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New State Medicaid Director: Dr. Julian Harris

Dr. Julian Harris, new Medicaid director

This just in from the Patrick administration:

BOSTON – June 1, 2011 – The Patrick-Murray Administration today announced that Dr. Julian Harris has been appointed to serve as Director of the Office of Medicaid, a state program that provides comprehensive health insurance for more than 1 million children, families, seniors and people with disabilities in Massachusetts.

Dr. Harris – who has served in a wide range of organizations – currently practices primary care at the Southern Jamaica Plain Community Health Center and hospitalist medicine at the Cambridge Health Alliance, both of which serve populations with high levels of participation in MassHealth and other state health programs. He is a clinical fellow on the faculty at Harvard Medical School and a senior resident in internal medicine and primary care at the Brigham and Women’s Hospital and its affiliated Southern Jamaica Plain Community Health Center. He formerly served at the World Bank, where he was charged with day-to-day management of the World Bank Institute’s AIDS program. He also worked on national health payment and delivery system reform for an international client at McKinsey & Company.

“Massachusetts is a national leader in expanding access to health care, and we are now at the forefront of cost containment efforts,” said Governor Deval Patrick. “As Medicaid Director, Dr. Harris will play a vital leadership role in our nation-leading efforts provide high-quality, cost-efficient care for our most vulnerable populations.”

The announcement doesn’t specify the fate of the current director, Terry Dougherty. It says only:
“Dr. Harris will assume his new role on July 18. Current Medicaid Director and Assistant Secretary for Administration and Operations Terry Dougherty will remain with the Executive Office of Health and Human Services through August to ensure a smooth leadership transition.”

The Massachusetts Medical Society welcomed the new director: Continue reading

Committee Seeks ‘Reason To Believe’ From Gov. Patrick


I’d describe Gov. Deval Patrick’s reception by the legislature’s joint committee on health care financing today as extremely warm. I mean, really, both chairmen — Sen. Dick Moore and Rep. Steven Walsh — brandished copies of the governor’s new memoir, “A Reason To Believe.” What could be more supportive than that? Of course, Dick Moore did take to brandishing the title with a bit of his own edge: at one point, he averred that he’s seeking “a reason to believe” that the governor’s proposed health care bill will accomplish his goals. But still, there was no grilling; they saved that for other Cabinet members.

Here are a few of today’s points from the governor:

“If the first phase of reform was about reaching the 400,000 or more uninsured, this phase is about relief for all 6-1/2 million Massachusetts residents.”

The challenge before us is big but we cannot be defeated by its complexity. The good news is that there’s an emerging consensus about solutions.

Some in the industry say the state needs only to lay out a framework for reforming the way we deliver care and the market will take care of the rest. It is true many good things happening in the market…but we need to scale these up, we need to set up common expectations and standards, and we need to make sure that the savings are passed on to consumers and patients in the form of lower premiums. The goal is not to punish any part of the industry or to return to the days of price regulation….The goal of this proposal is to keep the pressure on all of us.

Every day, he said, he appreciates more the 2006 reform extending near-universal access to health insurance
I also understand more clearly every day why cost control was put off to another day. Because if you think access was hard, wait until you take on cost control.

Some very powerful interests “have deep stakes in maintaining the status quo. Our job is to balance all the interests but always to strike the balance in favor of the public good.”

Patrick To Doctors: I See Your Winks And Nods

Call me a muckraker, but I thought Gov. Deval Patrick sounded a bit peevish at one point today when he spoke to more than 200 doctors who’d come to the State House to lobby their legislators.

He’d just laid out his determination to proceed with the next, cost-containing stage of health care reform, despite the great complexity of the challenge. (He phrased it much as he did at Harvard recently — here’s that text.) Then he told the doctors that he saw them exchanging looks across their tables, “the furtive glances you’re casting, winks and nods. Let me tell you, we are going here, to integrate accountable care organizations, we are going there together.”

The video is above. He concludes:

“We have got to deliver on what is ultimately a values statement, and that is that health is a public good, and everyone in this commonwealth deserves access to adequate, cost-effective care.”

The Massachusetts Medical Society, which organized the doctors’ visit to the State House today, is arguing for a dozen main elements in Patrick’s proposed payment reform, as expressed in talking points that the society distributed to the visiting doctors today. They include:

-Physician directed authority: Physicians will make most of the clinical decisions under a new health care model, so it’s only logical that they are at the center of decision-making, both at the public policy level and the clinical level. Continue reading

Patrick At Harvard: Health Care May Be Complex But I’m Done. We’re Moving.


Maybe they decided it was a forum, not a press conference? Or maybe there was a technical glitch?

For some reason, The Forum at Harvard School of Public Health did not read aloud our question for Gov. Patrick — not two other excellent ones from our readers — when he spoke about health care reform yesterday. They had requested questions via email, but ah, well. It’s always fun to hear him say, yet again, with undiminished emphasis, “This is going to happen.” Referring to the next, cost-containing phase of reform, that is. He wanted the health care types who parse his words as if they were reading entrails — as he put it — to know that yes, it’s all still on. Just in case you’re one of those entrail types.

My favorite bit of Gov. Patrick’s talk, which is online here, came about 50 minutes in when he shared a glimpse of what it’s like for him to grapple with the state’s health care forces and the complexity of the system. He said:

“This experience of trying to understand what’s driving health care costs, for a non-medical professional — I mean, I listen well, I’m trying — but for a couple of years, we had all these luminaries around the table, the brightest lights, and I would simply say, ‘How come, in a recession we’re seeing these kinds of increases? And it would always start the same way: ‘Governor, it’s complicated.’

And then they would do this (he crossed his arms and pointed in opposite directions.) The insurers point to the hospitals, they say, ‘It’s because the rates of the hospitals, the costs of the hospitals, are going up, and that’s why your premium went up double digits.’ And the hospitals would say, ‘We haven’t seen any double digit increases in our reimbursements! It’s not us, it’s him! It’s the doctor practices.’ The doctor practices say, ‘It’s not us, it’s the imaging lab down the street!’ Nobody takes any responsibility for it because it’s complicated.

Okay. We could spend the next two years peeling away all that complexity. I’m done. I’m not interested anymore. We’re moving. Something has got to give. Because when we debate the complexity, the point is that the people paying those bills, those families, those small businesses, those cities and towns are seeing those premiums go up. It’s not sustainable.”

Ask Deval Patrick Your Health Reform Question


The Harvard School of Public Health is making an offer we cannot refuse: Send in your health care reform question for Gov. Deval Patrick and he could answer it during a Webcast tomorrow afternoon. You can also send a question for any of these local luminaries on the discussion panel:

John Auerbach, Commissioner, Massachusetts Department of Public Health
Hurmon Hamilton, President, Greater Boston Interfaith Organization
Nancy Kane, Professor of Management, Harvard School of Public Health
John McDonough, Director, Center for Public Health Leadership, Harvard School of Public Health; former Executive Director of Health Care for All

They’re all slated to speak on the next phase of health care reform — costs and quality — at a forum at the school of public health’s aptly named “Forum,” which aims to bring scientific experts and political decision makers together on urgent health topics. It is scheduled to be Webcast tomorrow at 4 p.m. here. I just asked WBUR’s Martha Bebinger, my revered health care policy sage, what our question should be, and we came up with this:

What is your best indication that a shift to global payments will actually save money, and how soon do you think those savings can actually be realized?

Okay, just sent it in to theforum@hsph.harvard.edu. Readers, if you send in a question, feel free to cut and paste it as a comment here as well. Just wondering what you’re most wondering!

NEJM: Malpractice Reform Heads In New Directions, Because It Has To

Gov. Deval Patrick


Gov. Patrick’s plan for the next wave of health reform includes changes in malpractice rules. To quote our own Bob Oakes:

Under proposed changes, doctors in Massachusetts would be able to apologize to patients — without the risk that their apology could be used against them later, in court. The state would also implement a six-month “cooling off period,” so that hospitals and patients could try to resolve problems without lawsuits.

An article just out in the New England Journal of Medicine offers some enlightening background on the current state of thinking on malpractice reform. Written by two Harvard experts, Allen Kachalia and Michelle M. Mello, it describes a pivotal moment that I’d sum up thusly: Most of what we’ve tried so far hasn’t worked very well. Let’s try some new things.

The authors write:

Medical liability reform is headed in a new direction, reflecting dissatisfaction with both the narrow focus of traditional approaches to liability cost control and the lack of effectiveness of most traditional reforms in achieving even that limited objective. The launching of the federal demonstration projects may reduce the impetus for federal statutory reform in the immediate future, but it may reap longer-term gains. By spurring both private innovation and nontraditional public-policy reforms, the new approaches to medical-injury response that are now being tested may bring us closer to a liability system that fosters, rather than obstructs, progress toward safe and high-quality health care.

And they note some clearly good news: research on the effectiveness of various malpractice reforms has expanded and improved in recent years.

Patrick Comes Out Swinging On Health Costs: Complexity Is No Excuse For Inaction

Gov. Deval Patrick, in an effort to push lawmakers to take up his health care cost containment legislation sooner, not later, opened a public forum at the Statehouse today saying that health care costs must be reined in now. He said, adamantly, that the complexity of the problem can’t be an excuse for inaction. Here, edited and condensed, is what he said:

Massachusetts will be the place where we can crack the code on costs — it will be done.

Currently, 98 percent of residents have insurance, 99.8 percent of children are covered, no one else can touch that.

“Health is a public good. And all things being equal, health care is affordable,” Patrick said. The first phase of health reform increased costs by 1% of state budget, he said.

“The problem is that all things are not equal — insurance premiums are rising at an unsustainable rate. Some conservatives want you to believe this is happening because of health care reform — they are wrong.”

State government — that is, MassHealth, The Connector and other subsidized programs make up 40 % state budget, he said. These costs are squeezing out public education, public safety and other critical services.

We are trying to balance this on the municipal side — but it can’t be done by cost shifting alone
(Again, he says, insurance premiums are simply too high.)

Businesses are ready to start hiring, but then they see the cost of health insurance plans, he said. There’s an “annual ring around the rosy of shifting plans.” Health care costs are a major roadblock to adding jobs — it’s a problem in particular for small businesses. Continue reading

At The State House Health Cost Panel This Morning: Rachel Reporting


Rachel is over at the State House this morning at Gov. Patrick’s panel on containing health costs. We’ll post updates periodically this morning. Her first dispatch:

As the panel and audience waited for Deval Patrick to arrive, secretary of administration and finance Jay Gonzalez said: “The point of this session is to talk about cost containment.”

Gonzalez says cost threatens government’s ability to provide health care for those who can’t afford it, it threatens businesses, threatens families. The challenges are huge, so is the breadth of the initiative the governor’s undertaking”

“The governor is not the most patient guy on earth, he’s interested in getting things done.”

“It is about ensuring that all residents of Massachusetts have access to better, more affordable health care. That is our common goal and we must act with urgency to achieve it.”

“The governor thought it was important to bring everyone together for this information session.”

Who’s here on the panel?

JudyAnn Bigby, Secretary, Health & Human Services
Delores Mitchell, Executive Director, Group Insurance Commission
Glen Shor, Executive Director of the Commonwealth Health Insurance Connector
Barbara Anthony, Undersecretary of the Office of Consumer Affairs and Business Regulation

Reminder: Patrick Panel Discusses Health Costs Tomorrow


From the governor’s official Website:

“We have led the nation on health care reform and we are going to do it again on health care cost containment,” said Governor Patrick. “This forum is an opportunity to highlight the various tools government, consumers, insurers and providers can utilize to control costs while ensuring that the people of Massachusetts continue to receive world-class care.”

Several of the proposals to be discussed during the forum include legislation filed by Governor Patrick in January to help cities and towns realize immediate cost savings in their municipal health insurance plans; the Administration’s comprehensive health care payment and delivery reform legislation filed in February to control rising health care costs and improve patient care; and the Massachusetts Health Connector’s procurement strategy to contain costs by promoting innovation and competition among the state’s managed care organizations. In addition, the Group Insurance Commission’s efforts to control rate increases and incent employees to move to lower cost plans will be examined.

The forum is scheduled to begin at 9 a.m. in the Gardner Auditorium at the State House. Readers, if you attend and want to share what most strikes you, you’re deeply welcome to comment below…

Globe’s Kevin Cullen Takes Patrick To Task On Blue Cross Payout


In case you missed it, Globe columnist Kevin Cullen perfectly captures here the public outrage over Blue Cross Blue Shield’s $11-million payout to former CEO Cleve Killingsworth. Kevin’s anger extends beyond Blue Cross to the governor who has failed to denounce that “big fat wet kiss” as obscene when so many are struggling to pay for health insurance:

Cornered by reporters Friday, Deval Patrick sounded like Peter in the Garden at Gethsemane, rejecting chance after chance to speak the truth about the money Blue Cross hands its big shots.

“It doesn’t matter what I think,’’ the frustrated governor said. “I’m not going to get into managing individual companies or individual compensation.’’

Hmmm. That doesn’t sound like the same guy who threatened to withhold state business from Hyatt Hotels after the chain crudely and cruelly replaced 100 housekeepers at its hotels in Boston and Cambridge with people who were forced to work more for less pay and benefits.

“You tell me that there are sound financial reasons for the company’s decision, and I accept that,’’ Patrick wrote Sept. 22, 2009, to Mark Hoplamazian, the chief executive of Hyatt Hotels. “But the manner in which these workers were discharged is so inconsistent with both the expressed values of the Hyatt organization and basic fairness.’’

Blue Cross flunkies can bleat as much as they want about the compensation packages they give their CEOs and board members being commensurate with the marketplace and blah blah blah. The truth is, to paraphrase the governor, it is inconsistent with both the expressed values of a nonprofit and basic fairness.