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166 posts categorized "Massachusetts"

August 04, 2014

A Sunday bike ride with 5700 of my closest friends

Pmc-badgeI rode in the Pan Mass Challenge this past weekend, and surprised myself by riding faster than expected. I did not ride Saturday (it rained all day; my injury and lack of training really paid off ...), but Sunday was a wonderfully cool day for a ride with just a few sprinkles. The weather and the adrenaline helped me out. Thank you to everyone who has supported my ride and the Pan Mass Challenge. We're working to raise $40 million this year to add to the $414 million raised to date by the PMC for the Dana Farber Cancer Institute's Jimmy Fund. There is still time to whip out your credit card (or those appreciated securities) and join in -- on my PMC profile (offer ends October 1).

Check out the Storify of my #PMC2014 ride after the jump.

Continue reading "A Sunday bike ride with 5700 of my closest friends" »

March 13, 2014

Medical Marijuana in Massachusetts: Is the Application Process Broken?

MMOn January 31, the Massachusetts Department of Public Health announced that it had identified twenty provisionally-approved applicants for certificates of registration to operate medical marijuana dispensariesDPH is running point for the state under the medical marijuana law passed in Massachusetts by ballot question in November 2012.

Since the announcement, the local media have published innumerable stories raising questions about the medical marijuana dispensary application review process. Many of these stories are about local and state elected officials, public safety officials and disappointed applicants airing concerns about the process in a variety of different manners and forums, including a Boston City Council committee hearing, an inquiry into the process by leadership of the state legislature, and at least two appeals (1Releaf, Apex) filed in court thus far.

Continue reading "Medical Marijuana in Massachusetts: Is the Application Process Broken?" »

December 23, 2013

Massachusetts Health Policy Commission Cost Trends Report

The Massachusetts Health Policy Commission released its preliminary cost trends report for 2013. In case anyone needed confirmation, Massachsuetts health care costs are above the national average.

The report says: “Spending in Massachusetts is the highest of any state in the U.S., crowding out other priorities for consumers, business, and government.”

Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report

The Massachusetts Medical Society summarized the report on its blog. Here are a few excerpts:

  • Massachusetts is No. 1 in the country for personal health care expenditures:
    • Massachusetts: $9,278 per person
    • U.S.: $6,815
    • If you adjust the data for our older population, broad access to care, and higher overhead costs (wages, rent, supplies, etc.) the difference is still 20%.

Continue reading "Massachusetts Health Policy Commission Cost Trends Report" »

December 11, 2013

Digital Health: Apps, Analytics & Agencies

I spoke yesterday at the Massachusetts Bar Association's "Hot Topics in Healthcare" program. (Webcast live, and available behind a paywall at the link.)

Here are my slides:

Continue reading "Digital Health: Apps, Analytics & Agencies" »

November 12, 2013

Health Exchange Enrollment: Speed of Light or . . . Molasses





















Much has been said and written about the dearth of new commercial health insurance plan enrollees on the federal and state exchanges and, by contrast, the excessive numbers of Medicaid expansion enrollees, the death spiral signified by the absence of Young Invincibles from the exchanges, etc.

The HealthBlawger suggests: Cool your jets.

Continue reading "Health Exchange Enrollment: Speed of Light or . . . Molasses" »

June 18, 2013

Alternative Quality Contract with Blue Cross Blue Shield of Massachusetts: A model for ACOs?

Managed Care Magazine recently ran a story on the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), which serves as a model for the ACO program under the Affordable Care Act. Check it out: Bay State Blues Combine Global Payment With Quality Metrics. The author of the piece, Joe Burns, contacted me as well as others in Massachusetts for comment.

My take, drawn from the story:

David Harlow, a health care lawyer in Newton who writes the HealthBlawg, agrees [that the early findings are encouraging], calling the AQC a significant development for two reasons. First, it is an alternative to fee for service.
“That’s appropriate because there is a need to change the incentives of health care providers in the system,” he adds. Second, the AQC is important because it has served as a model for the federal Centers for Medicare & Medicaid Services’ accountable care organizations.
“The problem with past attempts to control health care spending is that adequate quality standards were not in place,” Harlow says. “It was all about keeping costs down. While this model represents an improvement over other models, the amounts at risk are relatively trivial and, standing alone, will not bend the cost curve.
“Nevertheless, the AQC is different because no provider group can earn a quality bonus unless the physicians and hospitals achieve or exceed the quality standards.”

As I've written before, I think the focus should be on long-term planning for a wholesale shift away from fee-for-service medicine rather than trying to expose and rationalize payment levels. Global payments (a euphemism for that dirty word, capitation), a bonus structure tied to performance against quality benchmarks pegged at a level sufficient to change provider behavior, and dedicated funding within the global payment system for nurse case managers and other elements of the medical home model, are the key elements of the solution we are looking for.

The AQC is a good start. 

David Harlow
The Harlow Group LLC
Health Care Law and Consulting 

November 21, 2012

Engage With Grace

As patients, as family members, as friends, as health care providers, we have all faced end-of-life issues at one time or another, and we will face them again. And again. 

Having been through this process twice in the past year, I can only repeat that it is important to have The Talk, to help ensure that your family members' and friends' wishes about end-of-life care are clear, are documented and, as a result, are followed. If it helps to get the conversation going, use the Five Questions in the slide at the end of this post. 

Download your copies of the Massachusetts health care proxy form or other states' proxy or living will forms -- and add specific instructions about nutrition, hydration, and anything else that is important to you so that everything is crystal clear.  Having the conversation is a starting point; we all need to follow through and make sure that our loved ones' wishes are documented, placed in medical records, discussed with physicians and other caregivers, and honored.

And with that I turn it over to @engagewithgrace for #blogrally12 (the latest edition from a group of us kickstarted by Alexandra Drane, Matthew Holt and Paul Levy.) If you blog, consider copying the rest of this post, and putting it up now through the end of Thanksgiving weekend. 

- O -

One of our favorite things we ever heard Steve Jobs say is… ‘If you live each day as if it was your last, someday you'll most certainly be right.’

We love it for three reasons:

1) It reminds all of us that living with intention is one of the most important things we can do.
2) It reminds all of us that one day will be our last.
3) It’s a great example of how Steve Jobs just made most things (even things about death – even things he was quoting) sound better.

Most of us do pretty well with the living with intention part – but the dying thing? Not so much.

And maybe that doesn’t bother us so much as individuals because heck, we’re not going to die anyway!! That’s one of those things that happens to other people….

Then one day it does – happen to someone else. But it’s someone that we love. And everything about our perspective on end of life changes.

If you haven’t personally had the experience of seeing or helping a loved one navigate the incredible complexities of terminal illness, then just ask someone who has. Chances are nearly 3 out of 4 of those stories will be bad ones – involving actions and decisions that were at odds with that person’s values. And the worst part about it? Most of this mess is unintentional – no one is deliberately trying to make anyone else suffer – it’s just that few of us are taking the time to figure out our own preferences for what we’d like when our time is near, making sure those preferences are known, and appointing someone to advocate on our behalf.

Goodness, you might be wondering, just what are we getting at and why are we keeping you from stretching out on the couch preparing your belly for onslaught?

Thanksgiving is a time for gathering, for communing, and for thinking hard together with friends and family about the things that matter. Here’s the crazy thing - in the wake of one of the most intense political seasons in recent history, one of the safest topics to debate around the table this year might just be that one last taboo: end of life planning. And you know what? It’s also one of the most important.

Here’s one debate nobody wants to have – deciding on behalf of a loved one how to handle tough decisions at the end of their life. And there is no greater gift you can give your loved ones than saving them from that agony. So let’s take that off the table right now, this weekend. Know what you want at the end of your life; know the preferences of your loved ones. Print out this one slide with just these five questions on it.

Have the conversation with your family. Now. Not a year from now, not when you or a loved one are diagnosed with something, not at the bedside of a mother or a father or a sibling or a life-long partner…but NOW. Have it this Thanksgiving when you are gathered together as a family, with your loved ones. Why? Because now is when it matters. This is the conversation to have when you don’t need to have it. And, believe it or not, when it’s a hypothetical conversation – you might even find it fascinating. We find sharing almost everything else about ourselves fascinating – why not this, too? And then, one day, when the real stuff happens? You’ll be ready.

Doing end of life better is important for all of us. And the good news is that for all the squeamishness we think people have around this issue, the tide is changing, and more and more people are realizing that as a country dedicated to living with great intention – we need to apply that same sense of purpose and honor to how we die.

One day, Rosa Parks refused to move her seat on a bus in Montgomery County, Alabama. Others had before. Why was this day different? Because her story tapped into a million other stories that together sparked a revolution that changed the course of history.

Each of us has a story – it has a beginning, a middle, and an end. We work so hard to design a beautiful life – spend the time to design a beautiful end, too. Know the answers to just these five questions for yourself, and for your loved ones. Commit to advocating for each other. Then pass it on. Let’s start a revolution.

Engage with Grace.

Engage With Grace

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

September 05, 2012

CO-OPs - The Stealth Public Option Under the ACA?

362px-Minute_Man_Statue_Lexington_Massachusetts_croppedLast week, the Massachusetts CO-OP was approved by the federales under a provision of the Affordable Care Act that was key to the Act's passage, yet not widely known. The Consumer Operated and Oriented Plan, known as the Minuteman Health Initiative, secured a startup loan as part of the approval, intended to cover operational expenses as well as state-mandated reserves. Here's an excerpt from the Minuteman presser, as published by CommonHealth:

Tufts Medical Center, its New England Quality Care Alliance (NEQCA) physicians network and Vanguard Health Systems (NYSE: VHS) are proud to sponsor the Minuteman Health Initiative, which has received an $88.5 million loan from the Centers for Medicare and Medicaid Services (CMS). This new member-governed, non-profit health insurance option for Massachusetts residents intends to offer consumers and employers lower-cost, high-quality care with unprecedented transparency, as well as increased efficiency and satisfaction for physicians, patients and employers alike. Plan members will ultimately govern this health plan via Minuteman’s unique ownership structure.

Congressional proponents of "Medicare for All" (aka the public option) took their lumps when the ACA did not include such an animal -- in part, because it did include the CO-OP requirement: one CO-OP per state, to be a nonprofit founded by providers and run by consumers, whose margins are to be plowed back into premium reductions, improving benefits and improving quality of care. (Don't confuse the CO-OPs with co-ops, which are simply group purchasing cooperatives for health insurance that manage to eke out tiny group discounts. In Massachusetts, co-ops are limited in total enrollment to 85,000, a fraction of the small group and individual market population.) CO-OPs are supposed to be operational in every state, ready to enroll members (and therefore with provider networks already in place) by 2014, so they can get started on an equal footing with other health plans on state exchanges, on offer both to individuals and to employers (though 2/3 of enrollees must be from the individual and small group markets).  Founded by providers, they are required to transition to member control within a year of beginning member enrollment.

Did that political horse trade make sense? Do CO-OPs make sense?

The CO-OP in any state has the potential to become a serious competitor to existing health plans. Since there is a limit of one per state, the potential enrollment is high, and the attractiveness to providers and provider networks -- including a willingness to enter into pricing and contracting arrangements favorable to the CO-OP, such as global caps and ACOs -- is also high. In the Massachusetts example, seventeen non-founder hospitals have expressed interest in participating. (That's about 20% of the state's acute care hospitals interested in the CO-OP before it's even off the ground.) The only other insurance plan on offer statewide is Blue Cross Blue Shield, so if the CO-OP can build or rent a provider network quickly, and differentiate itself in the various markets statewide, it has the potential to become a real powerhouse.

On the downside, a CO-OP has to price its products without having historical claims data, which could be tricky, and it needs to scale up its administrative infrastructure before it has the membership base to support it (of course, it could contract for those services, and the loan from the federales is intended to cover such up-front costs). It's a big gamble: trying to break into a market dominated by a small handful of players is never easy, and trying to do so as a nonprofit that can have no ties to existing insurance companies may make it harder.  

The potential difficulties ahead of the CO-OPs explain why CMS reportedly anticipates a 35-40% default rate on the startup loans and may raise an eyebrow (after all, a billion here, and a billion there, and soon we're talking serious money).  Do we need CO-OPs to make the ACA work, or is this one of the throw-it-against-the-wall-and-see-what-sticks provisions?

The CO-OPs may well play out as the Medicare for All / Accountable Care Organizations for All sleeper cell of the ACA. A well-managed CO-OP in a state with the right market conditions could end up as a significant player. In Massacusetts, if Minuteman picked off half of the individual and small-group subscribers through its likely more attractive pricing, and the maximum number of larger-group subscribers to go along with them, it could be looking at 375,000 subscribers (and some multiple of that for covered lives) in not too long from now. Let's say, for argument's sake, 1 million covered lives in a state with a population of around 6.5 million. Not too shabby for a startup. While some may say that Massachusetts is a bad example as a poster child for this initiative, because the "big three" health insurers here are all nonprofits and we don't have a significant uninsurance problem thanks to state health reform, there is still room for improvement here -- nonprofits still have highly-paid execs and other elements of high-cost structures that may be different in a member-controlled CO-OP, and there are rural parts of the state that would benefit from the innovations that could be brought to bear by a high-functioning CO-OP partnering with ACOs and PCMHs. And if there's room for improvement here, I think there's room for improvement in most states.

The CO-OPs have the potential to be the tail that wags the dog -- larger insurance companies may well adopt the commercial market pricing and provider network contracting and benefits strategies of the CO-OPs in order to remain competetive. And in an era of legislated medical loss ratios (and the CEO of Aetna saying that he sees his company as a health information company rather than as an insurance company), that dog seems ready to be wagged.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

August 30, 2012

HealthCamp Boston 2012: Brainstorming the Future of Healthcare


I am on the organizing committee for HealthCamp Boston, which will roll into town on Friday, September 14th. You should be there! 

HealthCamp Boston is a forum for people with interest in all areas of health and wellness to gather, to generate ideas, and to take practical steps towards building the future of health care. HealthCamps are different from traditional conferences where speakers talk at you. At HealthCamp Boston, an “unconference,” attendees set the agenda, and all contribute to the event according to their interests.

The Boston area is a center of innovation for all aspects of health care, so you can be certain that people at HealthCamp Boston will be discussing things like:

- Big Data in health care

- Improving engagement and outcomes through mobile devices and social media

- Personalized medicine and translational medicine

- Empowered patients

- Practical impacts of health care reform

- and more...

Join us on September 14th and be part of the conversation with academics, industry experts, innovators, investors, analysts, and engaged patients.

Register here: You can see a list of registrants to date as well.

We are looking for sponsors that may be interested in presenting "4x4" sessions -- 4 slides, 4 minutes, presenting a current issue or problem, which, along with a "firestarter" panel, will help get the juices flowing.

This year's HealthCamp Boston is scheduled as a lead-in to Medicine 2.0.  If you are coming to town for Medicine 2.0, come a day early and join HealthCamp.  If you are local and would like to join in the fun, come to HealthCamp.

If you're coming and would like to introduce yourself, answer the questions posed in this email interview of a camper and email them to me (it is not hard to find my email address) -- we'll post them at

Please share/post as appropriate.

I look forward to seeing you at HealthCamp Boston 2012.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

July 31, 2012

Massachusetts Health Reform Bill Tackles Cost Control and More

The Massachusetts legislature is voting today on "An Act improving the quality of health care and reducing costs through increased transparency, efficiency and innovation" reported out of conference committee at the eleventh hour, last night. (Update: The law was passed by both houses and sent to the Governor for signature this evening.) The headlines include:

1.    The health care cost growth rate may not exceed growth of the "gross state product" (GSP) for five years, and must be between the GSP and .5% below the GSP for the next five.

2.    Certification programs for Patient Centered Medical Homes and Accountable Care Organizations.

3.    Transparency and accountability for cost and quality.

4.    Investment in wellness and in community hospitals.

5.    Med-mal reform including a 6-month coooling off period and inadmissibility of medical apologies in court proceedings.

The full text of the bill, and a summary, are set forth below.  It's been a long haul, and this Part III of Massachsuetts health reform was kicked off by Governor Deval Patrick almost 18 months ago.

A return to central health planning?  Not quite, but certainly more heavily regulated than things are at the moment. Is that a bad thing?  Well, consider how the free-market approach has been working out: overall, we've seen a high-cost, low-quality experience (relatively speaking) that could use some help. Is this new law the panacea we need? Too soon to tell. But we surely cannot stick with the status quo.

MA Health Care Reform Bill - Summary


MA Health Care Reform Bill S 2400 7 30 2012

David Harlow
The Harlow Group LLC
Health Care Law and Consulting