Posts Tagged ‘kevin schwartz’

Massachusetts 2006 Universal Health Care Bill Cited as National Model

Wednesday, December 29th, 2010

By Kevin Schwartz

Massachusetts has been cited as a model for the nation health care reform with its 2006 bill mandating health insurance for all.

The initial intention of the bill has been realized – 98 percent of state residents are now covered. But experts say exploding medical costs are driving up insurance rates, threatening not only the gains in coverage, but the state’s economic welfare as well.

Insurance premiums are taking a bigger bite out of individual, state and municipal budgets. From 2001 to 2009, the median monthly premium for individual insurance plans rose from $251 to $442. A recent study by the Boston Foundation found health care costs for school districts have grown faster than state spending on education. From 2000-2007 health care costs in school budgets increased by $1 billion, while state aid increased by $700,000.

Cutting those costs will be a priority in the next legislative season on Beacon Hill. What may be decided could bring large-scale changes to the way patients are cared for and how doctors and hospitals are paid.

The Legislature began addressing the issue in 2008 when it created a special commission to study alternative payment models and asked the attorney general’s office to produce a report on health care cost trends.

The findings of these studies and the actions of the Legislature could keep Massachusetts in the forefront of national debate on health care. New initiatives here could influence how the rest of the country deals with the issue.

The following is a primer on two of the major ideas for addressing the problem.

IDEA: Global Payment System

The Problem

The majority of health insurance plans use the fee-for-service model, which compensates providers for individual treatments such as doctor’s visits and CT scans.  The Special Commission on the Health Care Payment System found that the model’s high-profit margins provide financial incentives for unnecessary treatments and procedures.

The Proposal

Global payment systems pay providers a pre-determined sum for each patient’s medical costs, placing responsibility on doctors and hospitals to stay within the budget.  Insurers assess an individuals’ potential health risk, and supplement that payment with rewards for quality care.

The commission recommends the development of Accountable Care Organizations that would coordinate patient care and be responsible for staying within the budget.  ACO models will differ, but each organization of hospitals, physicians, and other non-clinician providers will be accountable for all or most of a patient’s care.

There is evidence such a plan would work. Prof. Gerard Anderson of Johns Hopkins University conducted a study of Medicare programs that found global payment systems reduced re-admissions to hospitals and preventable hospitalizations by 25 percent. The study did not look at quality of care.

“All the unnecessary hospitalizations are expensive.  We waste literally billions of dollars,” he said.  “A better delivery system could save lots of money.”

The commission found that 20 percent of private insurance physician payments in Massachusetts are made under the system. Several major insurers have a global payment plan, including Tufts Health Plan and Blue Cross Blue Shield of Massachusetts (BCBSMA).

BCBSMA’s program is the Alternative Quality Contract, a voluntary five-year agreement signed by physician groups with a goal of decreasing costs by half within the five-year period and making health care trends more predictable.

According to press spokesperson Jenna McPhee, initial data found that all providers who signed up in 2009 met their budget. BCBSMA expects a more comprehensive review in February.

In December, the Beth Israel Deaconess Physician Organization (BIDPO), an independent physician network affiliated with Beth Israel Deaconness Medical Center, became the largest physician group to sign the contract.  The organization includes approximately 1,800 physicians; the agreement covers more than 75,000 BCBSMA members.


The Massachusetts Medical Society says the main drawback to global payment plans is the difficulty of fast, wide-spread adoption.  In August, MMS President Alice Coombs, released a statement warning about the complexity shifting to global payments.

“While some elements of our health care system might move to a global payment system in a relatively short time frame the vast majority of physicians and hospitals will find any transition to be fraught with significant technical, logistical and clinical challenges,” she said in her statement.

The medical society recommends multiple compensation systems, including “limited pilot studies that utilize global payment system,” according to its website.

IDEA: Cost Transparency

The Problem

“We need easy access to the true price of our office visits, hospitalizations, and diagnostic tests,” wrote Dr. Michael F. Collins, chancellor of the University of Massachusetts Medical School in the Worcester Telegram & Gazette.  “If we can find out the price of a hotel room or a cross-country flight with a few clicks of the mouse, we can lift the veil currently covering the price tag attached to health care.”

There are two separate issues with the lack of transparency in health care costs. A lack of cost information makes it hard for policy makers and insurance companies to understand the health care economy. Consumers have a hard time finding and comparing costs of individual treatments at various hospitals.

The Proposal

The Massachusetts Division of Health Care Finance and Policy is creating the All-Payer Claims Database (APCD), a robust cost and quality database for consumers, employers, insurers, and government.

Beginning in January, all payers in the state will be required to submit data from the last three years for medical, dental, and pharmacy claims.  In February, they will be required to update the information monthly.

The APCD will streamline administrative costs by providing claims data to other agencies, such as the Health Care Quality and Cost Council and the Group Insurance Commission, which now collect comparable data.

Six other states, including Maine, Vermont and New Hampshire, have similar databases, but Massachusetts will have the most complete data set, according to DHCFP Commissioner David Morales.

“First and foremost, I think it’s important for policymakers and employers to understand the market of health care,” Morales said.  “It’s important to make available more public information.”

The attorney general’s report also found prices for medical care vary greatly within similar demographic zones. The higher prices didn’t correlate with higher quality care. The differences, the report said, are associated with “market leverage” – the ability of a provider or insurer to influence negotiations.

The report found differences between the highest and lowest paid providers in an area sometimes exceeded 200 percent.

At this year’s annual conference of the Massachusetts Association of Health Plans, Attorney General Martha Coakley said that increased cost transparency is the best way to begin resolving the issue.

Consumers can now get a glimpse at the range of costs. The website My Health Care Options ( has a search engine that allows consumers to make side-by-side comparison of treatment costs at different hospitals within a geographic zone.

The first annual report on the website’s data by the DHCFP found significant cost differences between hospitals. A CT scan of the chest ranges from $350 to $1,300, and a mammogram costs between $75 and $250.

The site, run by the Health Care Cost and Quality Council, a semi-independent state agency created in 2006, also allows health care consumers to compare prices against the state average.


While a CAT scan might have a straightforward price, it would be more difficult to assess the cost and quality of a complex surgery. Cost transparency is seen as a stepping stone rather than a solution. Whether transparency lowers costs will be determined by how the information is used.

Monitoring Programs Have Success in Other States

Saturday, December 25th, 2010

By Kevin Schwartz

With State Map

Massachusetts was once a national leader in prescription drug monitoring, but it had fallen behind over the past decade as other states expanded on such programs.

In 1992, the state became one of the first to track who was giving and getting prescriptions for the mostly opiate-based drugs listed under the federal Schedule II category. Ten years later, just 15 states had monitoring programs.

But when Congress passed a bill sponsored by Kentucky Congressman Harold Rogers providing federal funding for new programs the number rose by 29.  Most of the new programs track past Schedule II.

Schedule II drugs are prescription drugs with a high risk of abuse.  Schedules III through V have decreasing risks. The state’s new law, which goes into effect Jan. 1, will track drugs through Schedule V.

“Given that not many people had a program, we were ahead of the curve,” said Prof. Peter Kreiner, head of the Center for Excellence at Brandeis University, which serves as a national clearing house for prescription monitoring data.

“It’s sort of like Massachusetts with our subway system.  We have a history of being early innovators then the system gets eclipsed by other states.”

Thirty-three states and Guam have created prescription monitoring programs, and 10 others have enacted legislation to that will enable them to do so.   Of the 44 programs, 24 track up to Schedule V drugs, 17 up to Schedule IV, two go to Schedule III, and Pennsylvania only tracks Schedule II drugs.  Washington’s program has been temporarily suspended for financial reasons.

In helping the state Department of Public Health make its case for upgrading the law this summer, Kreiner said the center assessed data from the Maine program. It found its program had a significant impact in locating “questionable activity,” the official term for potential doctor shopping by people looking to get multiple prescriptions of the same medication.

Other early evaluations have been promising.  A 2006 study by Simeone Associates, Inc., a public policy consulting firm specializing in management of drug control programs, compared the 20 states with monitoring systems to states without them.  The report, which only examined Schedule II drugs, found monitoring to be effective in decreasing the supply of prescription drugs, which in turn decreased abuse.

Simeone also found programs that sent reports to warn pharmacists of potential doctor shoppers were more successful than programs that only sent reports requested by prescribers, which include physicians and nurse practitioners.

According to Kreiner, Massachusetts is one of the more proactive states.

In a 2010 study of Kentucky’s program, 90 percent of respondents, which included prescribers, pharmacists, and law enforcement officials, said the program was effective in preventing drug abuse, diversion and doctor shopping.

Only 18 percent of the doctors and pharmacists polled said the reports had no effect on their decision to prescribe or dispense drugs.

Coakley Wins

Thursday, November 4th, 2010

By Kevin Schwartz

BOSTON – Martha Coakley took a step towards political redemption Tuesday, easily defeating Republican James P. McKenna with 64 percent of the vote to remain the state’s attorney general.
“Sometimes you lose a round, and sometimes you lose the whole fight.” she said in her acceptance speech. “But, I also believe that losing doesn’t mean that you quit.”
With her extended family on stage, Coakley emphasized how privileged she felt serving the commonwealth and thanked the voters for placing their trust in her.
“At the attorney general’s office, we understand that every case we bring it’s about the people that we help,” she said. “For families who fall victim to predatory practices of Wall Street, we take on those companies to recover millions to allow people to stay in their homes. For the children who are at risk from predators who are being harassed at school or online, we work with police, schools and parents to keep them safe. And for those who are threatened or discriminated against because of race, gender, or sexual orientation, we stand up for them and help to protect their civil rights.”
Coakley, seemed close to political oblivion in January when she lost the special U.S. Senate race to Republican Scott Brown. The defeat earned her sharp criticism from many Democrats for running a lackluster campaign.
Coakley resolved over the past months not to underestimate McKenna, a unknown in political circles, who gained the Republican nomination in a late write-in campaign.
Chastised by the impression she didn’t like campaigning, Coakley shook more hands and made more appearances in this campaign. She even hauled out apair of lucky shoes s emblazoned with Andy Warhol’s tomato soup cans that she used during her first run for Middlesex District attorney, but kept in the closet against Brown.
But, mainly, she countered McKenna’s attacks that she wasn’t tough enough on illegal immigration and government corruption. She touted her accomplishments assisting investors and homeowners regain $440 million from Wall Street firms, helping 15,000 people keep their homes, and challenging proposed gas and utility rate, saving customers more than $100 million. She also was influential in pressuring Craigslist to remove the adult services section from their website.


Thursday, November 4th, 2010

By Kevin Schwartz and Sarah Tann

BOSTON – Gov. Deval Patrick’s victory capped a strong day for Massachusetts Democrats who bucked a national Republican tide. But, in his acceptance speech, Patrick emphasized he would govern the entire state, not just his own party and supporters.

“I plan to be your governor too,” he said, addressing the supporters of his opponents in his victory speech Tuesday evening. “I’m proud to be a Democrat and proud to have won this race as a Democrat. But I am not a governor of the Democrats. I am governor of the folks who voted for me and the people who didn’t.”

The governor was positive about the state’s future, paraphrasing Bill Clinton’s quote that “There is nothing wrong with Massachusetts that can’t be fixed by what is right with Massachusetts.”

The crowd began the evening began in a tense mood, but as the night wore on supporters lightened up with each new vote count. By the time Charlie Baker came on the television screen to give his concession speech, the crowd of around 1,500 were hugging each other and making celebratory cell phone calls.

By the time Patrick came on stage, the crowd was in a frenzy, yelling “Four more years!”

Throughout his campaign run, Patrick was emphasized his accomplishments, touting statistics that Massachusetts ranked first in the country in education and health care, and was recovering from the recession faster than any other state.

Before Patrick came on stage, Lt. Gov. Tim Murray said the administration would continue to preserve the state’s future by investing in education.

Throughout the campaign, Republican Charles Baker criticized Patrick for his fiscal management. In addition to eight tax increases, Patrick was cited for using one-time fixes like stimulus money and rainy-day funds to balance the state budget and his failure to reform state government.

Yasmin Cruz, a senior analyst at John Hancock Financial Services who attended the party, said she supported Patrick’s fiscal priorities.

“He has a sense of social funding while being fiscally responsible,” she said. “I’d like to see him finish what he started.”
Jamile Lewis, who worked at the Democratic headquarters in Brockton said Patrick deserved a second term.

“I walked around Brockton and knocked on people’s doors and talked to people in Shaw’s to get out the vote for Deval Patrick,” she said, “I believe he cares about the community and especially people who are going through a hard time.”

Patrick encouraged the crowd to enjoy the victory, but just for one evening.

“Celebrate tonight,” he said, “This victory is sweet indeed. But tomorrow, each and every one of us goes back to work”