellness, the 153-year-old company is also trying to bestow a youthful glow on the aging life insurance industry.

“It’s great to be at sort of the forefront of all this technological change, which hasn’t always been the case for the life insurance industry,” Bromley said.

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Bill Would Toughen Oversight Of Planned Hospital Mergers

Attorney General Maura Healey is pushing legislation designed to give her office stronger oversight of hospital mergers.

The bill would toughen the authority of the Health Policy Commission when considering mergers of health care providers.

The bill would allow a report issued by the commission to be considered strong enough evidence that the Healey’s office could use it to seek a temporary block of a proposed deal between health care organizations if the deal would force up health care costs.

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Find The Uninsured Rate In Your Mass. Town

(Courtesy of the Blue Cross Blue Shield of Massachusetts Foundation)

(Courtesy of the Blue Cross Blue Shield of Massachusetts Foundation)

Among states, Massachusetts has the lowest rate of residents lacking health insurance. We know that. But beneath the topline state figure, there’s significant variation on a more local level.

For instance: Suffolk County’s uninsured rate (5.7 percent) is more than double the rate for Norfolk County (2.5 percent). Drilling down further, there’s more variation among municipalities: Take Boston’s 5.3 percent uninsured rate, compared with next-door Chelsea’s 10.8 percent rate.

The figures come from an analysis released Thursday by the Blue Cross Blue Shield of Massachusetts Foundation and the Urban Institute. The brief, titled “The Geography of Uninsurance in Massachusetts, 2009-2013,” is based on census data over the five years.

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