Drawing Lessons: Different Results from State Health Insurance Exchanges

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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.

Health Insurance Cost Control

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The combined use of limited, or selective, provider networks and a defined contribution strategy presents an immediate opportunity for government entities and employer groups to achieve significant and sustainable health insurance savings and reduce medical cost trends, while maintaining coverage levels and quality of care. This solution illustrates the impact of changes in consumer behavior that occur as a result of economic conditions and opportunities.

A National Market for Individual Health Insurance

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Health insurance markets are regulated by the states under the McCarran-Ferguson Act (15 U.S.C. 1011) of 1945. The 'purpose clause' of the Act states that regulation and taxation of the business of insurance by the states is in the public interest. As a result of McCarran-Ferguson, every health insurer must be licensed in the policyholder's state of residence. The states have responded with a complex patchwork of mandates and laws that vary widely across the country.

Massachusetts Healthcare Reform: A Framework for Evaluation

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Passed in 2006, the Massachusetts healthcare reform bill represents an innovative approach to healthcare reform in the United States. The bill (Chapter 58 of the Massachusetts Laws of 2006) has four main goals: to use an individual mandate to expand access to near universal levels; to establish guidelines for employers' fair share' contribution and involvement; to reorganize insurance markets and manage the distribution and subsidization of several insurance plans through the new Massachusetts "Connector"; and to establish transparency that will aid in understanding and assessing the bill's cost and quality of care.

GIC Consolidation

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The Middle Cities Initiative seeks to help the Commonwealth's older cities, which face economic, demographic, and political challenges. These challenges cover a wide range of issues—entrenched political cultures, significant infrastructure costs, underperforming schools, struggling retail and manufacturing sectors, crime, and poorly targeted state programs. The Initiative's goal is to develop and disseminate concrete policies to help the Middle Cities grow.

Wellness Health Incentive Payment Program

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Sustainable healthcare should always involve an accountable partnership between the payor and the third party insurance administrator. The Wellness Health Incentive Payment (WHIP) Program facilitates better health/wellness outcomes by holding health insurance vendors fiscally responsible for health and wellness activity. The WHIP rewards or penalizes health insurance administrative vendors according to the vendor's wellness activity performance against nationally recognized health and wellness standards.

The Clinical Performance Improvement Initiative

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The Massachusetts Group Insurance Commission (GIC) has embarked on a groundbreaking plan to control costs, improve healthcare quality, and promote cost-efficiency. Labeled the Clinical Performance Improvement (CPI) Initiative, this multi-year effort has the potential to save the Commonwealth and its enrollees tens of millions of dollars, while improving the quality of care.

The Elephant in the Room: Unfunded Public Employee Health Care Benefits and GASB 45 Public Employee Benefits Series: Part 3

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This paper will review Statement 45’s potential impact on governments and review existing disclosures in financial reports as well as bond offering statements. The paper will discuss the Statement’s impact on budgets and governmental operations, including collective bargaining. Funding options under Statement 45 will be detailed, including the advantages and disadvantages of irrevocable trusts and OPEB bonds.

Comparing the Clinical Quality and Cost of Secondary Care in Academic Health Centers and in Community Hospitals

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This study analyzes data from hospitals in six states, including Massachusetts, to compare the cost and quality of secondary care for under-65, privately insured patients in Academic Health Centers (AHCs) and non-AHC or community hospitals.

Rationalizing Health and Human Services

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Over the course of the past decade, thousands of organizations have used business process redesign and information technology to get to know their customers well, and they have used that information to do a better job of meeting their customers’ needs. Five years ago, anyone who had a checking account, a mortgage, an auto loan, and a credit card with the same financial institution might as well have been dealing with four different companies. Today, more often than not, that individual gets one statement each month that consolidates his or her entire relationship with that financial institution. The bank knows the extent of its relationship with each customer, and its customers can manage their accounts and loans in a unified, coordinated manner.

An Economic History of Health Care in Massachusetts 1990-2000

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This paper traces the economic history of the health care system in Massachusetts from the early 1900s to the present and offers a series of recommendations that would bring to Massachusetts the advantages of a more market-based system.

Nonprofit to For Profit Conversions in Health Care: A Review

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The analysis presented in the paper suggests areas in which caution must be exercised to assure that community benefits provided by nonprofits are preserved in a post-conversion environment, and that full value is realized and appropriately redirected. Nothing in the analysis indicates that nonprofit to for-profit conversion should be barred from consideration in Massachusetts.