Entries by Joshua Archambault

Session 6 -CMS & Mass Marriage Counseling

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Today marks the 6th extension granted to the Commonwealth for the Medicaid waiver that serves as the foundation for our 2006 reform. I have written about this before here and here. As a review, the Massachusetts MassHealth 1115 waiver from the federal government allowed the 2006 health reform to become a reality financially. The waiver was last negotiated by the Patrick Administration in 2008, and was extended until June 30, 2011. From SHNS this morning ($): HIGH-STAKES MEDICAID TALKS DRAG ON: Secretive negotiations between the Patrick administration and the Obama administration over the distribution of billions of dollars in Medicaid funding have failed to produce an agreement and will continue into December.  The outcome of the talks, which are occurring as Washington looks […]

Questions for the AG on Health Reform 2

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Attorney General Coakley spoke this afternoon at MAHP’s annual conference. I wanted to offer a few thoughts and questions. Video can be found here. I like the AG’s focus on transparency and health literacy, but I am not sure these actions alone move us towards fully engaged consumers when they still have employer sponsored insurance that covers most costs. What is their motive? Other questions: 1)Why are providers responsible for giving pricing information when insurers have that data? 2)What is the value of bringing everyone around a benchmark average price for a service? That does not reward low-cost/high quality service, it does the opposite, and allows higher cost/ lower quality service to remain. 3) Will rejections of provider contracts be per procedure, […]

Obama Admin Rethinking Massachusetts Model? Part 2

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My now monthly blog post wondering if there will be agreement soon between the Obama Administration and the Patrick Administration on a multi-year extension of the Massachusetts health care waiver. As a review, the Massachusetts MassHealth 1115 waiver from the federal government allowed the 2006 health reform to become a reality. The waiver was last negotiated by the Patrick Administration in 2008, and was extended until June 30, 2011 at that tome. Quietly this summer, the new deadline was pushed back three times, and is set to expire again tomorrow. The Boston Globe’s Liz Kowalczyk and Chelsea Conaboy were kind enough to ask CMS Administrator Dr. Don Berwick about it in a recent interview: Berwick would not comment on negotiations with Massachusetts over […]

Is Cake Health the Answer to Our Health Care Cost Problem?

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I just stumbled upon a great app that is helping individuals become better consumers of health care AND understand the piles of health care related paper work sent to their homes. It is available at:  CakeHealth.com If we are to move in the direction of more consumer driven health care, we will need LOTS more where this came from. BCBS of MA has mentioned an app they are developing to help control costs by directing patients to nearby hospitals with lower rates. So lets hope other local insurers get on board and make this information available to their members in some form in the future.

Patrick Admin’s Misdiagnosis on ACA Transparency

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This post was co-written by Michael Morisy. During this year’s budget debate, Pioneer asked many questions about the reality behind optimistic health care cost predictions which, if flawed, could leave the state facing a $900 million budget hole next year alone. The passage of the Patient Protection and Affordable Care Act (PPACA) could make things even worse down the line – if it survives judicial challenges. But as much as we’d like to share the state’s optimism, we have had an incredibly hard time getting answers to some basic questions about the underlying assumptions that the state may have about future health care costs. Back on April 9, we requested documents from the Massachusetts Health Connector that discuss the financial […]

Are ACOs designed to care for grandparents also good for their grandkids?

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This op-ed ran in the Boston Business Journal Friday September 2, 2011. Boston’s Children’s Hospital was recently recognized as the nation’s top hospital for children by U.S. News and World Report. But what will Obamacare and Gov. Patrick’s “Phase II” state health reform, which move the health industry toward so-called accountable care organizations (ACOs) and alternative payment methods, have on world-class medical facilities like Children’s? An ACO is a network of doctors and hospitals that share responsibility for patient care. In theory, it’s like purchasing a car from a dealership; instead of buying each part yourself, an ACO brings together the different parts of patient care and ensures that the pieces work well together. Yet the reality isn’t so simple. […]

Does Your Doctor Know How Much That Costs?

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A local group  (run by a former classmate of mine) is accepting entries for an annual contest that highlights stories of medical costs gone wild. The group Costs of Care’s mission is that:  All doctors should understand how the decisions they make impact what patients pay. The prompts for the contest stress the importance of all stakeholders being more aware of the impact of decisions that we make in receiving our health care. Do you have a story about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost? How about a time you figured out a way to save money […]

Obama Admin Rethinking Massachusetts Model?

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The summer has led to little news from the Legislature and Governor Patrick on the health policy front. Which, on the first day of September, left me to wonder whatever happened to the temporarily extended Massachusetts MassHealth 1115 waiver? Simply put, this waiver from the federal government allowed the 2006 health reform to become a reality. The waiver was last renegotiated by the Patrick Administration in 2008, and was extended until June 30, 2011. Quietly this summer, that deadline was pushed back twice, and was set to expire yesterday. I have just learned that the waiver was extended for another 30 days. So I am left to ask–what is the issue(s) holding up a longer term renewal? In a summer […]

Governor, When is Excessiveness Excessive?

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The state senate is trying to decide whether to override the governor’s veto of provisions that were included in the state budget that …narrow the amount of time the insurance commissioner has to review [health insurance] rate-hike proposals to 30 days from 45 days. In addition, if the commissioner fails to make a judgment within 30 days, the proposed rate hikes would automatically take effect. These provisions were included in the budget in response to the Division of Insurance’s denial of 235 of 274 increases proposed by insurers for plans covering individuals and small businesses, last April. However, the madness of this debate from the Administration comes in the next paragraph of the State House News Services ($) story: Under […]

Wishful Thinking On Romneycare & Obamacare for Employers

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Over at the left-of-center blog The Incidental Economist, Austin Frakt has picked up the misplaced logic of those on the left to compare the experience of Massachusetts and extrapolate it to the national level, especially for employer behavior. Perhaps some wishful thinking. By pointing to recent state data on employer offer rates for insurance, it seems to prove that employers under a mandate system at least still offer insurance. But I am not sure offer rates are a good indicator of much, especially in a down economy. Weaker companies go under and push up the rate. Plus if you look at historical data, offer rates have always been higher in Massachusetts compared to most of the rest of the nation. […]

Massachusetts is 1st in the Nation on Health Care Cost!

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However, this gold medal is one we wish we could return. Kaiser Family Foundation released a report this week that documents the wide ranging differences in health insurance premiums across the country. Massachusetts led the pack with an average individual insurance premium topping $437 per person per month. This is almost double the national average. It should be noted that this report does acknowledge the many factors that lead to high insurance costs, such as  cost of living, patient cost-sharing, generosity of benefits, the base cost of care, age-based demographics, and cost control efforts. As a result, most of the Northeast is considered expensive. From a long term health policy perspective, the report will provide a baseline to measure changes […]

Do you feel safer in a hospital or on an airplane?

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The World Health Organization released a report recently that led with the headline that you are more likely to die from a medical error than from flying in an airplane. Reuters take on the report: While being treated at a hospital, there is a one in 10 chance a patient will experience a medical error and a one in 300 chance that a patient will die because of the error. Meanwhile, the risk of dying in an airplane crash is about one in 10 million… Each year in the United States, 1.7 million infections are acquired in hospital, leading to 100,000 deaths, a far higher rate than in Europe where 4.5 million infections cause 37,000 deaths, according to WHO. More […]

Feds Crapping Away Health $ and Increasing Deficit

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GAO (Government Accountability Office) will release a report today on the failings of the fraud and abuse system for Medicaid or Medicare. The study was requested by Massachusetts Senator Scott Brown (R) and Delaware Senator Thomas Carper (D). From the AP story this morning: The federal government’s systems for analyzing Medicare and Medicaid data for possible fraud are inadequate and underused, making it more difficult to detect the billions of dollars in fraudulent claims paid out each year, according to a report released Tuesday. The Government Accountability Office report said the systems don’t even include Medicaid data. Furthermore, 639 analysts were supposed to have been trained to use the system — yet only 41 have been so far, it said. […]

Vermont Single-Payer Plan Full of Holes

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The Blue Cross Blue Shield Foundation of Massachusetts held a forum in Boston recently on Vermont’s efforts to move towards single payer. A few takeaways. 1) Using the data and criteria cited at the forum,  every state should be moving towards a single payer system. Of course some on the left nod their head in agreement, to the rest of us, the logic seems flawed at best. For example, how does 7% uninsured in Vermont justify single payer? The national average is close to 17%. In addition, the architect of the plan Dr. Hsiao wrote recently in the New England Journal of Medicine. … Vermonters are also largely unwilling to reduce their level of benefits. Our analysis found that, on […]

Beacon Hill’s Budget MassHealth Mirage

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Today the Legislature will vote on the final state budget. I wanted to take one last opportunity to highlight the unrealistic assumptions that are being used for the MassHealth (Medicaid) program. If the state is unable to achieve these “savings” and instead follows historic spending trends, it could be looking at a $900 million gap, just for MassHealth. For years, Medicaid costs have advanced robustly, at roughly 7% per year which is a big number given that it’s building on a base of billions. See Pioneer’s work on this here. The Legislature is hoping for the state to drive down its per Medicaid enrollee costs by 3.5% next year. How have we done at that recently? On average, per enroll […]

HCFA & GBIO’s Misdiagnosis

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Health Care for All and the Greater Boston Interfaith Organization held a rally today at the State House to call for a zero percent increases in premiums for health insurance. The intent may be worthy, but the mechanism is misplaced. Focusing on a cap of premium increases is like trying to prevent all car accidents by adding an extra bumper at the end of a production line. (The analogy only goes so far, I know) Until consumers understand the cost impact of their health care decisions, and small businesses are relieved from the burden of state mandates and over regulation in Massachusetts, this cap will be an unrealistic goal that will result in one more year of finger pointing without […]

Misinformation About Massachusetts Reform from the Left

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Jonathan Cohn, Senior Editor of The New Republic tries to undercut the controversial McKinsey study on employer sponsored health insurance (esi) under Obamacare at Kaiser Health News. I wanted to take a moment to highlight one talking point that I have seen repeatedly in the media from the left to defend the federal law and bash the McKinsey study. …studies have consistently shown a very different result: that the majority of employers will continue to offer health insurance, even after health care reform… While these predictions could be wrong, obviously, their findings are consistent with what happened in Massachusetts, where a similar coverage scheme actually bolstered employer-sponsored insurance. (I added the link to DHCFP data here in MA) The problem with […]

Doc Gives Grim Diagnosis to “HCR II” in MA

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WBUR’s CommonHealth blog posted an interview with Dr. Wayne Glazier on payment reform that hits so many of the important issues on this complex topic. I have written on the Governor’s proposal a few times before and testified in front of the Joint Committee on Health Care Financing outlining some of my concerns. However, Dr. Glazier provides a front line perspective that many on Beacon Hill try to simplify in an effort to pass health care reform “phase II” quickly. 1) Global payments don’t get the patient involved in containing costs. The consumer needs to get involved. The current situation puts us in a very bad spot. My patient says ‘I want to go to UMass for my surgery,’ and […]

Mass Takes a Pass on HSAs

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America’s Health Insurance Plans (AHIP) released a report on the utilization of health savings accounts (HSAs) around the country. Massachusetts has lagged behind for years in the adoption of HSAs. One reason may be that only 43.1 percent of Massachusetts private-sector employers were enrolled in a plan with a deductible compared to 73.8 percent of employers nationally. Massachusetts residents enrolled in high deductible plans (often coupled with an HSA) account for only 2 percent of those with health insurance,  placing the Commonwealth with one of the lowest percentages of residents enrolled in these plans in the nation. The trade-off is two fold. One, these employees are receiving a pay cut as more money is spent on health insurance. Second, the […]

Beacon Hill’s Magical Mystery Medicaid Savings

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As the Senate and House work to reconcile their respective versions of the 2012 budget, I wanted to take one last opportunity to highlight the unrealistic assumptions that are being used for the MassHealth (Medicaid) program. If the state is unable to achieve these “savings” and instead follows historic spending trends, it could be looking at a $900 million gap. See graph here. A recently released report from The National Governors Association and the National Association of State Budget Officers “The Fiscal Survey of States” contrasts Massachusetts’s projections to the 49 other states and Puerto Rico. Annual Percentage Medicaid Growth Rate (p52) The average percentage Medicaid growth rate is 18.6 across the nation, Massachusetts will be 0.5%? First introduced in […]

MA Public Opinion of RomneyCare

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Kay Lazar had an interesting piece in The Boston Globe on a joint survey with Professor Bob Blendon of the Harvard School of Public Health on Massachusetts health care reform. I am sure it will be part of the narrative of the presidential race. Some general trends that they noted: Increasing support for repealing the mandate. Forty-four percent said they oppose the mandate in the Massachusetts law, compared with 35 percent who opposed it in a 2008 poll. Residents don’t see a connection between the law and increasing health care costs. Yet when asked about the law’s role in boosting health costs in Massachusetts, 72 percent said rising costs were mainly because of factors other than the law. Perhaps this […]

More Bad News for Governor’s Regulatory Regime for Payment Reform

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A Washington Post article today is sure to influence the debate in the beltway on reforming our health delivery system towards accountable care organizations (ACOs), one can only hope it will reach the leaders of the Commonwealth before they pass the Governor’s “phase II” payment reform legislation. ACOs are the skeleton that Governor Patrick is attempting to fuse his alternative payment methods with. ACOs are the hot concept in health policy circles, as the Obama Administration is rolling out new regulations to form ACOs for the Medicare population. Many experts believe that as the Medicare delivery system goes, so does the rest of the health care market. So the article brings to light many concerning devolpments that should influence the […]

Is Medicaid (MassHealth) Preventing the Poor from Breaking out of Addiction?

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Lawrence Harmon of The Boston Globe had a very interesting article that highlights the intersection of medicine and public policy. The issue was the debate whether MassHealth, our state’s Medicaid program, should move to pay for Suboxone versus methodone for opioid-addicted patients (for example heroin addicts). The article examines the growing medical evidence of the clinical effectiveness of Suboxone and the benefits versus commonly utilized methadone. I suggest you read the whole article for yourself to get the full medical discussion of the upsides of Suboxone versus methodone, but here are the sections I found most interesting on the public policy front: In 2007, MassHealth paid $325 million to treat 18,000 low-income addicts with either methadone or Suboxone, according to […]

Gov. Patrick’s Regulatory Regime for Payment Reform

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This was the testimony I submitted today to the Joint Committee on Health Care Financing for the hearing on the Governor’s proposal to reform the payment methods we use in health care and to change the delivery system. Thank you to Chairman Moore and Chairman Walsh and to the Committee members for the opportunity to speak with you today. My name is Josh Archambault, Director of Health Care Policy at Pioneer Institute. The issue before the Committee today—the Governor’s proposal to change the payment methodologies for the delivery of health care—would as currently written set up a framework for momentous regulatory intervention in the health care marketplace, and possible significant adverse impacts on health care access and spending in the […]

Maine Moving on Health Care

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An interesting experiment is about to be unleashed in one of our neighbors to the north–Maine. The newly Republican controlled House and Senate are moving quickly (too quickly for some) to strip away state regulations and mandates that were put in place over the past two decades and open up the individual and small group insurance market to more competition. The bill, among many things, will allow individuals to purchase insurance from companies licensed in other states (including Massachusetts.) And it will permit the price differential that insurers can charge sicker residents when compared to healthier residents to grow. Maine currently only allows a very narrow ratio of 1.5 to 1. The current law translates into healthier (mostly younger) folks […]

Massachusetts Medicaid “Savings” in Trouble?

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The New York Times reports In a new effort to increase access to health care for poor people, the Obama administration is proposing a rule that would make it much more difficult for states to cut Medicaid payments to doctors and hospitals. I wonder if this will impact Governor Patrick and the Legislature’s reduction in reimbursement levels included in the FY 12 budget? If yes, there goes another chunk of the $1 billion in projected “savings”–making the near-impossible prediction of reducing per enrollee spending by 3.5% this year all that more improbable. See Poftak’s Do You Believe in Medicaid Miracles? This is also an interesting move from the Obama Administration as the Secretary of HHS recently advised states to use […]

Connector Saving Taxpayer Money

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On this blog– and in the press– I have often been critical of the policy choices of the Connector and its governing Board. However, credit is due to the staff at the Connector for the latest round of negotiations with CommCare’s managed care organizations, in which $80 million of taxpayer money was saved.  With a projected 11% membership growth this coming year, any savings is welcome in a program with subsidies of roughly $840 million. As Executive Director Glen Shor said in his monthly update e-mail, this will mean that CommCare “members will not have to face the prospect of benefit reductions…”– good news in a tight budget year.

Harvard’s Effort to Make Cities Matter

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Harvard’s Advanced Leadership Initiative has recently launched an interesting academic exercise of a virtual think tank at the Harvard Business Review website HBR.org on the topic of revitalizing cities. The series of thought pieces serve as the appetizers for an upcoming multi-day conference feast at Harvard Law School on the same topic. Thursday, April 28-Saturday, April 30. Globally, 2008 marked the first time that a majority of citizens would reside in cities. Locally, the most recent census data showed significant growth in many smaller cities in Massachusetts. While large cities like Boston garner significant attention and resources as they adapt to population growth, the new growth in these smaller cities is more significant since they often have fewer resources to […]

Pioneer Goes Local! “MuniShare” Municipal Report Contest

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As part of Pioneer Institute’s annual Better Government Competition, Pioneer is offering two $3,000 awards for the best municipal reports. No daunting application and little effort!  Entering is as simple as submitting a report by e-mail, with a brief (150-word) summary. What Kind of Reports? We are interested in public opinion surveys, departmental studies, environmental audits, and really, any type of report. The only requirement is that the report tackle an issue that fellow municipal governments might face as well. The reports can focus on department-specific or municipality-wide issues, and can be up to ten years old. There is no minimum or maximum length and no limit to the number of entries from a municipality. The more, the better! Selection Process: A panel of judges with vast experience […]

Lessons from Massachusetts Health Care Reform (Romneycare)

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Last month marked the first anniversary of the federal healthcare law; this week the fifth anniversary of Massachusetts’ own health reform. President Obama likes to tout the federal effort as paralleling the Massachusetts’ reform, but the fact is that Obamacare has created a lot of uncertainty for states across the country, including Massachusetts. For example, will Massachusetts now have two individual mandate penalties? Will we shift close to 100,000 individuals from the new healthcare exchange to Medicaid? What are the implications of the federal law for the cost picture in already expensive Massachusetts? Obamacare is of little benefit to Massachusetts beyond pouring billions more dollars into the Massachusetts healthcare industry, which is likely to push the cost of care even […]