This week, a team from Massachusetts will travel to Chicago for the initial meeting of the State Quality Improvement Institute. The Institute is a program of Academy Health and the Commonwealth Fund to assist several states, including Massachusetts, to improve the quality of health care. Our team, led by Health and Human Services Secretary JudyAnn Bigby, MD, will have the opportunity to brainstorm on possible solutions to several important issues with national experts on those topics. This intense review will assist the Commonwealth to better conceptualize quality improvement strategies, analyze potential tradeoffs, and consider possible implementation tools.

The Commonwealth Fund, which is the sponsor of the State Quality Institute, issues an annual report card on state health system performance. Massachusetts currently ranks #8 in this assessment, and we hope that what we learn through the Institute will be put to use to improve our ranking and the quality of care offered to Massachusetts residents.

Why should we care about our ranking? Well, it’s not about ego or bragging rights. Read more…

Our state – this Commonwealth – is founded upon one of the great themes of religious faith – the responsibility to care for each other and for those less fortunate. The very meaning of the term “commonwealth” reflects a concern and caring for the public good – a covenant among members of the community for the welfare of the least among us.

In his noteworthy sermon aboard the Arbella entitled, “A Modell of Christian Charity,” our first Governor – John Winthrop – admonished the first citizens of the Province of Massachusetts Bay with a clear statement of our civic responsibility as a reflection of our actions as people of faith. No document better exemplifies the spirit behind the Puritan migration to the New World, effectively summarizing the goals of these first American Puritans.

Winthrop said that “to do justly, to love mercy, to walk humbly with our God,… we must be knit together in this work [of building a new society] as one man, we must entertain each other in brotherly affection, we must be willing to abridge ourselves of our superfluities for the supply of others’ necessities, we must uphold a familiar commerce together in all meekness, gentleness, patience, and liberality, we must delight in each other, make others’ conditions our own, rejoice together, mourn together, labor and suffer together, always having before our eyes our commission and community in the work, our community as members of the same body.”

A Modell of Christian Charity, 1630 Read more…

In the last legislative session (2005-2006), Massachusetts launched a comprehensive, historic effort to extend affordable, high quality health insurance through a public-private partnership featuring shared responsibility among individuals, employers, and government. We increased access to private market coverage as well. As we continue to implement Health Reform – we have more than 300,000 previously uninsured who now have health insurance.

Our new Commonwealth Care and Commonwealth Choice insurance products, as well as our expanded Medicaid coverage that are the cornerstone of health care reform are subject, however, to many of the same economic pressures experienced by the more than 90% of our residents and employers who have had health insurance all the along. Rising health costs are not sustainable for anyone – our newly insured through health reform or the larger population who have been insured.

The federal government (CMS) has projected rising costs nationally, and we are seeing rising costs in our state health insurance programs as well. Health care spending, according to CMS, continues to outpace overall economic growth and general inflation by more than 6% in both cases, and the share of health care spending of our gross domestic product is growing beyond the current 16%.

We’ve learned that just cutting spending can significantly harm quality, shift burdens to others, and harms our state’s economy which depends so heavily on health care, so arbitrary cuts in services, salaries, equipment, etc. is not the answer. Read more…

When we embarked on the mission to expand access to health insurance three years ago, our goals were to expand access to Medicaid and Children’s Health (SCHIP), restore Medicaid cuts necessitated by the Recession of 2002-4, expand access for small businesses and their employees to the Insurance Partnership, provide affordable insurance to the middle class, and get to universal coverage, in part, through an individual mandate. We wanted to reduce cost-shifting in health care and maintain or expand the partnership with employers in providing access to health insurance. Of course, the goal was not simply to expand the actuarial pool to ease the double-digit premium rate increases, but to connect the newly insured to primary care providers in order to reduce the reliance on emergency departments and their high quality, but expensive care.

Our goal in expanding Medicaid and SCHIP was to enroll about 85,000 adults and children, and we are well on the way with over 73,000 now enrolled. We sought to enroll 160,000 in Commonwealth Care (subsidized insurance), and we have reached that goal. We have also enrolled 56,000 in Commonwealth Choice (non-subsidized, “affordable” insurance), although we believe there could be as many as 150,000 more to be reached in this category.

We have succeeded in increasing provider rates for hospitals and physicians and more support is scheduled, and will be needed in the coming fiscal year – especially in the recruitment and retention of primary care physicians. Read more…

Last week, state leaders, business organization, health care advocates and others joined to celebrate the fact that by the end of this calendar year, some 300,000 Massachusetts residents who were uninsured a year ago now have health insurance. This is an accomplishment that no other state can claim, and it is a substantial improvement over the trend in health insurance on the national level.

One of the media representatives in the audience that day at the State House asked, “How many uninsured residents are left?”

At this point, no one really knows. There are, of course, estimates, but they vary widely depending on timing and methodology. Read more…

The passage and ongoing implementation of the Massachusetts Health Reform law has sparked interest among governors and legislators across the country in finding ways to expand access to affordable, high quality health care. It seems, in fact, that there is a growing political consensus that reforming the health care system should be a major national priority. Despite the growing recognition of the pressing need for health care reform, consensus on how to go about reforming the health care system has been elusive at the federal level. If history is any guide, this will become even more challenging in the coming election year.

As we approach the presidential elections in 2008, every presidential candidate is being pressed to present their detailed plans for health care reform. Not surprisingly, many of these plans view “fixing the system” from a national vantage point. However, our health care system is an amalgamation of different component delivery mechanisms with varying levels of quality and efficiency in delivery and practice. While some major aspects of heath care are truly national in scope, the reality of our health care system is that health care delivery is truly local.

In this regard, it is not surprising that some states and local communities are leading the way to health care reform through innovation in coverage expansion and by enabling and promoting greater quality and cost savings in health care. California, Connecticut, Maine, Indiana, New Hampshire, New York, Vermont, Wisconsin and Massachusetts, are notable examples of states that are already exercising leadership in this area. However, there is the potential that state leadership and innovation in health care could easily get lost in the clamor for “national solutions”, particularly in an election year. Read more…

1. What, in your opinion, was the catalyst for Massachusetts taking such extraordinary legislative and regulatory measures to try and get all Massachusetts residents insured?

SENATOR MOORE: There were several factors that prompted the Legislature to tackle health care reform. First, Read more…

Under the Massachusetts Health Care Reform Act, employers with 11 or more full-time equivalent employees in Massachusetts must make a “fair and reasonable” contribution toward the cost of their full-time employees’ health insurance. Employers that fail to do so, or which do not offer any employer-sponsored health insurance, will be required to pay an annual fee of up to $295 per full-time employee. The fee, known as the “Fair Share Contribution,” will be pro-rated for part-time and seasonal employees.

This Fair Share Contribution is used to help fund state-subsidized health plans that are available to low-income people who do not have access to employer-sponsored health insurance, and to provide rate increases to certain Medicaid providers. Its purpose is to help equalize the burden of expanding health care access among all employers.

When the Health Care Reform law was being negotiated in the legislative Conference Committee, legislators did discuss whether it was necessary to set minimum levels of contributions by business. However, legislators were told that the major health insurance plans did not write insurance for groups that did not have at least fifty percent of employees in the program and for which the employer contributed at least fifty percent of the premium cost. The average employer share at that time was 75%. Therefore, the actual provisions for implementing the “Fair Share Contribution” were left to the executive branch of government.

When the Romney Administration was developing its standards, numerous healthcare advocates, unions, and other organizations criticized the proposals and asked the Division of Health Care Finance and Policy to increase the minimum company contribution to 50 percent of an insurance premium to avoid the assessment. At the time, Representative Patricia Walrath and I, as co-chairs of the health care conference committee, wrote to the Administration to underscore that the legislative intent was not to go below the levels of employer-based insurance then in effect. However, leaders of business and taxpayer groups endorsed Romney’s proposed regulations setting a very low standard. Read more…

Washington State is among the latest of our sister states to take great strides in expanding access to health care. They earmarked money to cover more children, allowed small employers to purchase coverage at a government-negotiated price and let parents cover dependents up to age 25. Officials in that state are reasonably confident that they can cover all children by 2010 and all residents by 2012.

It’s certainly encouraging to see so many states take hope from what we are achieving in Massachusetts. They are recognizing, as we did earlier, that the problems of caring for the uninsured and the burden they place on the rest of the system have become acute. We can’t wait for the federal government to develop a national plan. Read more…

Most of us are familiar with the time-tested advice to doctors, “First, no harm.” Some have attributed this famous dictum to Hippocrates and others to the Roman physician, Galen. Regardless of its origin, physicians and other health professionals have come to understand the vital importance of patient safety and medical quality.

However, the best advice that all of us should do our best to follow is not to get sick or injured. Obviously, if we can prevent illness or injury, we live a much healthier life and we don’t add to the cost of health care. Of course, we can’t always prevent an illness, but regular physician visits and health screenings that help to detect illness at its earliest stages, can often help assure an early return to health. Similarly, we may not prevent accidents, but we can take steps to minimize injury.

The new Massachusetts Health Reform Law, which is off to a terrific start, recognizes the importance of prevention. The law encourages insurers to offer incentives for not smoking, for participating in wellness programs, and for complying with chronic disease management such as complying with an appropriate diabetes regimen. Read more…