National spotlight on Bay State healthcare industry in 2007

By Margaret Leroux

This coming year will see Massachusetts’ ground-breaking health care program emerge from legislation to reality. Last October, the new insurance program, Commonwealth Care, began enrolling adults with incomes below the federal poverty line of $9,800; in January it will open for adults with incomes up to three times the federal poverty line of $29,400.

By July 1, new insurance options are to be available for small employers and uninsured people ineligible for Commonwealth Care. Providers are now developing insurance products, while the Commonwealth Health Insurance Connector Authority, which oversees the operation, is busy with outreach efforts to employers, employees and the general public.

“This is so dramatic and significant the whole country is watching,” says Daniel Moen, chair of the board of the Massachusetts Hospital Association and CEO of Heywood Hospital in Gardner. If the state succeeds in providing coverage for the previously uninsured, estimated to number more than 500,000, it will reduce the financial burdens of uncompensated care for hospitals. But legislation alone cannot address significant issues of rising costs and looming personnel shortages, warn the region’ s health care leaders. Wiser use of available resources, improved technology, and accessible information on cost and quality will be critical to the new law’ s success, they indicate.

The storm ahead

Having more patients come through the doors with some form of insurance coverage would be a major financial relief for institutions like UMass Memorial Health Care, which provided $100 million in uncompensated care in 2006, making it one of the largest providers of indigent care in the state. CEO John O’ Brien says the new law creates an opportunity for patients and a benefit to all hospitals.

Andrei Soran, CEO of MetroWest Medical Center in Framingham, predicts the year ahead will be “a defining moment for the healthcare industry as we face the convergence of many factors.” He cites the high costs of capital, as hospitals expand and renovate in order to compete, as well as counter-punches from the rising costs of insuring their own employees.

Medicare reimbursements are not keeping pace with hospitals’ expenses, Soran says, and community hospitals face competition from large academic centers that are offering laboratory services and outpatient surgery facilities in their own neighborhoods. Some community hospitals “won’ t make it through the storm ahead,” he warns.

Affordability is very much on the minds of healthcare providers too. If health care costs continue to rise, it will be hard to sustain the reforms enacted by the state’ s health insurance reform legislation, says Andrew Dreyfus, executive vice president, healthcare services for Blue Cross Blue Shield of Massachusetts.

“The big test of the new law will come for people who don’ t qualify for subsidies,” Dreyfus says. Low-cost insurance products call for cost sharing in the form of co-payments or high deductibles. “How receptive the public is to the new insurance products will be a major issue in 2007.”

“We’ll continue to see a lot of activity in new products,” says Robert Egan, senior vice president, marketing and product development of Waltham-based Tufts Health Plan Inc. “The goal is to find affordable price points to increase the numbers of insured people.”

Massachusetts leads in prescriptions

A first-of-its-kind collaboration between healthcare providers and technology vendors with support from drug store chains puts Massachusetts ahead of the nation in promoting electronic prescriptions, with almost six million of them being written in the Bay State right now.

The eRx Collaborative partners are: Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, Neighborhood Health Plan and technology partners DrFirst, Inc. and Zix Corporation. Participating pharmacies include: Brooks, CVS and Stop & Shop. The Collaborative has given more than 3,400 prescribers a handheld device and/or web browser. Prescription information is transmitted from the prescriber’ s software through electronic data interchange into the pharmacy system.

Doctors using the eprescription software get immediate information about their patients’ medication histories, potential drug interactions or allergic reactions, and receive real-time FDA safety alerts.

Andrew Dreyfus, executive vp, healthcare services, Blue Cross Blue Shield of Massachusetts, notes that in June of this year, nearly 8,000 potentially harmful prescriptions were changed as a result of drug-drug and drug-allergy interaction alerts through the eprescription software. The Washington D.C. based eHealth Initiative estimated the financial benefits of the national use of e-prescribing to be $2.9 billion.

The first physician in central Massachusetts to use eprescription software is an enthusiastic convert. Dr. Deborah Hazen, a Shrewsbury internist who’ s been using Pocketscripts software by Zix Corp. for two years, says, “there’ s no downside whatsoever” to eliminating handwritten prescriptions.

“The system is easy to use; it’ s very intuitive,” Dr. Hazen says. “My staff and I had no problem learning, even though we represent a wide range of computer abilities.”

A sole practitioner who writes about 150 prescriptions per week, Dr. Hazen says the electronic system has saved her practice “a huge amount of time.”

“For any task that is done repetitively, I look for the easiest and least painful way to accomplish it,” she explains, “and it’ s amazing how easy it is to do prescriptions this way. Renewing a prescription is just a matter of pressing renew and send and you’re done.”

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