In 2017, 96.3 percent of #Massachusetts residents had #healthinsurance. Here’s how they got it.

From the Massachusetts Center for Health Information and Analysis:

Enrollment Trends monitors health insurance coverage in the Commonwealth of Massachusetts, where coverage is defined by unique Massachusetts residents with primary medical membership in the 13 largest commercial payers, MassHealth (Medicaid), or Medicare.

The August 2018 edition of Enrollment Trends offers insights into changes in health insurance coverage in Massachusetts from March 2016 through March 2018.

Key Findings from August 2018 Enrollment Trends

    • Over four million Massachusetts residents received their primary, medical health insurance coverage through private commercial insurance between March 2016 and March 2018.

 

    • In March 2018, MassHealth shifted approximately two-thirds of its Managed Care Organization (MCO) and Primary Care Clinician (PCC) plan enrollees to Accountable Care Organization (ACO) plans.

 

    • Unsubsidized Qualified Health Plan (QHP) enrollment decreased by 14.4% (-7,000 members) from March 2017 to March 2018, while subsidized QHP enrollment increased by 55.0% (+5,000 members) over the same time period.

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Why does Partners cost more than other #Massachusetts #hospitals? Price variation revealed in new report.

The Commonwealth of Massachusetts tracks not only what it spends on Medicaid, but total  health care spending.  Modern Healthcare reports on the variation in care spending recently identified by the in Massachusetts Health Policy Commission. 

The highest-cost providers in Massachusetts spent nearly a third more per patient than their lowest-cost peers, mirroring the widespread cost variation found in markets throughout the country. 

Massachusetts’ largest and highest-cost organization, Boston-based Partners HealthCare, spent 32% more per patient annually than Reliant Medical Group, after adjusting for treatment severity, according to a new report from the Massachusetts Health Policy Commission that analyzed the 14 largest providers in the state. That variation amounted to more than $1,500 per patient.

varaiation in speanding

 

#Internet-based data can help track the #flu when official data lags

A new paper from a team led but Mauricio Santillana, a mathematician, and member of the computational health informatics team at Boston Children’s Hospital, offers this in a new paper:

We show that information from Internet-based data sources, when combined using an informed, robust methodology, can be effectively used as early indicators of influenza activity at fine geographic resolutions.

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From MA DPH

From City Data site. 

Crowdsourced data can be valuable, especially in developing countries where official health data can lag by months. But on their own, these maps tend to overpredict, said Mauricio Santillana, a mathematician, assistant professor at Harvard Medical School, and faculty member of the Computational Health Informatics Program at Boston Children’s Hospital. “They don’t add the nuances when they try to predict at a hyperlocal level,” he said. Many are also commercially driven, so he questions their objectivity. “They’re produced by people who’d benefit by people rushing into pharmacies.”

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KHN: Now that the Massachusetts Medical Society has”rescinded its longstanding opposition to physician-assisted suicide,” others may follow

As Doctors Drop Opposition, Aid-In-Dying Advocates Target Next Battleground States

khn_logo_facebookWhen the end draws near, Dr. Roger Kligler, a retired physician with incurable, metastatic prostate cancer, wants the option to use a lethal prescription to die peacefully in his sleep. As he fights for the legal right to do that, an influential doctors group in Massachusetts has agreed to stop trying to block the way.

Kligler, who lives in Falmouth, Mass., serves as one of the public faces for the national movement supporting medical aid in dying, which allows terminally ill people who are expected to die within six months to request a doctor’s prescription for medication to end their lives. Efforts to expand the practice, which is legal in six states and Washington, D.C., have met with powerful resistance from religious groups, disability advocates and the medical establishment.

But in Massachusetts and other states, doctors groups are dropping their opposition — a move that advocates and opponents agree helps pave the way to legalization of physician-assisted death.

The American Medical Association, the dominant voice for doctors nationwide, opposes allowing doctors to prescribe life-ending medications at a patient’s request, calling it “fundamentally incompatible with the physician’s role as healer.”

But in December, the Massachusetts Medical Society became the 10th chapter of the AMA to drop its opposition and take a neutral stance on medical aid in dying.

Most of those changes occurred in the past two years. They proved a pivotal precursor to getting laws passed in California, Colorado and Washington, D.C., said Kim Callinan, chief program officer for Compassion & Choices, an advocacy group that supports legalization efforts around the country. (The practice is also legal in Washington, Oregon, Vermont and Montana.)

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The shifts come as doctors’ views evolve: Fifty-seven percent of U.S. doctors supported medical aid in dying in a 2016 Medscape survey, up from 46 percent in 2010.

Because of the medical society’s vote, Massachusetts is the state most likely to legalize medical aid in dying this year, predicted David Stevens, CEO of the Christian Medical & Dental Associations, a national group of 19,000 health professionals that has opposed such laws in every state.

“I think a neutral stance is probably what’s going to push it over,” he said.

Doctors’ opinions are also playing a role in New York, where the New York State Academy of Family Physicians endorsed an aid-in-dying bill, and the state medical society is surveying its members on the subject.

Efforts to legalize the practice have faced pushback nationally: Last year, lawmakers in 27 states introduced aid-in-dying bills, and none passed. And in Congress, Republican lawmakers have launched several attempts to block the District of Columbia from implementing its law.

This year, Compassion & Choices’ Callinan identified New Jersey, New York and Massachusetts as its top three target states.

Peg Sandeen, executive director of Death With Dignity National Center, an aid-in-dying advocacy group based in Oregon, cited Hawaii as another top target. Advocates there are “trying to break the logjam in the legislature,” where the state Senate passed a bill in March, she said. Hawaii came close to legalizing the practice in 2000.

Massachusetts has been a fraught battleground for the right-to-die movement: In 2012, opponents narrowly defeated a referendum that would have legalized the practice. Home to a robust medical hub and Harvard Medical School, the state is a stronghold for academic medicine.

Kligler, who’s 66, has publicly described his interest in using lethal drugs to die on his own terms rather than endure what he expects to be several months of significant pain, fatigue and declining quality of life.

Kligler said he wants other dying people to have the same option: When he used to serve as a hospice physician to cancer patients, he said, patients used to “ask me to help them to die,” but he had no legal way to do so. Kligler is also suing Massachusetts, arguing that terminally ill patients have a constitutional right to medical aid in dying.

“It’s a question of justice,” Kligler said.

When the Massachusetts Medical Society surveyed members last year, 60 percent said they supported medical aid in dying, and 30 percent said they opposed it.

Dr. Barbara Rockett, a surgeon and past president of the medical society, urged fellow doctors to uphold the group’s long-standing opposition to the practice. Doctors should focus on helping dying patients through hospice and palliative medicine, she said.

“To intentionally help them commit suicide is wrong,” Rockett said. Proponents, meanwhile, say the practice is not “suicide” because the patient is already being killed by a terminal disease.

Rockett said she was disappointed that her fellow delegates in the society voted to adopt a neutral stance.

Even with the doctors group stepping out of the way, the latest aid-in-dying bill, dubbed the Massachusetts End of Life Options Act, faces formidable opposition. Catholic groups, a significant force opposing aid in dying nationally, have a robust base in Massachusetts: Over a third of residents are Catholic, second only to Rhode Island.

Catholic groups provided much of the $5.5 million that opponents spent to defeat Massachusetts’ ballot referendum in 2012, outspending proponents by nearly 5-to-1.

The Boston Archdiocese did not respond to repeated requests for comment for this story. But at the time the referendum failed, a spokesman said the church could not afford to lose on this issue in a Catholic stronghold: “If it passes in Massachusetts,” the spokesman said, “it’s a gateway to the rest of the country.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

 

Will a legislative study put Massachusetts on the path to single-payer? Supporters head to Beacon Hill to push for it.

single payer posterTucked inside the health care bill passed by the state Senate is a provision to study the possibility of a  single-payer health care system.

The bill’s cost control measures are getting all the attention. From the Globe:  

The 100-page bill attempts to help struggling community hospitals by setting a floor for the reimbursements they receive from insurers. It also sets a benchmark for annual growth in hospital spending, estimated at 2.7 percent. If the hospital industry exceeds that benchmark, some hospitals would have to pay hefty penalties.

But MassCare, the state’s single-payer advocacy group, says the proposed study creates “a real path in the near future to create a Single Payer system for the Commonwealth!” They’re headed up to the State House this week to lobby House members. lobbyday-958x538

These folks are in if for the long haul, which, according to political scientist James Munroe of Brown University,  is the way to go on single-payer. Writing in the a recent NEMJ, he says:

It is a policy proposal designed to improve health care delivery, an ambitious claim about equality and social justice, and an effort to usher in a more progressive era in American politics. Each is a long shot, but Medicare for All and its advocates stand in a venerable reform tradition that has rewritten U.S. politics many times in the past. It would be a mistake to dismiss them now.

BHN reports: Push for single-payer lives on in Massachusetts

by Tinker Ready All rights reservedWith the ACA under constant fire, it’s easy to think that single payer is off the table.  Try getting that through Congress.  Still, seems, here in Massachusetts, single payer supporters are not ready to give up.

On Wednesday night,  Mass-Care invited former CMS director and gubernatorial candidate Don Berwick to a meeting on “What can be done legislatively to achieve Single Payer in Massachusetts.”  An overflow group filled a small meeting room in the Downtown Crossing office shared by Mass Care and other progressive groups like The Women’s Institute for Leadership Development and the Industrial Workers of the World.

Berwick, who added single payer to his campaign platform, didn’t really need to make a case for the plan. He was preaching to the converted when he argued that turning the government into our insurer would help the country achieve “better care, better health and lower costs.”

It will have to happen on the state level, he said. “I don’t expect national leadership on this from either party.”

He cited the usual statistics – we spend 40 percent more per-capita than any other nation. Then he added a few more. While running for governor, he took a look at 15-year tends in the state budget. Funding was down for almost every item, he said.  – local aid, parks, higher ed. For health care, state spending rose 72 percent in that period.

To pull that lens out a bit, he cited a recent  Commonwealth Fund study that estimate the costs savings had the US had adopted a single –payer plan similar to one used in Switzerland: $15.5 trillion over 30 years.

None of these arguments has provided single payer with the kind of traction it needs to move into the mainstream.

“When you say, don’t worry, the state is going to be your insurer, that’s a hard sell,” Berwick said.

So, he and others are starting to emphasize another point – we are spending money on health care that could be better spent elsewhere. In other words, the co-pay may be so high on your knee surgery, you’re might not be able to pay the rent.

“There is a transfer of opportunity in society from other things to health care,” Berwick said.

Or pay for a week at the beach or a private college for your kids.  As the discussion turned to how to sell the approach to the public, several people – including a group of medical students from BU – pointed out that high health care costs are not just a problem for the low–income and uninsured.

“How do we sell this to the middle class? “ asked Andy Hyatt, a first-year medical student at BU and a member of the school’s chapter of Physicians for a National Health Program. While it’s important to help the disadvantaged, he said, health for middle-income people “still sucks”

Just how to address that group is what these supporters of single payer health care are trying to figure out.

“We’re wondering what we as medical students can do,” asked Jawad M. Husain, also of the BU PNHP. “We want to practice in a system where we can treat people fairly.”

Berwick’s answer: “Political mobilization.” But he noted that the students will have to look outside the classroom for guidance on that. ” It’s not something I learned in medical school”

Compare Massachusetts doctors via quality reports and patient feedback

CR MA. Doc Ratings Insert_300Searching for health care services on the Internet can be like searching info about food, hotels or pets. You have to sort through a lot of low quality or scraped sites that don’t offer much.

Healthcare Compass looks like a good destination for Bay Staters.

On this website, there are two different ways to compare doctors’ offices:

  • A survey of more than 40,000 patients across Massachusetts that collected details about the care they receive at their own doctors’ offices.
  • Reports that measure how well the doctors’ offices achieve nationally recognized standards for high-quality primary care…

This website helps patients answer two questions about their health care quality:

Are primary care doctors giving their patients the correct preventive care services (such as cancer screenings) and chronic disease care (such as asthma or diabetes care)? The Clinical Quality report looks at how this of care was given to patients at doctors’ offices.
Learn more about the Clinical Quality Report

 How are patients’ experiences with their doctor office? Does their doctor’s office know about them and the care that they should be receiving? The Patient Experience Survey is a statewide survey that asks patients to report about their experiences with a specific primary care doctor and with that doctor’s office. 

Learn more about the Patient Experience Survey report

 

Also, click here for a source of raw data: Patient HealthDecider