The Merit Rating Board: Review and Recommendations

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Significant administrative failings involving the Registry of Motor Vehicles have drawn attention to an entity called the Merit Rating Board (MRB or the Board). MRB’s administrative personnel and processes have been the subject of sharp criticism, and also extensive ongoing reform efforts. This policy brief reviews the relevant circumstances, and makes recommendations for consideration by MRB and other government personnel as they move forward.

MassHealth Protecting Medicaid Resources for the Most Vulnerable

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This report finds that Massachusetts' enhanced eligibility verification has allowed MassHealth, the Commonwealth’s Medicaid program, to save significant resources that could be redirected to the care of truly needy Medicaid recipients.

What Massachusetts Should Do in an Uncertain Healthcare World

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Regardless of what happens in the debate over repealing and replacing the ACA in D.C., Massachusetts has to tackle health care costs intelligently. We need to do more than provide insurance; we need to increase access to care. That means thinking seriously about the role of private market insurers, insurance regulations and the regulation of medical providers.

Counter Point What Massachusetts Should Do As Uncertainty Engulfs US Healthcare System

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Regardless of what takes place at a national level, Massachusetts has its own set of challenges to continue pursuing the state’s commitment to universal coverage at affordable prices. This report offers a ten-point program that the state should vigorously focus on in the days ahead.

Combating Opioid Addiction in Massachusetts: A Hospital-Based Solution Shows Promise in Reducing Relapses and ER Costs

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Preliminary results suggest that a new program that gives opioid overdose patients at Beth Israel Deaconess Hospital-Plymouth (BID-Plymouth) multiple opportunities to access detox programs, psychological counseling, anti-abuse drugs and other services is proving effective at reducing recidivism and returning opioid users to more productive lives.

Whistleblowers Expose the Massachusetts Connector

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State officials knew that development of a federal Affordable Care Act (ACA) website was off track for more than a year before the October 1, 2013 launch date.  Instead of raising concerns about the project, they misled the public by minimizing the shortcomings of the contractor hired to build the website, asked state workers to approve shoddy work and appear to have covered up the project’s abysmal progress in a presentation to federal officials.

Baker's Dozen A Common Sense Healthcare Agenda for the Next Governor

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Healthcare must remain a top policy priority for the next administration. It consumes nearly half of the state budget, has been a "pac-man" eating up resources for every other public policy priority, and has been an important driver of legislative discussions around tax increase proposals. The current path is unsustainable.

Out of the Filing Cabinet and Into the Fire: How the Shift from Paper to Electronic Health Records Has Endangered Patient Privacy and Security and How to Calm the Flame

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This paper will discuss the importance of secure medical records in health information exchanges (HIEs), the general history of EHRs in the US and in Massachusetts particularly, the history of privacy rights in the medical field, and finally efforts being taken to ensure more protected and private EHRs.

A First Step Toward Retiree Healthcare Reform, But Much More is Needed

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A First Step Toward Retiree Healthcare Reform, But Much More is Needed was provided in October 2013.

Consumer Driven Health Care: A New Agenda for Cost Control in Massachusetts

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This paper provides a discussion of CDHC, what it is and how it can help constrain health care costs and increase patient engagement in Massachusetts. While supply-side approaches are also necessary for cost control, without engaged consumers, Massachusetts may find that it cannot accomplish its cost-containment goals as quickly or as successfully as desired.

Innovative Medical Liability Reform

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This paper describes Massachusetts' existing medical liability system, including how it has failed to achieve its social objectives, the impact of the system on health care costs, and recent efforts towards reform. It presents policy options for medical liability reform. It examines both traditional and nontraditional avenues of reform along with strategies for advancing medical liability reform in Massachusetts.

Business Solutions to the Health Care Crunch

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While larger employers have engaged their employees in wellness initiatives and consumer-driven approaches, small employers have often lagged behind. Small businesses can, however, adopt these health benefit approaches to address their own rising health care costs.

Fixing the Massachusetts Health Exchange

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The importance of this work is especially clear as the Patient Protection and Affordable Care Act of 2010 (ACA) requires a health benefit exchange to be operating in every state by 2014. The question of the Connector's effectiveness is of critical importance to other states as they try to plan and design what an exchange will look like in their own state' For Massachusetts, the ACA provides both opportunities and challenges moving forward.

An Interim Report Card on Massachusetts Health Care Reform: Part 4

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This report is the final report in a series of four. Earlier reports in this series evaluated access to health insurance and health care, equitable and sustainable financing, and administrative efficiency. The focus of this report will be on cost-effective quality, and the analysis will be organized by the four "Scorecard Metric,' presented in Figure 1. 

An Interim Report Card on Massachusetts Health Care Reform: Part 3

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This report is the third in a series of four. The focus of this report is on administrative efficiency.

An Interim Report Card on Massachusetts Health Care Reform: Part 2

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As an alternative to analyzing the reform’s impact on isolated issues, in January 2009 the Pioneer Institute proposed a framework for evaluating the reform.

An Interim Report Card on Massachusetts Health Care Reform: Part 1

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The focus of this report is on the reduction of barriers to access.

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.

Fixing Maintenance in Massachusetts

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The horrifying spectacle of the Minnesota bridge collapse has prompted a national reevaluation of the condition of our public infrastructure. In Massachusetts, two recent reports have found a multi-billion dollar backlog of deferred maintenance.

The Estuaries Project

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The Massachusetts Estuaries Project, through the University of Massachusetts-Dartmouth School of Marine Science and Technology (SMAST), supports the Massachusetts Department of Environmental Protection (DEP) in the development and implementation of policies to protect nitrogen-sensitive coastal embayments. The Project collects data and develops models to manage and restore the 89 embayment systems that comprise the coastline of southeastern Massachusetts. The Project encompasses new technologies, regulatory approaches and funding mechanisms to reduce the costs of conducting estuarine restoration.

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.

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.