Entries by Barbara Anthony

Time for Boston to open up to limited service clinics

As a little girl I have a dim memory of my mother taking me to a medical “dispensary” in what was then not-very-trendy East Boston. I remember it being really convenient; it was just down the street from where we lived, had short wait times, and a nominal cost, if any at all. This was during a time when physicians made home visits. I guess my mother couldn’t reach our family doctor, so off to the dispensary we went. Medical dispensaries—we might call them “clinics” —were quite common in Boston beginning in the early 1800s. (That is not when I went!) Most were operated as charities for people who could not afford private physicians or were not sick enough for […]

Op-ed: Getting to yes on MassHealth

State leaders need to work together to tackle Medicaid challenge MASSACHUSETTS HAS A unique culture when it comes to health care.  Over the last quarter century, we have seen the business, provider, payer, consumer, and academic sectors come together to advance reforms aimed at expanding coverage and containing the cost of care. Whether it was repeal of hospital rate-setting and passing insurance reforms in the 1990s, or the 2006 the passage of Romneycare, or major cost control legislation enacted in 2010 and 2012, stakeholders across the board have had a seat at the table. Consensus may not be the right goal in all cases, but given the way it has careened from one extreme to the other on health care in […]

Public Statement on the Recommendations of the Legislature’s Healthcare Provider Price Variation Commission

Commission Misses Great Opportunity to Advance Healthcare Price Transparency While most of the country is focused on national health care issues playing out in Washington, Massachusetts is in the midst of an extremely important debate with lasting effects on what Commonwealth residents pay for healthcare prices, about which few citizens are even aware. Last year, as part of a hastily crafted law replacing a ballot initiative to institute limited provider rate-setting pushed by 1199 SEIU, the state legislature established a special commission to study the Bay State’s stubbornly high healthcare prices. The Provider Price Variation Commission (PPVC), populated by a who’s who of local healthcare bigwigs, very diligently attempted what was asked of them: not only identifying the reasons for […]

Governor’s Plan to Cap Healthcare Provider Prices Misses the Mark

The Governor filed a number of healthcare market reform proposals along with his fiscal 2018 budget. One of his proposals aimed at reining in healthcare costs would impose limits, or capitate, the prices that insurance companies are allowed to pay providers (physicians and hospitals); it appears that the capitated prices serve as an indirect way of putting price caps on provider prices.  Hmm, sounds complicated. Let us try to explain. Background The best place to start is with a description of the problem the Governor is trying to fix. Massachusetts has an insatiable appetite for healthcare services. According to the Health Policy Commission (HPC), the Bay State’s total spending on healthcare increased by 4.1 percent in 2015 to $57.4 billion; […]

Statement on Governor Baker’s Proposed Healthcare Business Assessment

In January, the Baker Administration introduced a number of healthcare market reform proposals in its fiscal 2018 budget. The public face of these proposals is found in a slide presentation on the website of the Executive Office of Health and Human Services (EOHHS). There have also been news stories written about the proposals and certain stakeholder groups have been briefed. Beyond the EOHHS document, however, there is not much transparency or explanation about any of these proposals. Two of them are especially important as each has potentially far-reaching impacts: a new annual $2,000 penalty per employee on businesses who do not attain 80 percent enrollment in their employer-sponsored health plans and a proposal to limit what insurance companies may pay […]

State Leadership Needed on Healthcare Price Transparency

Governor Baker’s recent healthcare proposals include provisions aimed at improving transparency in healthcare pricing. These policies imply that it is necessary to release more information in order to realize cost savings through healthcare price transparency measures, but current state laws already require the disclosure of price information upon request. Enforcing existing laws and creating incentives for carriers and providers to promote consumer friendly price transparency are necessary complements to the Governor’s proposals. The Governor’s proposal (found in a slide presentation on the EOHHS website) has two major components.  The Center for Health Information and Analysis (CHIA) is to: “Collect data from the health plans to develop a market-level report.” Create a list of healthcare pricing data across all providers for […]

Achieving a Sustainable and Transparent Healthcare System

As the Legislative Special Commission on Provider Price Variation wraps up its work (their potential report/recommendations are due in mid-March), PioneerHealth took this opportunity to provide our expertise and vision for moving towards a sustainable and transparent healthcare system. We envision a host of policy recommendations, enhanced enforcement of existing laws, and a statewide education campaign to help consumers learn to make value-conscious decisions. Following these steps will put the Commonwealth on a path towards healthcare cost containment.

Insurer Using Market Clout to Lower Healthcare Costs for Consumers

There are rumblings among some in the hospital community voicing displeasure with the Group Insurance Commission’s (GIC) new plan to cap payments to providers at 160% the Medicare rate. The GIC says this move will help save the agency $50-100 million annually and meet the state’s cost growth benchmark. Over the years, the GIC has been a leader in healthcare cost containment, from tiered provider plans to a recently launched cash incentive program called Vitals SmartShopper designed to incentivize high-value healthcare decisions. In yet another innovative program from the state agency responsible for 436,000 state workers and their family members, the GIC has voted to limit payments to providers, some of the most prestigious of which have attacked the plan […]

How To Tell If The Price Is Right: Fostering Transparency in Healthcare Prices for Massachusetts Consumers

Notwithstanding a Massachusetts law requiring the clear, prompt disclosure of price estimates to patients upon request, recent studies by Pioneer of a sample of hospitals, specialist physicians and dentists throughout the state showed that it is still not easy to obtain this information, often requiring some persistence and longer than the two days allowed by law (“Survey: Price Information Difficult to Obtain by Massachusetts Hospitals,” June 24, 2015; “State Healthcare Price Transparency Law Still Not a Reality,” August 12, 2015). The 2012 Massachusetts law requires healthcare providers to give consumers procedure prices within two business days of request (Chapter 224 of the Acts of 2012, “An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency […]