A bill that would increase mandatory insurance coverage for mental health issues is pitting consumer advocates against insurers and business groups worried about rising premium costs. Here’s a description of the change:

“Under the Commonwealth’s current law, benefit parity exists for nine “biologically-based” mental health conditions for adults and for any conditions in children (18 and under) that limit functioning and social interaction. Conditions specified under this law are covered without annual or lifetime benefit limits and are also at parity with regard to cost sharing. Other conditions not included in these requirements must be covered for at least 60 inpatient days and 24 outpatient visits. Currently, benefits for alcoholism and chemical dependency are mandated to include 30 days of inpatient treatment and $500 for outpatient treatment. H. 4423 extends this partial parity to full parity for both mental health and substance abuse services, requiring non-discriminatory coverage for the diagnosis and medically necessary treatment of mental health and substance abuse disorders as described in the most recent edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders.”

That description is in a report out today on the cost and other impacts of the bill. Here’s a summary of the findings:

“The projected increase in spending that would result from H. 4322 ranges from 0.1% to 0.3% of premiums or $12.9 to $38.8 million. The per member per month (PMPM) impact ranges from $0.46 to $1.39.”

Worth it? Read more…

As “CommonHealth” blog readers have surely been following in the news, Governor Patrick and I traveled to Washington to meet with key Bush Administration officials about our Medicaid waiver renewal application.

Extending the state and federal partnership embodied in Massachusetts’ Medicaid waiver is critical to our historic effort to reach near universal health insurance coverage.

Why should the federal government support our waiver renewal?

Evidence of the successes of health care reform continues to come in. The 1115 Medicaid Demonstration Waiver has helped us dramatically reduce the number of working-age adults in Massachusetts who are uninsured. Not only are more people insured, but we have seen an expansion in access to health care. Primary and preventive care are on the rise as we continue to implement health care reform. More low-income adults report having a primary care provider and fewer have unmet health care needs.

The Medicaid Waiver is a large part of the success. Read more…

A flu pandemic and disaster preparation plan that has languished for more than two years is finally moving at the State House. The bill gives the Department of Public Health new authority to direct state resources and personnel and quarantine areas or people. It provides liability protection for medical staff that might be required to work in nontraditional settings. Department of Public Health Commissioner John Auerbach says although bird flu outbreaks, for example, are not in the daily news, the state must be prepared.

All indications are that we will have a serious influenza epidemic in the coming years and part of our responsibility is to plan for possible emergencies even if they are emergencies that are not likely to occur for many, many years.

The bill does not provide funding for additional hospital beds, medical supplies or medications, but asks for a report on funding needs by years’ end. Massachusetts has begun stockpiling anti-virals.
The bill cleared the Senate today. A House sponsor says he expects a similar version will pass in that chamber.

Sermo, the online professional/social networking service for physicians, aims to become an organizing site for physicians dissatisfied with the way they practice health care. Sermo is out with this press release about it’s “Open letter from American Physicians.” The letter describes frustrations with health insurers, regulation and medical malpractice laws. Sermo says the next step will be asking doctors for solutions the company hopes to raise during the presidential campaign.

Senate President Therese Murray called leaders of the Massachusetts Hospital Association and the Massachusetts Nurses Association to her office yesterday to say that the Senate will vote soon on nurse staffing legislation that has cleared the House. The bill would give the Department of Public Health the authority to set nurse to patient staffing ratios. Murray, according to 2 people at the meeting, told both sides that the bill may come up on short notice and offered the opportunity to discuss common ground. She did not suggest any compromise language or say whether she thinks the controversial measure will pass. Aides to Governor Deval Patrick have said they hope the bill does not reach his desk.

There’s a birthday party for the National Health Service Tuesday at Wembley Stadium in London. Dr. Don Berwick, president of the Institute for Healthcare Improvement in Cambridge (MA), delivers the keynote on the theme of the day “Energising Innovation.” Berwick was appointed an honorary Knight in 2005 for his “distinguished service to healthcare improvement in Britain’s National Health Service.”

Dr. Berwick’s address is scheduled to begin at 8:15 AM (EST). Click here to register.

For a couple of different perspectives on the NHS at 60 here’s a physician in The Guardian arguing against a move towards more private health coverage and then a more celebratory view here.

I was fortunate to have begun my tenure as Commissioner of the Massachusetts Department of Public Health just about the time that health care reform was going into effect. I spent much of the first few months in the job reviewing health data of Massachusetts residents and traveling around the state for a series of health dialogues to identify a short list of public health priorities.

What was repeatedly reinforced during that experience is that health care reform is directly related to improving the health status of thousands of people, increasing the public’s safety on a population-wide basis, and reducing health care tragedies and premature deaths.

Health care reform in Massachusetts is still in its infancy, but we’re already seeing some impressive results.

1. According to the Division of Health Care Finance and Policy, more than 330,000 people have enrolled in private or subsidized insurance programs since the implementation of this groundbreaking initiative.

2 This influenza season we saw a dramatic increase in the number of adults in Massachusetts who received a flu vaccine. Read more…

It is an accepted fact that health reform will succeed only with focused attention on cost control. All stakeholders seem to agree that we will not be able to afford universal coverage unless health care costs are brought under control, and there are many worthwhile ideas about how best to meet this goal. Unfortunately, there are just as many, if not more, ideas that would increase costs.

When it comes to coverage, Massachusetts’ health insurers are heavily regulated. The rules were established with the best of intentions, but each new rule adds to the cost of coverage, either by requiring coverage for specified services or by making it more difficult for health plans to manage care.

The Health Reform Act recognized the impact of such requirements on the cost of coverage. It imposed, for instance, a moratorium on new mandated benefits until the Division of Health Care Finance and Policy completed a study of the cost impact of existing mandates. The Division has not yet released this important report.

Against this backdrop, it is surprising that some of health reform’s staunchest allies are supporting laws that would expand benefits further. Read more…

Yesterday we announced the launch of the health information exchange in the greater-Newburyport community. The HIE is called WellportSM. It’s the culmination of an enormous and very successful collaboration among many parties, including MAeHC, our technology partners, and—most notably—the medical professionals and patients of the Newburyport community itself. Preparing to launch an HIE begins years in advance and involves a tremendous amount of work at many levels. It’s particularly challenging when you build it with a focus on putting patients first. Wellport is permission-based, meaning that patients choose whether they want their information shared among their care providers across the community. MAeHC and the Newburyport medical community strongly believe that having a more complete picture of a patient’s health profile available to caregivers at the point of care will provide better, more affordable care, but we also strongly believe that patients themselves need to be the determinants of who sees their medical information. With 90% of patients agreeing to participate to date, we are proud that Wellport is a system that is trusted by patients and physicians alike.

The launch of Wellport follows on the launch of the North Adams eHX, our first HIE, which now has over 25,000 patients participating in the network.

It’s our mission at the Massachusetts eHealth Collaborative to transform the delivery of healthcare and to enhance the quality, efficiency, and safety of care in Massachusetts. We are beginning to see this transformation at every level. Read more…

The other day I was asked, why I was taking a somewhat conservative approach to suggestions that eligibility for CommCare be expanded now. The excellent analysis presented to the Connector Authority (I am pleased to add that it was written by Bob Carey, a former GIC policy director) raised a number of questions about the fiscal implications of expansion, and the decision was made that the issue demanded further investigation and analysis — a sensible decision, in my view.

I’ve been giving this matter a lot of thought and it seems to me to present even larger policy issues. The distribution of state tax dollars across state sponsored programs, as we know, has changed over the years of health care inflation coupled with health insurance coverage expansion, be it Medicaid, state employees, or the creation of CommCare itself. And, while it is a matter of justifiable pride that we have covered so many of our fellow citizens with insurance that they didn’t have before, we need to keep our eyes on the other state needs that are competing for those dollars. The Governor’s new and exciting education program is just one example. As the administrator of one of the Commonwealth’s health care agencies — the GIC — and as a board member of another — the Connector Authority — I know I can support and feel very good about the health services that we can provide with every additional dollar we are given. But as a citizen of this Commonwealth, standing back and looking at all of the needs of our Commonwealth and its people, it is the obligation of every one of us to look long and hard at every expansion proposal that comes before us to make sure that it is well thought out, carefully costed out, and every alternative to saving dollars seriously considered. Read more…