judyann bigby


Major Turnover In Patrick Cabinet Expected; St. Elizabeth’s Chief To Lead Health

Dr. JudyAnn Bigby

Dr. JudyAnn Bigby

The Boston Globe broke the news late yesterday that Gov. Deval Patrick will announce replacements today for several top administration figures, including Health and Human Services secretary JudyAnn Bigby, finance chief Jay Gonzalez and public safety head Mary Beth Heffernan.

An administration source tells WBUR that the replacements include:

• Suffolk Sheriff Andrea Cabral as public safety secretary.

• The president of St. Elizabeth’s Medical Center, John Polanowicz, as health and human services secretary.

• Glen Shor, current head of the Massachusetts Health Connector, as head of Administration and Finance.

'Connector' Chief Glen Shor

‘Connector’ Chief Glen Shor

An administration official says: “This is a natural transition time and we expect some change in the administration. The Governor asked all of his Secretaries for a two year commitment at the start of the second term and has asked them for a similar commitment now.”

The Globe notes that the outgoing secretaries have both earned praise and been “dogged by controversies,” including: Continue reading

GOP Calls For Bigby’s Resignation In Wake Of Lab, Pharmacy Scandals

State House News Service reports that Republican lawmakers are charging Dr. JudyAnn Bigby, the Mass. Secretary of Health and Human Services, with lack of adequate oversight following an evidence-tampering scandal at the state drug lab and disclosures of tainted steroids at the The New England Compounding Center linked to more than 30 deaths around the nation. The news service reports that GOP leaders are calling for Bigby’s resignation:

JudyAnn Bigby, Mass. Sec. of Health and Human Services

House Minority Leader Brad Jones and members of his leadership team sent a letter to Patrick expressing their lack of confidence in Bigby to successfully manage the troubling situations, which both involve the Department of Public Health, an agency under Bigby’s oversight.

Bigby has testified twice this month before lawmakers during oversight hearings looking into the problems at the former Department of Public Health drug lab in Jamaica Plain and pharmacy industry oversight. While she has acknowledged that managers and regulators in both cases missed red flags and opportunities to limit the scope and spread of problems, she has told lawmakers that much of blame falls on the individuals involved in the wrongdoing. Continue reading

Bigby: Pharmacy, Lower-Level Staffers To Blame For Public Health Debacles

Dr. JudyAnn Bigby, Mass. secretary of health and human services

As hearings on the meningitis outbreak get under way today on both Beacon Hill and Capitol Hill, WBUR’s Deborah Becker aired an incisive interview on Morning Edition today with Dr. JudyAnn Bigby, the Massachusetts Health and Human Services Secretary.

The full sound file is here, but let me highlight one of the sharper moments. Toward the end, Deborah Becker asked the same essential question in several ways: Who, really, is responsible for these two major recent public health debacles in Massachusetts, the state crime drug lab scandal and the meningitis outbreak that emanated from a Framingham pharmacy that fell so incredibly through the state regulatory cracks?

What Deborah didn’t ask explicitly, but that I hear some people wondering sotto voce, is: Are you responsible, Secretary Bigby? If the widely respected public health commissioner, John Auerbach, had to resign over the state crime lab scandal, at what point does the buck stop with you?

In the interview, Dr. Bigby notes that the state board of pharmacy was the only entity that was truly responsible for overseeing the Framingham compounding pharmacy that produced the tainted drugs, and she says efforts are under way to improve the board and its inspections.

“Right now, we are in the field doing unannounced inspections of pharmacies, and we believe that in the future, that this is a necessary step to make sure that there is further oversight of the pharmacies.”

DB: And what would you say to the folks who say, ‘Yes, now you’re doing inspections but did it take 32 deaths and several complaints against this compounding pharmacy?’

JB: I think that is a very appropriate question. This travesty is one of the worst disasters in health care that I can remember that was preventable, and I do believe the NECC operated under conditions where they not only violated state and federal laws but they also violated their own practices. and we need to make sure that this never happens again.

DB: So if you’re looking at this, who’s responsible for the failure here? Is it a systemic failure? Continue reading

First Hearing On MA Health Reform, 2011: Where Does Everybody Stand?

Okay. I’ve posted Attorney General Martha Coakley here. I’ve posted Gov. Deval Patrick here. Now for everybody else. Today’s State House hearing was the season opener, time for the players in Massachusetts health reform — from huge hospital systems to individual consumers — to stake out their opening positions. How do they see Gov. Patrick’s proposal for the next, cost-cutting phase of health care reform? What are their concerns?

Here’s my overarching impression: General support for the idea of shifting the system toward payment for “global” budgets for “whole-patient” care, away from fragmented payments for each service. And broad concern that if done wrong, it could hurt.

Full testimony is available from several major organizations. The Massachusetts Medical Society is here. The Pioneer Institute is here. Health Care For All is here. I’ll post more as I get them, and you’re deeply welcome to share links or thoughts in the Comments section below.

Meanwhile, here are some noteworthy moments from the first three hours or so of today’s hearing:

Dr. JudyAnn Bigby, secretary of health and human services, and the governor’s point person on the bill:

What’s wrong with our current health care system is that it “doesn’t consistently pay for the right thing.” That is, “The problem with the way we pay for care is that it’s based on insurance billing codes and not based on what patients need and what physicians are trained to do.”

Many payers and providers are already moving away from fee-for-service and forming more integrated care organizations, but it is a change that we must all approach with great care. It is because this transition requires thoughtful planning and should not take place in a haphazard manner that the governor’s bill is so necessary.

‘Our only beef, quite frankly, is that this is a very government-centric, Cabinet-centric approach’ — Lynn Nicholas, Massachusetts Hospital Association

Secretary of housing and economic development Gregory Bialecki:
“The health care cost crisis in Massachusetts is the primary roadblock to our continuing recovery.”

The governor’s bill “sends the message to businesses that their health care costs, which they see right now as being out of control, are going to become more consistent and more predictable and frankly more rational

Bialecki said he sees no evidence that the governor’s bill would hurt employment in the health care industry.

Not a return to the bad old days of HMOs

Rep. Steven Walsh, house chair of the committee, expressed concerns that the reform would be a throwback to the bad old days of HMOs, and people might find themselves unable to get care at top specialty hospitals such as Children’s Hospital and Dana Farber Cancer Institute. JudyAnn Bigby’s response: Continue reading

Excerpts from Deval Patrick’s Speech On Health Reform, Phase II

“If the legislation I file today feels like pressure on the market, good! Good! That’s exactly what it’s intended to do.”– Gov. Deval Patrick

Herewith some choice excerpts from Gov. Deval Patrick’s speech this morning, as well as remarks from Dr. JudyAnn Bigby, chief of health and human services. My little fingers were flying as fast as they could, but if any errors crept in please let me know and I’ll fix them. (And if you have the time, here’s the full speech.)

“At the current pace of increase, health care spending will consume a third of the median family income in Massachusetts by 2016. What health care threatens to do to family budgets it is already doing to government and business budgets. Health care costs account for 40% of state spending and have grown at nearly 8 percent annually the past three years.”

“The challenge of high health care costs is not unique to Massachusetts and it has nothing to do with our experiment here in universal health care.”

“Just as we devised the model for universal access, I believe we can crack the code on health care costs. One of the main reasons for the high cost of health care is the way we deliver health care. Most health care is currently provided under a ‘fee-for-service’ model that creates financial incentives for the quantity of care a patient receives, not the quality…There is no financial incentive in the current system for good care, only for more care. what we have is an expensive system that fails to provide the best care for patients…That has to change.” Continue reading

Extra! Extra! Twelve Points of Broad Agreement On Payment Reform!!

It may look like torpor, but it's actually unaccustomed harmony on health care payment reform.

Naturally, as a member of the media, I am what Spiro Agnew called a “nattering nabob of negativism,” and always lean toward writing about conflict rather than harmony. So I thought of beginning my report on today’s meeting of the state panel on payment reform by pointing out the huge areas of continued contention.

But then I thought, “Wait, what makes news is the unexpected, the counter-intuitive, the “Man Bites Dog” headline. We all expect prolonged if not endless wrangling about the next stage of health care reform in Massachusetts, the daunting challenge of containing costs and revamping the whole system from “fee for service,” in which health care providers are paid for each procedure, to global payments, in which they’re paid a lump sum for a patient’s overall care.

So today’s big news is that, believe it or not, the state panel made up of all kinds of “stakeholders,” from hospitals to doctors to patients to insurers, has actually reached a broad if not perfect consensus on twelve goals for payment reform. For the wonks among us, they’re listed below, in near-final form still subject to tweaking.

Panel members actually sounded a bit disbelieving themselves as they thanked each other for all the hard work of the last four months and acknowledged that this was only a first step in a difficult process still to come. Dr. JudyAnn Bigby, the Health and Human Services secretary, said that the panel’s ideas and points of consensus had “been heard” by Gov. Deval Patrick, who is expected to deliver a major speech on health care tomorrow.

Just a brief note on the lingering dissent, since that is not the flavor of the day. Several members pointed out that the consensus was possible because some of the hardest issues had been skirted, to wit: Will providers’ participation in global payment arrangements be voluntary? What powers will a new global-payment oversight committee have, and who will be on it? To what extent will the state seek to set rates that global payment groups can charge? In sum, how sharp are the state’s teeth going to be?

State Inspector General Gregory Sullivan said that in his opinion, the committee’s consensus “does not include what I would consider the necessary elements to actually control the rising cost of health care.” Under current global payment plans, he said, rates keep going up for a total of 50% over the next five years. For Massachusetts families, that would translate into a rise in their average premiums from $16,500 now to $25,000 in five years, he said.

“That shoud not be a goal, that should be the goal of what not to allow to happen,” he said. “What I think is missing from the current discussion is the enforcement mechanism that’s going to control the increasing premium rates that people pay insurance companies” for global payment plans.

Back to the sweetness and light. Below are the twelve goals:

Goals for Payment Reform Legislation

PREAMBLE: The purpose of any payment reform legislation should be to encourage the restructuring of health care delivery and payment methods, commencing upon enactment and to be completed at no later than five years, in order to improve the quality of care for all residents and decrease the total per capita health expenditures made within the Commonwealth. Continue reading

Mass. Blue Cross Reports High Marks For Global Payment Plan

Dr. Bob Weinstein, chief of family practice at Signature Healthcare

WBUR’s Martha Bebinger reports this morning on promising results from the first year of a Blue Cross Blue Shield global payments plan. Check out her full report, including audio, here.

As the state ponders a move to global payments to improve care and control health care spending, there is early evidence the strategy works.

Eight hospitals and physician groups that have been under this new payment model through Blue Cross and Blue Shield for at least a year are releasing the results. The groups all came in under budget and scores show they improved care. The verdict is out on whether patients like the change.

These hospitals and doctors say the move to global payments is a big deal. Doctors and hospitals receive a yearly budget for all their Blue Cross patients instead of getting paid for every office visit, test and procedure. The goal is save money while providing better care.

So let’s look at how these providers did in their fist year in three areas: cost, the quality of care and patient satisfaction.

Quality goes up

On quality, Blue Cross says at least twice as many patients under a global payment got cancer screenings, regular check-ups and kept their diabetes or heart disease under control as did patients in traditional plans.

Doctors at Tufts Medical Center boosted their patient quality scores, in part, by creating a registry of patients with a chronic disease and assigning nurses to track who needed a test or an appointment.

Jeffrey Lasker, CEO at the Tufts physician network, says the registry “helped us identify the patients who are in need of screenings or other follow-up measures so that’s been very highly effective.” Two years ago, Tufts fought pressure from Blue Cross to sign this global payment contract. But Lasker says once physicians started working under it things went well.

Costs go down

On costs, Blue Cross has pledged that over five years, the move to global payments will cut rising health care costs in half. Instead of going up at roughly 10-12% a year, the increase would be 5-6%.

So are these providers on track? Continue reading

The Emotional Gamut Of Payment Reform, Including Deval Patrick: ‘It Will Be Hard’

“We want to crack the code, finally, on health care costs,” newly re-elected Gov. Deval Patrick could be heard telling WBUR’s Bob Oakes on Morning Edition today. Against that backdrop, Gov. Patrick said, “Payment reform is the next big step — and it will be hard.” (Emphasis his.)

It so happens that just a bit after Gov. Patrick’s interview aired this morning, the state panel charged with crafting him a bill on payment reform met near the state house, to continue grappling with some of the issues that make it all so hard. (For masses of public comments on same, the panel has just posted them here.)

The panel’s challenge today was to discuss eleven formal goals for the legislation, which the Patrick administration aims to submit early in the coming session. The draft language of the goals should be posted soon on the panel’s Website. Let’s talk, instead, about feelings. As one panel member, Dr. Gene Lindsey, President of Atrius Health, put it: It’s important not to gloss over the emotions of payment reform.

Here’s the personal list I took away from today’s meeting:

Pain: Health care providers, Dr. Lindsey noted, will have to go through a long and painful process of learning a new way to do business. Extracting waste takes more than just writing a memo; it involves developing new skills.

A sense of urgency: With health insurance costs rocketing ever upward, said state Inspector General Gregory Sullivan, “We have to do something.”
“We have to get into some speciifcs and come up with some recommendations and face the urgency of where we’re at right now,” he said. (In fact, the committee will begin to take up potentially controversial specifics next week, members said.)
Said Dr. Lindsey, a bit later: “The crisis is here. the building is on fire.” It is hard to change, he said, but “if your change occurs after the building has burned down you haven’t necessarily achieved anything.”

Little ‘Aha!’s and Resolve in the Face of Wrenching Change: Continue reading