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Consumer Driven Health Care: A New Agenda for Cost Control in Massachusetts

This paper provides a discussion of CDHC, what it is and how it can help constrain health care costs and increase patient engagement in Massachusetts. While supply-side approaches are also necessary for cost control, without engaged consumers, Massachusetts may find that it cannot accomplish its cost-containment goals as quickly or as successfully as desired.

Innovative Medical Liability Reform

This paper describes Massachusetts’ existing medical liability system, including how it has failed to achieve its social objectives, the impact of the system on health care costs, and recent efforts towards reform. It presents policy options for medical liability reform. It examines both traditional and nontraditional avenues of reform along with strategies for advancing medical liability reform in Massachusetts.

Fixing the Massachusetts Health Exchange

The importance of this work is especially clear as the Patient Protection and Affordable Care Act of 2010 (ACA) requires a health benefit exchange to be operating in every state by 2014. The question of the Connector’s effectiveness is of critical importance to other states as they try to plan and design what an exchange will look like in their own state’ For Massachusetts, the ACA provides both opportunities and challenges moving forward.

Ths is getting ugly.

Today’s Globe story regarding Insurance companies’ unwillingness to participate in the Connector’s new program “Business Express” is interesting but incomplete. The reporters should pay attention to bloggers’ comments about why the program may not be working and about how this option doesn’t really offer more affordable options for businesses. I do not know why the Connector and the Globe keep touting lower premiums. The Connector failed in its mission to serve small businesses by not offering a defined contribution model. Are they really going to sue the insurers for not offering this product through the Connector? That sounds desperate to me. I’m keeping my fingers crossed that the feds don’t follow suit when they promulgate regulations for state-level exchanges.

Unintended Consequences?

The Wall Street Journal reports today that the recently passed health care bill will soon negatively hit brokers’ bottom lines.   This is due to regulation of insurers’ medical loss ratio  (the amount of the health care premium dollar that goes to paying claims).   I don’t personally like the MLR requirements in the bill as I think they can be easily gamed and they don’t really get at the heart of growing health care costs.   That being said, if this requirement encourages insurers to pay brokers a fixed dollar amount (as opposed to a % on the premium) then it’s one of the unintended consequences I’m happy about.  Don’t get me wrong, there are some brokers who are doing really good […]

MA vs. US: Round 2: Employer Penalties

Sorry, It’s been awhile. Although the MA reform was considered bi-partisan.  There were a few elements that Governor Romney vetoed when the bill was signed.  The employer “fee” was one important one.   Employer requirements or fees don’t make sense for a number of reasons.   There is an on-going myth that the employer’s money and the employee’s money are two separate things.  And, by requiring an employer to offer insurance or pay a fee will result in added benefits to the employee.  In reality, there’s really no evidence that this occurs.  Instead, employers respond by reducing their full-time workforce, or increasing the price of their goods (if that’s possible) both having a potentially negative impact on the economy. How do MA […]

An Interim Report Card on Massachusetts Health Care Reform: Part 4

This report is the final report in a series of four. Earlier reports in this series evaluated access to health insurance and health care, equitable and sustainable financing, and administrative efficiency. The focus of this report will be on cost-effective quality, and the analysis will be organized by the four “Scorecard Metric,’ presented in Figure 1. 

MA vs. US: Round 1: Individual Mandate

A mandate made sense in MA for a few reasons.  First, it was clear that our non-group market was failing due to adverse risk.   It was sort-of like a high-risk pool but there were no options for healthy people.  Because of changes that were made to the insurance laws in the mid-1990’s including guarantee issue, adjusted community rating (no underwriting allowed), and very limited product choice in the non-group market, the market was unaffordable.  The only people purchasing in this market were people who really “needed” insurance.  We saw large drops in enrollment each year  (insurance jargon calls this a death spiral) leading up to the reforms in 2006. Second, we had VERY EXPENSIVE safety net, the Uncompensated Care Pool, […]

The Devil is in the Details

Anyone involved in the Massachusetts reform is probably being asked the same questions that I am being asked.  How does the federal reform differ from MA’s reform?  How will it affect what we’ve already put in place?  Why is there so much opposition, hasn’t the MA reform worked reasonably well?   The answers are not simple.   Unfortunately, one must review the 2000+ page bill and another 100+ pages of reconciliation language in order to prepare a comprehensive review.  And, even then, you’re only partially there.  Many details, which could have a material impact on MA and the nation as a whole, will need to be further detailed through the regulatory process during what will be a very lengthy implementation phase.  So, […]

New Report on MA Reform

It’s too bad that this new Cato report on health care reform in Massachusetts http://www.cato.org/pub_display.php?pub_id=11115  is not in a policy journal like Health Affairs as many more people would read it.  It certainly provides some interesting analysis and food for thought regarding the reform’s outcomes.  The results are in line with what I reported recently in the first chapter of Pioneer’s series evaluating the reform http://www.pioneerinst.wpengine.com/pdf/100113_interim_report_card1.pdf  The authors use CPS data to look at reductions in the uninsured, crowd-out from private to public coverage, and improvements in health.  They provide some interesting data assessing the effect of non-response on insurance questions pre and post reform.    They posit that the misreporting of insurance status is greater given the mandate to have […]

Be Careful What You Ask For

When I read the informative report released by DHCFP and reported on in the Boston Globe today, I was struck by how well this insurance seems to meet the needs of most students.  Less than 1% of students reach the caps that are imposed by the plans.  That seems like a small number to me.  And, the Safety Net Pool will wrap around these plans if the services that exceed that amount are sought in a hospital or community health center.  So, what’s real beef here?  I think some legislators cannot stand that insurance companies are a business and like any other for-profit business need to make a profit.  Is the solution to require every student have coverage equivalent to […]

Drawing Lessons: Different Results from State Health Insurance Exchanges

Policymakers are considering several options for national health reform, each of which includes some form of “insurance exchange.” These exchanges allow the uninsured, and employees of small to medium-sized businesses, to compare qualified health plans, purchase insurance and, if eligible, receive subsidies toward the cost of their plans.

Overseas Surgery

So, I’ve heard about the increase in Americans seeking expensive surgery abroad but today’s Wall Street Journal coverage of Dr. Shetty’s 1000-bed cardiac hospital in Bangalore, India was absolutely fascinating reading: (http://online.wsj.com/article/SB125875892887958111.html?mod=WSJ_hpp_MIDDLETopStories) Cardiac survey averages $2000 at Dr. Shetty’s hospital compared to between  $20,000 -$100,000 here in the US.  And it’s not just that India is a less expensive place to run a hospital.  It’s because Dr. Shetty has such high volume that he is able to achieve economies of scale unheard of in the United States.  He’s also able to drive hard bargains with manufacturers of cardiac supplies and equipment and his staff are incredibly productive.  What’s the quality like you ask?  Well, it has been well established that […]

Small Employers, there is something you can do.

Many people have received coverage via health care reform and that has been good for the Commonwealth.  However, it’s clear now, that there have been losers too— small businesses.  The Globe article yesterday highlighted the situation for small businesses today:  http://www.boston.com/business/articles/2009/11/15/blue_cross_rates_for_small_businesses_to_surge?mode=PF The state is holding hearings to examine the cause of these increases and to assess whether changes should be made to how small businesses purchase insurance.   We should examine what has caused these increases in rates, was it the merger with the non-group market (something that can only explain a very small increase, by my accounting), increases due to benefit mandates (like the Rx coverage decision made by the Connector), or simply health care trends (as the BCBS representative […]

Transparency — Bring it on

On Friday, my old agency released a report entitled “Measuring Health Care Quality and Cost in Massachusetts.”  The report can be found here:  http://www.statehousenews.com/qualitycost.pdf.  This report is full of really useful information on quality and costs for various procedures at hospitals in Massachusetts.   Unfortunately the report received very little press and consumers probably don’t even know it is available.  The information can also be found on the consumer website, developed by the Health Care Quality and Cost Council.  This new report allows you to see a profile of a  hospital’s indicators on one page and allows you to compare all hospitals in the state (compared to the website which only allows you to compare 4 hospitals at a time).   This is […]

Rethinking EMTALA

On the drive in this morning I heard an interesting idea being tested in Fort Worth Texas (isn’t that one of the highest health cost cities in the country?).  See the link here http://www.nbcdfw.com/news/local-beat/Call-An-Ambulance-Get-a-Taxi-66723887.html.     They are using EMTs as triage agents for patients who call 911 for an ambulance.  In many cases, the EMTs are telling patients, “you don’t need to go to the hospital.” If the patient insists on visiting the ER, and it is not an emergency, the EMT calls a cab.     Policymakers should re-think how EMTALA  (the Emergency Medical Treatment and Active Labor Act) gets operationalized and whether it needs some updating to encourage appropriate use of our scarce resources.   With the flu season upon […]

Let the Patients Choose

(Editor’s Note: Pioneer welcomes our Senior Fellow on Healthcare, Amy Lischko, to the blog. Amy will be writing on healthcare here from time to time, as well as working on research for Pioneer. Welcome.) It’s worrisome when the state tells us what kind of provider network we need.  Today’s Globe article “Insurer told to hold off in Mass.” highlights one of the reasons behind our increasing health care costs.  Carriers have often remarked that they have difficulty creating both tiered provider networks and narrow provider networks that offer lower costs.  Why can’t the state (via the Connector or DOI) allow Centene to offer these plans to consumers and let the consumers vote with their feet?  If no one signs up, […]