Entries by Scott Haller

Status of Healthcare Price Transparency across the United States

At a time when the coronavirus pandemic has caused massive shifts in state policies on telehealth and scope of practice in healthcare, a new Pioneer Institute study underscores that most of the 50 states continue to suffer from weak laws regarding price transparency.  The study identified states that have laws that require carriers, providers or both to provide personalized cost information to consumers before obtaining healthcare services.

Massachusetts Hospitals Score Poorly on Price Transparency…Again

Eighteen months after an initial survey of prices at hospitals in Massachusetts, Pioneer Institute conducted a follow-up survey of all but one of the hospitals from the first survey to see if there had been any change in the performance of these institutions since their last assessment. Initial survey calls were conducted between September 20th and November 2nd, 2016.

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; […]

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 […]

Transparency in Retail Drug Prices: Easy to Obtain but Accuracy May Be Doubtful

This paper is the fourth in a series on price transparency in the healthcare industry, and the first Pioneer report to focus on the retail price of prescription medications. Researchers called 44 retail drug stores across the state asking for the price of a 30-day supply of each drug in a common dosage. In each case the callers said they were self-pay and pressed the drug store for information about discounts.

Will All-Electronic Tolling Save Money?

This blog explores the State’s switch to an all-electronic tolling system from a financial perspective. For a more general review of the changes to come please see our full report.   Before gantries for all electronic tolling began to appear on the Turnpike, state officials underscored numerous projected benefits associated with the change, including a reduction in accidents and emissions, lessened congestion, and, notably, a sizable reduction in operating costs. Now that the new system is set to become fully operational, some of these claims are coming under closer scrutiny. In 2013, before the Tobin Bridge pilot program began, the state claimed that the new system would save $50 million annually in operating costs. It is worth noting that such […]

A Change in Toll Collection

For more information on Massachusetts’ new tolling system, read the full report.   Starting this fall, the Massachusetts Turnpike will become an open-toll road, meaning drivers will not have to stop or slow down to pay. Sensor arrays distributed along the length of the Turnpike will either read the driver’s E-ZPass transponder, automatically charging their tolling balance, or a picture of the driver’s license plate will be used to send out monthly bills in the Pay-by-Plate (PBP) system. The state maintains that the primary advantage of an all-electronic tolling system (AETS) is driver safety, emissions and congestion reduction, and general customer convenience. If implemented correctly, switching to an AETS will also save the state millions of dollars. Under the new system, […]

What to expect with all-electronic tolling

This blog is a summary of the changes an all-electronic tolling system will bring to the state. For a more in-depth look at this topic, please read the full length report, Driving Innovation: Tolling and Transponders in Massachusetts. This fall the Massachusetts Turnpike will transition to an all-electronic tolling system (AETS), meaning drivers will not have to stop or slow down to pay tolls. Massachusetts Department of Transportation (MassDOT) officials say that an AETS will yield cost savings, reduce accidents and pollution, and save drivers time. Toll booths along the Turnpike will be removed, and new gantries (under construction for the last few months) equipped with sensors and cameras will take over from toll-takers. All drivers will remain at normal driving […]

Fare Collection on the T is Unfair

A recent disclosure by the MBTA reveals that the agency forgoes an estimated $35 million annually in ticket revenue due to poor fare collection practices on the commuter rail system alone. When the bus system and green line are included, this number inflates as high as $42 million. Yes, this is the same cash-strapped agency that couldn’t wait to shut the doors on the costly late-night service, a program which cost $14.4 million a year while providing services to 13,000 riders a night. Yes, this is the same transportation system that recently saw fit to raise fares an average of 9 percent to help fill a massive revenue gap. And yes, this is under the “no-excuses” contract in which Keolis, […]

MBTA Transparency Is Now ‘Back on Track’

Today, the MBTA released its long-anticipated performance dashboard, bringing with it a sleek and interactive new website full of data metrics and detailed explanations of the data. Highlights and new features of the appropriately named mbtabackontrack.com include but are not limited to access to performance data from the prior day, ability to put data into historical context, info on the Green Line and every bus route, and ridership and financial statistics. The website promises to be a valuable tool, and it will regularly expose parts of the T’s performance for the first time in over a year. For example, the T this fiscal year has spent $259.86 million on debt service, just under a quarter of its total outlays. Also, […]

MBTA commuter rail should release on-time data from every station every day

As Pioneer has pointed out numerous times in the past, the MBTA has a habit of putting a positive public-relations spin on its shaky on-time performance record.  A Fox 25 investigative report takes the MBTA to task for massaging on-time data and keeping the public in the dark about its real record.  The report validates Pioneer’s ongoing concerns about the lack of transparency at the T, and furthers the call for increased accountability. After more than five years employing an easily-accessible, data-rich reporting scheme, albeit with summary rather than detailed data, the T has spent the last year crafting a new barebones successor. Although the T claimed in September that the new reports are still a ‘work in progress,’ there […]

Healthcare Prices for Common Procedures Are Hard for Consumers to Obtain Survey finds hospitals not prepared to give price information to consumers

This policy brief is the third in a series of reports on healthcare price transparency prepared by Pioneer Institute. Researchers surveyed six major metropolitan areas and spoke with 54 acute care hospitals across those regions: Des Moines, IA, Raleigh-Durham, NC, Orlando, FL, Dallas-Ft. Worth, TX, New York, NY and Los Angeles, CA asking for the price of an MRI of the left knee without contrast. In addition, they explored the existence of federal and state laws that might apply in the states where the hospitals surveyed are located. They also examined the websites of the 54 hospitals for price information. The results of this survey are described in this policy brief.

MBTA Management Discussions: Where Did They Go?

The government works for the people. As with any employee, the employer (citizens of Massachusetts) would prefer that the employee admit its errors or problems outright, instead of trying to cover up the tracks. Apparently, the MBTA needed this principle explained in greater detail. The T’s independent auditor, KPMG, recently said that the T has failed to include a critical part of its financial statements, the management discussion and analysis. This section is meant to cut through the numbers and accounting lingo to provide a layman’s understanding of the state of the agency’s financial situation. Starting in 2002, the T began including this section in its financial statements to comply with new standards set by the Governmental Accounting Standards Board […]

MBTA Performance Transparency: A Whole New Meaning to Deferred Maintenance

Governments need to adapt to the evolving needs of constituents, and in modern times, this increasingly becomes a matter of embracing technology. Examples of such progress include the ParkBoston App, eliminating the need for runs to feed the meter, and the cashless tolling system which is destined to relieve at least some of the Pike’s toll booth logjams. These uses of technology clearly improve basic government functions for the sake of consumers. Technology also eases government transparency efforts. Instead of manually copying hundreds of pages, an information request can be fulfilled by email. Technology has also increased the amount of data that governments have available. In this information age, thousands of data points are collected about healthcare, welfare, utilities, traffic, […]

Document Request Reveals Which Commuter Rail Trains Are Frequently Delayed

There is a unique relationship between the MBTA and its riders founded on a trust we give the authority in return for reliable transportation services. This is especially true for commuter rail passengers who pay more, expect more, and invest more in their commuting plans; whether it’s planning on dropping the kids off at school, bringing them to practice, or making it home in time to cook dinner, these riders have a lot more at stake if the trains are running slow. Lately this relationship has become strained, catalyzed most recently by last winter’s poor performance. From a 2009 peak of about 40 million riders, the commuter rail’s annual ridership dropped to approximately 35 million in 2013 despite adding service […]

MBTA Scorecards: A Work in (Backwards) Progress?

Three weeks ago the MBTA announced the long-awaited return of comprehensive performance reports. These ‘weekly’ scorecards include on-time performance data for both the commuter rail and the T’s subway system, the first regularly posted data regarding the subway since 2014. The MBTA has expressed that these reports are a work-in-progress and that they will be bolstered in quality and scope over time. Regaining the public’s trust is a critical part of the MBTA’s mission following disastrous winter performance, and while the new scorecards are a step in the right direction, Pioneer has already noted various ways that they could be improved. It seems that there is another way to improve the reports: Actually post them! As a constant watchdog of […]

New MBTA Performance Reports: Work In Progress

This week, the MBTA began publishing new weekly performance reports which provide daily summaries of on-time performance for all subway lines (except the Green line), buses, and commuter rail lines. The reduction in quality compared to previous performance reports raises questions following terrible winter performance and the resulting diminished public confidence. The MBTA used to publish monthly performance reports for all modes of transit including data on vehicle availability, distances traveled between breakdowns, on-time performance and more. The reports also included a summary page at the beginning describing ridership changes, and an addendum explaining the performance measures. The new reports contain only on-time performance data. (Examples of the previous scorecard layout for commuter rail and subway lines) The last report […]

T Has Failed to Hold Keolis to Commuter Rail Operating Contract

Over two-dozen rail operators initially expressed interest in the MBTA’s commuter rail contract, but only the incumbent, Massachusetts Bay Commuter Railroad Company (MBCR), and a French newcomer, Keolis Commuter Services, submitted final bids. Keolis ended up winning the contract for at least the next 8 years with a $2.68 billion bid, making it the largest transit contract in the history of the Commonwealth and the most expensive rail operating contract in the country. Many saw this agreement as a turning point for the beleaguered commuter rail system. MBCR had been in charge for more than a decade, and long-standing criticisms of an absence of meaningful performance incentives were purportedly cured in the “no-excuses” contract. Under the new contract, each late […]

There’s No Excuse for a ‘No-Excuses’ Contract With Excuses

Despite a “no-excuses” contract with Keolis Commuter Services for the commuter rail system, the MBTA has dropped the target on-time performance rate to 92% from its historical level of 95%. As Pioneer has shown before, this is a step in the wrong direction for the T. On-time performance is the most important metric for determining a commuter rail system’s performance and reliability; high marks improve rider confidence and can boost ridership. The MBTA’s contract with Keolis indicates that 92% on-time performance is the remedial performance level, i.e. the lowest acceptable value. In fact, achieving on-time performance levels below the remedial performance level for two consecutive months, or for three months within a twelve month period, is grounds to terminate the […]

Proving the Viability of a School Choice Voucher

In “Proving the Viability of a School Choice Voucher,” author Scott Haller surveyed 107 religiously affiliated private schools across Massachusetts including Catholic, Jewish, Adventist, Baptist, Islamic and Episcopal schools. The report found that an annual voucher of between $6,000 and $8,000 would be sufficient to provide low-income students access to an education in the majority of religiously affiliated Massachusetts K-12 schools. 

Guest Opinion: Reinstate the SNAP work requirement

Massachusetts, once a national leader in welfare reform, needs to reinvigorate its commitment to helping recipients succeed in the workforce. A good first step would be for Governor Charlie Baker to instruct the Department of Transitional Assistance (DTA) to reinstate the work component of the Supplemental Nutrition Assistance Program (SNAP), formerly known as the food stamp program. Under federal rules, SNAP recipients between 18 and 50 without dependent children can get benefits for only three months within a three-year period if they do not work or participate in a workfare or employment and training program. With some exceptions, able-bodied adults between 16 and 60 must register for work, accept suitable employment, and take part in an employment and training program […]

Getting Tough on Keolis?

You rush to feed your kids breakfast; leave your house so fast you forget your lunch; arrive breathless at the train station, right on time and sweating through your clothes. Each minute matters when you’re a commuter rail rider. Bet when you get there there’s no train in sight and no alert from the T. Sound familiar? Even with the never-ending blizzard of 2015 finally in the rear-view mirror, commuter rail riders are still experiencing what have become standard yet inexcusable delays. Two weeks ago, evening commute performance scored just 82 percent. It was 85 percent the week before and only 83 the week before that. Pioneer Institute has been a consistent watchdog of Keolis’ performance since they took the […]