THE PIONEER BLOG

Joshua Archambault

What can Oklahoma Teach Massachusetts on Healthcare?

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More patients and companies are moving away from traditional healthcare; this video of the Oklahoma Surgery Center explains why.

Tom Nash

Inefficiency at Wellesley Schools stifles transparency

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Sometimes the smaller the bureaucracy gets, the more inefficient or unwilling it is to provide basic data that would help show how well it’s fulfilling its responsibilities. The Wellesley Public School System is one example that Freedom of Information website MuckRock has encountered in its ongoing work to make public entities comply with the commonwealth’s public records laws. MuckRock, in partnership with the Pioneer Institute, filed several requests for Individualized Education Plan (IEP) data across Massachusetts. We were looking for basic enrollment information, including: – The number of students evaluated by the district to determine if they qualified for an IEP – The number of students who qualified for an IEP based on that evaluation – The number of students […]

Joshua Archambault

Can Mass ACOs & ICOs Co-Exist? Wait…What is an ICO?

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For those keeping track at home, ACO is the acronym for an accountable care organizations. Under the new growth capping law Chapter 224 passed in July of 2012 here in Massachusetts, they are given strong contractual preference to deliver care for all state programs, and for those in the non and small group markets. They also were part of the ACA at the federal level. In fact, five provider systems in Massachusetts have been federally registered as an ACO. In the new Massachusetts Medicaid “duals” pilot program, for 110,000 individuals on both Medicare and Medicaid, the state recently selected six insurer-centric ICO ” integrated care organizations” to deliver the care. So one is prone to ask: Will these two parallel […]

Joshua Archambault

9 States to Watch for ACA Implementation

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Healthcare reporters have been in a frenzy to report this week that the ACA is a done deal and states should get on with it. The election certainly changes the dynamic in the repeal effort, as Speaker John Boehner indicated in a recent interview with ABC News, yet the implementation battle is far from over. The next interesting story line is developing out of an OK lawsuit pertaining to the legality of subsidies being made available in the federal exchange. To be more specific, it challenges an IRS rule that imposes ACA employer mandate where the statute does not appear to authorize it. If this case were to prevail, it would undermine the “fallback” federal exchange that is going to […]

Jim Stergios

Don’t Count Your Chickens Before Elections: Tony Bennett’s Defeat in Indiana

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In what you might call a “count your chickens before they hatch” moment, even as late as the morning of Super Tuesday (November 6, 2012, 7:16:15AM EST) Virginia Edwards of EdWeek’s “Leadership Forum” sent an email invitation entitled “Save the Date: Road Maps to Common Core Success in March 2013.” I invite you to attend Road Maps to Common Core Success. This Education Week Leadership Forum is taking place in Indianapolis, IN on March 11, 2013 and in White Plains, NY on March 21, 2013. At this day-long event, you will hear from state and district leaders, education experts in, and other colleagues on their common core implementations, and discover and share new ideas on curricula, teacher training, and assessment. […]

Jim Stergios

Fallout from election 2012 on education

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  You can summarize the fallout of the elections on schools in three simple outcomes: No change in federal policy, two big state charter expansions got passed–and through ballot initiatives (!), and in a blow to supporters of national standards and tests the state superintendent of schools in Indiana got shown the door. In more detail, on federal policy: 1. Arne Duncan stays US Secretary of Education. 2. The next four years will look like the last three years. That is, the first Obama administration was split between a Year 1 and Years 2-4. Year 1 was all using the bully pulpit to get state legislatures to revamp charter laws. It was a sea-change on the education landscape, with the […]

Jim Stergios

Indiana’s airball on national education standards

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  Basketball fans will remember the scene from the epic 1986 Gene Hackman movie, Hoosiers , where Coach Norman Dale (Hackman) is taking his small-town high school team, Hickory, on the road to the Indiana state championships. As they peer into their opponent’s massive gymnasium, his players grow understandably nervous. Taking out a measuring tape, Coach Dale has them measure the distance to the free throw line and size up the height of the rim, and says: “I think you’ll find it’s the exact same measurements as our gym back in Hickory.” I’ve often thought about that scene when interacting with Indiana’s State Superintendent of Public Instruction Tony Bennett, himself a basketball coach, which is clear to anybody who meets […]

Jim Stergios

Why is the state not implementing the MCAS for U.S. history?

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We are in the middle of a U.S. Senate campaign and, while passions may run high on both sides of the partisan divide, what is a young Massachusetts student to think of the race? Given his or her ignorance of the role of a senator, whether in Massachusetts state government or at the federal level, the fact is he or she is unlikely to think beyond the partisan commentary that populates television and the internet. That is a shame and sadly ironic in Massachusetts where state Senate leadership was the driving force, behind the landmark 1993 Education Reform Act (MERA), which has brought many benefits to our students and to the state. In 1993, as former Senate President Tom Birmingham […]

Joshua Archambault

Responding to Cadillac Tax Report Concerns

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Pioneer’s recent report on the Cadillac tax has garnered a good deal of media attention and some political push back. Political pushback comes in the form of objections that fail to engage on the issue of the Cadillac tax itself; rather they focus on two assumptions made in the Pioneer study: 1) Healthcare growth rates in the future will look similar to the recent past, and 2) Income growth rates in the future will look similar to the recent past. Of course, we have no more of a crystal ball than anyone else does, however… As is our practice, we made our assumptions very clear, right up front. And second, we based our assumptions on data. Pioneer is an empirical […]

Joshua Archambault

Big ACA Middle-Class Tax Increase in Mass, $87K for Small Biz Employee

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Pioneer is releasing a new brief estimating the impact of the so-called “Cadillac tax,” targeted at high cost insurance plans, contained in Obamacare. The report finds that given our high premiums, a majority of workers in Massachusetts will pay the tax in 2018. On a more micro level, the report examines the impact of the excise tax on a small business employee, a police officer, and a teacher. The future looks expensive! For the 10 years following the introduction of the tax: Business employee on a family plan will owe $86,905 in additional taxes. Police officer on a family plan will owe $53,907 in additional taxes. Teacher on an individual plan will owe $20,807 in additional taxes. Remember this is all on top of paying […]

Joshua Archambault

Case Study-When Politics Influences Policy: Liberal Health Wonks from Mass

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This afternoon FamiliesUSA released a report from a trifecta of liberal health policy wonks– Jon Gruber, Stuart Altman and John McDonough. I joined the press call to listen to the discussion. Just to say upfront, I know all of these authors and consider them friends or good acquaintances. However, as you will see below we don’t always see eye-to-eye. The goal of the new report was to compare RomneryCare vs ObamaCare vs RomneyCandidateCare. Not surprisingly, Obamacare comes out smelling like roses, and RomneyCandidateCare will push Americans into the deep uninsured abyss. Avik Roy over at Forbes.com rightfully takes issue with a number of assumptions being made in the modeling of Governor Romney’s plan for the nation. One in particular is […]

Joshua Archambault

If Doctors Know the Price, Would It Change Behavior? Essay Contest

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The great folks over at Costs of Care have opened their 2012 essay contest to collect stories (the good, the bad, and the ugly) from both patients and  medical professionals as they wrestle with healthcare costs.  The full details: Essay Question: 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 while still receiving high-value care? Judges Pauline Chen, surgeon, New York Times columnist Jeffrey Drazen, editor-in-chief, New England Journal of Medicine Donna Shalala, former United States Secretary of Health and Human Services Ezekiel Emanuel, ethicist and […]

Joshua Archambault

NYT: Medicare Bills Rise as Records Turn Electronic

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The theory of cost savings don’t always match what happens in reality: When the federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records, the goal was not only to improve efficiency and patient safety, but also to reduce health care costs. But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care. Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier… A future unintended consequence of […]

Joshua Archambault

Does Health IT Guarantee Better Care & Save Money?

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Given the near universal HIT mandate in Chapter 224 of the Acts of 2012 in Massachusetts, research on the effectiveness of the policy mechanisms in the bill should draw close interest. A WSJ op-ed this morning tackles the HIT question. SEPTEMBER 17, 2012 A MAJOR GLITCH FOR DIGITIZED HEALTH-CARE RECORDS Savings promised by the government and vendors of information technology are little more than hype. By Stephen Soumerai and Ross Koppel In two years, hundreds of thousands of American physicians and thousands of hospitals that fail to buy and install costly health-care information technologies—such as digital records for prescriptions and patient histories—will face penalties through reduced Medicare and Medicaid payments. At the same time, the government expects to pay out tens of billions of […]

Jim Stergios

Huck, Jim and our interest in education

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Twain famously noted that the difference between the right word and the almost-right word is the difference between the lightning and the lightning-bug. Getting words right is arguable the key task in educating an individual, for precise use of language is critical to developing the ability to observe and to think. Then there is the sinister twisting of language for reasons of power (most often political power). This was a topic of intense focus by George Orwell, who in his staple of 9th grade reading courses, Animal Farm, described how the vision of Old Major was transformed to the darker purpose of other animals after his death. In the novella, the animals rebel against the drunken farmer Mr. Jones for […]