FAQ: Why did the Connector need a new website? Why can’t they just use the old one?

With the continuing issues with the Health Connector/MassHealth enrollment website, we get asked the following questions constantly:

The old web site worked just fine. Why did they need to build a new one? Why can’t they just go back to the old one?

It’s a fair question. It’s also being asked in a more accusatory manner by some political candidates, who are claiming that we should have asked for a “waiver” from the whole ACA and just kept our old system.

What most people who ask this question don’t realize is that the Connctor and MassHealth are trying to build more than just a website. The web interface is just the visible tip. Underneath is a whole new processing system for health program applications, eligibility and enrollment.

So, here’s part of the answer, based on what we know:

1. Until now, there was no enrollment website for most people. The Connector’s web site only allowed people seeking unsubsidized coverage to fill out an online form to enroll and select a health plan. That was for just around 40,000 people out of the over 250,000 people covered by the Connector. For everyone else, there was no public enrollment website.

To enroll in subsidized coverage, one had to go to a community health center, hospital, or a few community groups that were authorized to use the state’s “Virtual Gateway.” It was not open to the general public. We’ve been told that once, by accident, it was open for the general public for a few hours on a weekend. A number of people filled out applications while they could, and all of the applications were filled out incorrectly and had to be redone. That’s why the state only allowed trained people to fill out the form.

The new system will allow the general public to set up an account, fill out their own forms, and submit it themselves.

2. The old “Virtual Gateway” form did not process verifications. If you had a hospital worker fill out the form for you, you still had to fax in separately the income,  residency and other verifications required for state programs. Then state workers had to manually associate the faxed-in documents with the form transmitted by the Gateway.

The new system will perform these functions automatically, in the background and in real time, by checking information already known to the state or federal government. For example, the system will check your wages with the Department of Revenue to see what your income is. Only if there’s a substantial discrepancy will the enrollee have to submit verifications.

3. The old system that determined eligibility was antiquated and difficult to update and maintain. Decisions took a long time to process. Under the old system used to process Connector and MassHealth applications, the determination of which program an applicant was eligible for was made by a system called “MA-21.” This 1980s era mainframe-style system was slow and very difficult to update. Changes in eligibility rules required lengthy, complex programming changes. The system produced awful form letter notices that were locked into a format that made it hard for people to understand. Decisions often took weeks.

The new system is designed to make instant real-time eligibility decisions. It will be easier to upgrade as program needs change. It also will be a platform for applications for other programs beyond health care.

Our HelpLine staff’s full-time job is enrolling people into coverage, so the current dysfunctional system makes us frustrated and furious at time (but note: the past few days we have had reports of substantial improvements in the system, with some people successfully applying, being determined eligible, and enrolling at one sitting). But the old system wasn’t so wonderful either.

We have two goals. First, everyone eligible for insurance must have a temporary solution, even if it means creatively working around some rules while the systems work is in progress. Then second, if we can get to a system that meets the goals outlined by the state, we will have made enormous strides to building a responsive, modern eligibility system that should last for a long time.

We’re looking forward to Thursday’s Connector Board meeting, just announced today, where we hope more progress can be made on system improvements.
-Brian Rosman

Posted in MA Health Reform | 3 Comments

BREAKING: Health Connector Board Meeting Scheduled For Noon Tomorrow (UPDATED)

The Health Connector has scheduled a board meeting for Thursday, Feb. 6, from 9:00 am to noon. (UPDATED UPDATE: The meeting will start at noon, and is scheduled to go to 3 pm.)

According to the agenda (pdf), the only topic is the current open enrollment period. The agenda indicates that a vote is scheduled.

Because the meeting was not on the previously established schedule, it will be at Gardner Auditorium, in the State House.

Posted in MA Health Reform | 1 Comment

When Things Go Wrong in the Ambulatory Setting

HCFA is one of a number of organizations involved in the PROMISES (Proactive Reduction of Outpatient Malpractice: Improving Safety, Efficiency, and Satisfaction) Project in Massachusetts. This project, which was funded through the federal Agency for Healthcare Research and Quality (AHRQ) Medical Liability Reform and Patient Safety Demonstration Grants, has been working to test interventions to improve safety in 16 ambulatory primary care practices.

The focus is on improving safety through improvement in test results management, referral management and medication management, with an overarching goal of improving communication (among staff, between providers and practices, and between staff and patients).

One of the areas that the PROMISES group, including HCFA, worked on was developing guidelines for primary care practices to follow when there has been harm caused to a patient. In 2006, Harvard hospitals came together to develop a document called When Things go Wrong which focused on the inpatient setting and the importance of disclosing errors to patients and families. The PROMISES group discussed the need for similar guidelines for the outpatient setting and together developed When Things Go Wrong in the Ambulatory Setting. HCFA is a co-author for an article about this document which was recently published in The Joint Commission Journal on Quality and Patient Safety.

This article will give national attention to these carefully considered guidelines, hopefully spreading their use not just in Massachusetts but across the country. These guidelines will be extremely useful as health care providers strive to carry out the apology and disclosure sections of the Massachusetts 2012 payment and delivery system reform law (Chapter 224).

You can see the guidelines on the PROMISES Project website, which includes the video above, featuring Dr. Lucian Leape, lead author of the original When Things Go Wrong document, and Dr. Gordon Schiff, lead primary care physician for the PROMISES Project, and case study videos.
Deb Wachenheim

Posted in Health Care Quality | Leave a comment

Health Disparities Bill Advancing in House (UPDATE)

disparities bill

The State House News Service reported on Friday that the House Ways and Means Committee is voting on legislation to create a permanent Office of Health Equity within the Executive Office of Health and Human Services.

(UPDATE: On February 3, the House of Representatives gave its preliminary approval to the bill, adopting the Ways and Means technical amendment. A final House vote is required before the bill goes to the Senate, so please call your Representative.)

Health Care For All has long supported this legislation, working with a broad coalition of disparities advocates in the Disparities Action Network to draft the bill back in 2009. This session’s bill, H. 2071, was introduced by Representatives Jeffrey Sánchez and Byron Rushing, along with 30 co-sponsors. It was already approved by the Public Health and Health Care Financing Committees (which offered a minor amendment).

In addition to creating an address in state government focused on health disparities, the bill would create a framework for a comprehensive approach to health disparities. The approach encompasses all the activities of state government, such as housing, transportation, education and economic development. It requires that each state budget submission identify major state initiatives that affect health and health care, and their impact on health disparities. It also calls for an annual report card on progress in reducing disparities.

HCFA urges the House and Senate to approve the legislation. The state has made important strides, creating a Health Disparities Council and an Office of Health Equity within DPH. Passage of this legislation would make health disparities an institutional concern at the highest levels of state government.
– Brian Rosman

Posted in Health Disparities | 1 Comment

The End of an Era – A Legislative Giant Retires in Washington

Normally, the retirement of a member of Congress representing a district nearly 2,000 miles from Massachusetts would not be mentioned on this blog.  But Congressman Henry Waxman’s announcement today that he will be leaving public life at the end of this year is a notable exception.

During his 40 (yes, 40!) years in the House of Representatives, there was scarcely any piece of health care legislation that did not have his fingerprints on it.  As Chairman of the Health and the Environment Subcommittee, Waxman held the first hearings into the emerging HIV/AIDS crisis, exposed deceitful practices by the tobacco industry, and authored legislation that created the generic drug industry.

Expanding health coverage was a passion.  He is responsible for expanding Medicaid coverage to millions of low income children, pregnant women, and seniors, and along with our own Senator Ted Kennedy, he worked to ensure that children of working families had health coverage through the Children’s Health Insurance Program (CHIP).

In 2009, Congressman Waxman became chairman of the Energy and Commerce Committee, giving him a pivotal role in an effort to achieve one of his lifelong goals: guaranteeing that all Americans would have access to health insurance through the Affordable Care Act.

One would be hard pressed to find a more effective or dedicated policy maker to the principle that the health care system must work for consumers.  In countless ways, Massachusetts residents have benefited from the work of a congressman from California.  Our country is a better place for his efforts and Congress will have very large shoes to fill when he leaves.

(Full disclosure: I had the incredible honor and privilege to work for Congressman Waxman from 1999-2002 as a junior aide in his Washington office.)
-Matt Noyes

Posted in Health Care Politics, MassHealth/Medicaid, US health policy | 1 Comment

DPH Announces Historic Prevention Trust Grants

Huge news.

Today the Department of Public Health announced the first grant awards to nine recipients from the $60 million Massachusetts Prevention and Wellness Trust Fund. This marks a historic milestone in Massachusetts health reform, as we expand our focus on preventing disease and keeping people healthy.

The awards will focus on combating tobacco use, pediatric asthma, hypertension, and falls among older adults. According to DPH, the nine partnerships will serve a total of 978,000 people, with a focus on reducing health disparities based on race, ethnicity, income, and other factors.

Health Care For All was part of a broad coalition of health, civic, business, and labor leaders – led by the Mass Public Health Association – that pushed for the Trust as part of the 2012 cost containment legislation.

Massachusetts is the first state in the nation to pioneer this investment in community-focused prevention.

The lead grantees (each of which are partnering with numerous other groups) announced today are:

  • Barnstable County Department of Human Services
  • Berkshire Medical Center
  • Boston Public Health Commission
  • Holyoke Health Center
  • City of Lynn
  • City of New Bedford Health Department
  • City of Worcester
  • Manet Community Health Center
  • Town of Hudson

Each grantee will receive up to $250,000 for a planning grant, and, may receive $900,000 to $1.5 million annually over the next three years to implement their plan.

The MPHA release and Patrick administration announcement, with lots of details, are below: Continue reading

Posted in Healthcare Cost Control, Public Health | Leave a comment

Health Policy Commission Unveils 2013 Cost Trends Report and Awards $10M for Community Hospitals

HPC slide showing major components of cost trends report

The Health Policy Commission (HPC) met Wednesday, January 8, for its first meeting of 2014.  Following suit from the last full meeting, the 2013 Cost Trends Report was a main topic of discussion. Also on deck was a presentation about the award recipients for the Community Hospital Acceleration, Revitalization, and Transformation (CHART) program and an update on the registration of provider organizations.

Materials from the meeting are here, and our full report is on the back side. Continue reading

Posted in Healthcare Cost Control | Leave a comment