Insurance

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

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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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House Passes Bill To Fix Medicare's Doctor Payments. What's In It?

House Speaker John Boehner speaks to members of the media during his weekly news conference on Capitol Hill Thursday. (Andrew Harnik/AP)

House Speaker John Boehner speaks to members of the media during his weekly news conference on Capitol Hill Thursday. (Andrew Harnik/AP)

The troubled payment formula for Medicare physicians is one step closer to repeal.

The House Thursday overwhelmingly passed legislation to scrap Medicare’s troubled physician payment formula, just days before a March 31 deadline when doctors who treat Medicare patients will see a 21 percent payment cut. Senate action could come this week as well, but probably not until the chamber completes a lengthy series of votes on the GOP’s fiscal 2016 budget package.

According to a summary of the bill, unveiled by Republican and Democratic committee leaders earlier this week, the current system would be scrapped and replaced with payment increases for doctors for the next five years as Medicare transitions to a new system focused “on quality, value and accountability.”

Hundreds of state and national physician groups are urging Senate passage.

“It will relieve many years of frustration and uncertainty for all physicians by eliminating that sword of Damocles, that’s been hanging over our heads with regards to cuts and replacing it with a predictable albeit small increase in fees over the next four to five years,” said the Massachusetts Medical Society’s president-elect, Dr. Dennis Dimitri.

There’s enough in the wide-ranging deal for both sides to love or hate.

Senate Democrats have pressed to add to the proposal four years of funding for an unrelated program, the Children’s Health Insurance Program, or CHIP. The House package extends CHIP for two years. In a statement Saturday, Senate Finance Democrats said they were “united by the necessity of extending CHIP funding for another four years” but others have suggested they may support the package.

Some Democratic allies said the CHIP disagreement should not undermine the proposal. After the House approved the package by a vote of 392-37, Ron Pollack, executive director of the consumers group Families USA, urged the Senate to “adopt a CHIP funding bill as soon as possible. Families USA believes that a four-year extension is preferable to two years. We also know that time is of the essence, and it is crucial that the Senate act quickly.”

Some senators have also raised concerns about asking Medicare beneficiaries to pay for more of their medical care, the impact of the package on women’s health services and cuts to Medicare providers.

In a letter to House members before Thursday’s vote, the seniors group AARP said the legislation places “unfair burdens on beneficiaries. AARP and other consumer and aging organizations remain concerned that beneficiaries account for the largest portion of budget offsets (roughly $35 billion) through greater out-of-pocket expenses” on top of higher Part B premiums that beneficiaries will pay to prevent the scheduled cut in Medicare physician payments.

Hospitals, nursing homes and rehabilitation centers would see lower rates of increase, but are largely backing the legislation.

“Although nothing’s perfect, at a time when it’s so difficult to reach accord on really complicated issues, broad support for this solution is really impressive,” said Tim Gens, executive vice president at the Massachusetts Hospital Association. “And if it fails, we go back to these temporary patches that only solve the problem in a very expensive way for months at a time.”

Some GOP conservatives and Democrats are unhappy that the package isn’t fully paid for, with policy changes governing Medicare beneficiaries and providers paying for only about $70 billion of the approximately $200 billion package. The Congressional Budget Office Wednesday said the bill would add $141 billion to the federal deficit.

For doctors, the package offers an end to a familiar but frustrating rite. Lawmakers have invariably deferred the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals have always been temporary because Congress has not agreed to offsetting cuts to pay for a permanent fix. In 2010, Congress delayed scheduled cuts five times. In a statement Sunday, the American Medical Association urged Congress “to seize the moment” to enact the changes.

Here are some answers to frequently asked questions about the proposal and the congressional ritual known as the doc fix. Continue reading

Connector Gains New COO, Corner Office Adviser

The Baker administration continues to put its stamp on the state’s Health Connector Authority with the hiring of two top officials.

Vicki Coates, a former vice president of dental management at DentaQuest, starts on Monday as chief operating officer, according to Louis Gutierrez, the authority’s executive director.

Coates has also worked at Harvard Pilgrim Healthcare, Blue Cross Blue Shield of Massachusetts, and Metro West Medical Center.

Gutierrez also announced Patricia Wada, who has worked on state information technology projects, will take the job of special assistant to the governor for project delivery. Continue reading

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Gov. Baker Fills 2 Connector Board Seats

After sweeping out four Connector Board members, Gov. Charlie Baker on Thursday morning named insurance executive Mark Gaunya and business consultant Rina Vertes to serve on the Massachusetts Connector Authority Board.

Vertes and Gaunya were appointed minutes before a scheduled board meeting and the governor’s office reported they plan to participate in that gathering in Boston.

Gaunya is co-owner and chief information officer at Borislow Insurance. Vertes is president of Marjos Business Consulting.

Baker during the 2014 campaign for governor complained that there had been no major personnel changes at the Connector Authority despite major problems with the rollout of an expensive website intended to help people comply with requirements of the new federal insurance law.

“Our administration believes these health care professionals with decades of experience will continue the turnaround effort of the Connector, and provide the people of Massachusetts with an efficient, well run exchange,” Lt. Gov. Karyn Polito said in a statement.

Gaunya is filling a seat reserved for a member of the broker community on the 11-member board, with Vertes taking a seat set aside for a health insurance actuary. Continue reading

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