It’s a health policy truism: one person’s waste is another person’s paycheck. And it’s vividly playing out in the debate over proposed ban on drug and device maker gifts to physicians in Senate President Therese Murray’s cost control legislation. It’s not just the lobbyists and the drug reps (we estimate 2,000 to 3,000 just in Massachusetts), it’s the pharmaceutical “bling” makers and distributors, it’s the caterers, it’s friends and relatives of the above. A veritable industry devoted to the subtle and not-so-subtle seduction of physicians. All of them contacting their legislators to oppose the ban.

So the proposed gift ban poses an important and timely question – does Massachusetts possess the political will to address wasteful rising costs when a well-heeled lobby protests? If we can’t address this blatant waste, what waste can we address? Read more…

is an interesting time indeed for health care reform. The successes of reform to date have been well documented. As anticipated, we are indeed faced with some bumps in the road as we fully implement reform. How to maintain the success of coverage expansions while addressing affordability and cost is on everyone’s mind. In short, access and cost have received a great deal of attention in the reform debate. Let’s not forget about quality.

2007 was a banner year in Massachusetts in terms of changing the way we talk about quality. 2008 is shaping up to be a bigger year in that regard. Programs that promote transparency and include public reporting go a long way toward improving quality and educating the public and policy makers.

But hospitals in Massachusetts – different from other states – are not waiting for mandates. Read more…

Previously I’ve spotlighted the Medicaid member “churn” phenomena and have advocated for improvements to keep people who are eligible for Medicaid from getting bounced on and off coverage. The churn issue is important because it results in fragmented care, and burdens safety-net health care providers and medical homes, MMCOs, and the state with the time and effort to re-enroll these members.

As Commonwealth Care moves beyond its freshman year and into a maturing program, the same eligibility redetermination process is now being applied to its members — with disquieting results.

The redetermination process kicked off in December. At Network Health, we have subsequently seen 12,000 Commonwealth Care members involuntarily disenrolled in February and March, nearly three times the previous disenrollment rate.

To put a human face on these numbers, I can offer an unfortunately “spectacular” story of one of our Commonwealth Care members who has lost his Commonwealth Care coverage not once, but twice since his enrollment last spring. Read more…

Happy St. Patrick’s Day. According to Thomas Cahill’s How the Irish Saved Civilization, Patrick – a former slave – was the first person in recorded history to speak categorically against all forms of human slavery. That’s for real. The snakes – well, that’s another matter.

In his honor, let’s get down to business…

The advocacy community is concerned that the Connector Board is moving toward a Thursday vote on premium increases up to 14 percent and doubling/tripling of many co-pays for Commonwealth Care enrollees.

When the late February Board meeting was cancelled to give time for a “broader” stakeholder involvement, the advocacy community submitted numerous ideas to address funding challenges. The Administration set a 30 day timeframe for consideration. Thirty days is not up, but the Connector now is moving to put the weight of financial problems on the backs of enrollees before asking any other stakeholders to participate. Read more…

In January, I forecast the Legislature’s priority to address containment of health care costs during this session. Here we are, in March, the day after the Joint Committee on Health Care Financing held a lengthy and productive hearing on bills related to just that. The Committee now begins the process of parsing the bills and redrafting what promises to be the most significant health reform legislation since Chapter 58 of the Acts of 2006. Cost-containment is no small challenge. It is, in many ways, a greater one than expanding access to coverage. But it is a similar challenge in that it requires significant investments before some of the savings can be realized. Responsibility for expanding access had to be shared, and now investing in cost-containment has to be shared as well. Read more…

Medical expense is looming large over not only Massachusetts, but our nation, and it continues to cast its long shadow over health care conversations occurring countrywide. And, as Nancy Turnbull pointed out in her recent post, medical expenses aren’t our sole cost problem. While, as she says, “the biggest savings in health insurance premiums will come from controlling medical expenses,” her analysis also showed alarming increases in administrative costs.

The full health care cost picture needs continued close analysis, and we all will need to do our part to bring about solutions. At Network Health (one of four managed care organizations contracted to provide MassHealth and Commonwealth Care coverage), we have worked aggressively to keep our administrative costs down. Over the past five years, we have held our administrative costs steady on a per member per month basis, despite dramatic (122 percent) membership growth. To control administrative costs in the face of such growth, we are constantly looking for innovative ways to streamline our operations. One measure of our achievement in this area is that more than 97 percent of our interactions with our participating provider community occur through electronic channels. Read more…

Take a look back at recent posts to this blog and you will see one recurring theme: Health Reform has been a tremendous success so far, but the rise in health care costs continues to worry everyone. The cost associated with the Reform effort has a growing price tag.

Every single blog contributor, who has offered such a thought about rising cost, is right on. Many of the regulars in this space are starting to offer new and innovative proposals to get at the issue. Last week, Blue Cross offered a new, voluntary payment structure that hospitals and other providers should examine.

But proposals like these, while welcome, fail to get at a core cause of what is inflating health care costs – fixed input prices. Significant among those input prices is the rising cost of labor. There is a growing workforce shortage that greatly affects cost. We need to address the shortage of a variety of caregivers – including primary care physicians – in order to maintain the quality of our care delivery. We are also experiencing cost pressures filling jobs in other areas including physical therapists, ultrasound techs, and even in non-clinical areas like medical record coders and billing/collections. To ignore the impact that labor has on health care costs and to focus solely on other cost containment measures would relegate our efforts to the periphery.

Of course, the cost of nursing comes to the forefront when discussing the topic. Read more…

Last month, my colleague Brian Rosman was in a part of Manhattan near a major medical center. Passing a local deli, he couldn’t help but notice a large sign in the window – “Drug Reps: Get Your Party Platters Here!”

A new coalition starts today on a key aspect of health care cost control. Health Care For All is joining forces with consumer advocates, non-profit organizations, insurers, and providers to launch the Massachusetts Prescription Reform Coalition (MPRC). We are taking action against pharmaceutical marketing practices that wastefully inflate prescription drug costs.

Why drugs? Cost control is critical to the financial viability of health reform. Controlling inappropriate drug marketing should be a key item on any list of meaningful cost control measures. Prescription drugs are among the most commonly used forms of health care today. Over 72 percent of American households have someone taking a prescription medication. And drug prices continue to rise. The average price for the most widely used brand-name drugs rose nearly 50 percent from 2000 to 2006 – more than twice the rate of inflation.

Pharmaceutical marketing is an obvious place to start. Drug companies invest $7 billion yearly in marketing to physicians. Read more…

When I began my first full legislative session as Speaker of the House of Representatives, I resolved to lead the members of the House toward the design and successful passage of legislation that would protect all of the Commonwealth’s residents from the harms of being uninsured or underinsured. When the health reform law was enacted by the Legislature in 2006, we all resolved to support a three-year implementation for what would be a lifetime of positive change. We knew that the change would be vast – a culture change that wouldn’t come easily or without controversy.

As 2008 begins, we are right where we hoped to be – seeing enormous financial and political investment to bring health insurance to market for hundreds of thousands of people. Chapter 58 was a delicate balance of policies created to improve the lives of our uninsured while protecting the already insured. Now, the final phases of implementation have piled onto the delicate balance new entities like the Connector and the Health Care Quality and Cost Council, new responsibilities for existing agencies like the Department of Revenue, and newly insured residents of all incomes. As the challenges build, so too must our resolve to address them.

Cost containment is the next such challenge. Read more…

Finding new and effective ways to manage health care costs seems to be on everyone’s minds these days. With the recent announcement that our state’s historic health care reform efforts are exceeding everyone’s wildest expectations, there has been great excitement about our collective achievements — and yet growing trepidation about whether or not we can truly sustain this level of success.

Of course we can. In fact, we must.

One of the important things we must do to make reform a continued success is to work together to slow the health care cost trend in Massachusetts. Some solutions will take time to develop. Some apparent solutions may yield uncertain results.

However, the good news is that we know of a few simple proposals that we consider ‘low-hanging fruit’ if you will, that will yield tens of millions of dollars in health care savings – pretty quickly. By simply streamlining the way we do business, simplifying the backroom operations of health care, we can reap huge saving, while not cutting back on health care quality or access. Here’s how: Read more…