Catalyst for Civic Improvement

On April 13, co-chair, Gary Campbell, welcomed attendees to the fourth panel in the Lowell Plan’s Speakers Series. The topic was health care.

The panel was moderated by Congresswoman Niki Tsongas and included Ray Campbell, Norm Deschene, Leanna Moran and Susan West Levine.

Ray Campbell is the Executive Director of the Center for Health Information and Analysis (CHIA), the state’s primary health data agency, collecting and analyzing data from hospitals, physicians, and health plans to create an accurate portrait of the Massachusetts health care sector. CHIA measures the financial condition of provider organizations such as hospitals and nursing homes, generates all the basic statistics about health care in Massachusetts (enrollment, coverage types, expenditures, premium  levels, etc.), and collects patient-level information to measure the utilization of different types of health care services.  In addition to data collection, analysis, and publication, CHIA works closely with the state’s major health care agencies (MassHealth, DPH, the Connector, the GIC, and others) to provide them with data and analytic services that help them do their jobs.  Before CHIA, Ray was at the state’s Group Insurance Commission where he served as the Deputy Director and Interim Executive Director.  
Norm Deschene is a Lowell Plan Board member and the newly-appointed CEO of Wellforce, a health system formed by Tufts Medical Center and Circle Health in 2014. On January 1, Hallmark Health became the third founding member. Wellforce provides hospitals and physicians with a better option for collaboration. The system brings together the strengths of academic medicine and community care in a model that respects both equally.  Wellforce organizations collaborated to bring expert Tufts Medical Center pediatricians, neonatologists, surgeons, ICU specialists and others out of Boston and into the Merrimack Valley. Wellforce includes nearly 3,000 physicians, 12,000 employees, four community hospital campuses, one academic medical center, and a children’s hospital.  

Susan West Levine, Lowell Plan Board member, was appointed Chief Executive Director of the Greater Lowell Community Health Center (LCHC) in April, 2016. Now located on Jackson Street and with plans for further expansion, the LCHC provides access to high quality, affordable health care to children and adults regardless of their ability to pay.  Prior to joining LCHC, Sue was the Chief of Staff to the Johns Hopkins University provost. She has a great deal of experience in Massachusetts health care. She previously served as chief executive of the nonprofit UHealth Solutions, the UMass Medical School affiliate that offers administrative services for health care organizations.

Leanna Moran, Lowell Plan Board member, was appointed in March, 2016 by Fallon Health to be the Site Director of Summit ElderCare, a Program of All-Inclusive Care for the Elderly (PACE), on the campus of D’Youville Life & Wellness Community.  PACE offers complete, coordinated, individualized care for older adults who want to live at home instead of a nursing home. Fallon Health is a not-for-profit health plan, started in 1977. Their mission is “making our communities healthy.”  They have a range of insurance product offerings, including Medicaid and Medicare funded government programs.  Fallon has always been innovative, and interested in the senior niche.  They were the first health plan in the nation to offer a Medicare Advantage HMO product.  They were the only health plan in Massachusetts that is also a provider of care, through PACE.   Prior to her role with PACE, Leanna was the Executive Director of our Senior Care Option program, which is also a coordinated care program for seniors.

Congresswoman Niki Tsongas, Representative for Massachusetts' Third Congressional District, is a strong supporter of the Affordable Care Act and has spoken on the House Floor against GOP efforts to repeal the landmark health care bill. Congresswoman Tsongas is focused on communicating with the constituents in the Third District to hear how the ACA has affected them personally and what a repeal of the law would mean for individuals, the health care sector, the Commonwealth and our economy.

Panel Discussion

Gary Campbell, Co-Chair, Lowell Plan Board of Directors: I am pleased to introduce the moderator of this morning panel - Congresswoman Niki Tsongas, Representative for Massachusetts' Third Congressional District.  Congresswoman Niki Tsongas is a strong supporter of the Affordable Care Act. I look forward to hearing about what’s happening in Lowell in terms of positive examples of collaboration, innovation, and progress being made in the health care arena.

Congresswoman Tsongas: My term in office has coincided with the debate on health care. As a necessity, I’ve had to deal with personal issues many have experienced. My husband’s career was cut short because of illness. One of our major worries at one point was his pre-existing condition. Fortunately, the law firm he joined had group health insurance, but for far too many, that is not the case. As we debated ACA, it was made clear to me that government has to play a role for those who can’t pay. It should be noted that the Massachusetts model, developed by Romney and Kennedy, was a conservative idea. I was on the floor of the House when ACA was passed, it was a monumental political act.

Health care is a business in this state and it is under threat. If some changes were adopted, about 999,000 people with pre-existing conditions were at risk of having their coverage take away or significantly changed. The state was at risk of losing $1.86 billion in Federal Medicaid funding. The fight is not over, much is at stake.

Congresswoman Tsongas introduced the panelists and Norm Deschene acknowledged his successor, Jody White, who will be CEO of both Lowell General Hospital and Circle Health effective April 10th.

Norm Deschene: Our focus is to provide appropriate care, in the right setting, for the right cost. We are committed to moving cost down and reducing cost costs to enable member hospitals to see a significant savings. Clinical decisions are backed by cost determinants and care. We have a strong academic partner at Tufts with a great price point. Approximately 85% of pediatric referrals in Lowell go to Tufts at about 1/3 the cost of Children’s Hospital in Boston.

Sue Levine: I started as ED of the Lowell Community Health Center last June and consider myself an honorary Lowellian. I talk about how special Lowell is wherever I go. There is a fighting spirit here and I am grateful to be a part of it. The LCHC is the largest health care provider group in Lowell. We touch the lives of half of the citizens in this city. We are a federally-qualified health center serving a population that may have challenges accessing care due to their socio-economic status. Here are a few statistics: 600 visits per day; 70% Medicaid; 13% commercial insurance; 6% uninsured; 46% served in a language other than English; 63% staff live in Greater Lowell; and we have 400 employees.

Leanna Moran: This year, Fallon Health celebrates its 40th anniversary of making this community healthy. Fallon Health is a HMO plan with a Medicare contract and a contract with the Mass. Medicaid program. We are incentivized to be proactive and preventative. Fallon’s Summit ElderCare, a Program of All-inclusive Care for the Elderly (PACE), serves area residents age 55 and older who are eligible for a nursing home level of care yet seek to live as independently as possible in their own homes. The program provides patient-centered, all-inclusive and coordinated health insurance, medical care and non-medical supports in one location. With more than 1,000 participants at five locations in Massachusetts—Charlton, Leominster, Springfield and two locations in Worcester—Fallon is the largest provider of PACE in New England. We coordinate care and coverage for seniors through NaviCare. A Care Team works with people to develop a personalized care plan. The strategy is to deepen existing relationships.

Ray Campbell: There is a Chinese curse that says, “May you live in interesting times.” We are all headed into more interesting times. Every four years, we roll out major changes. We are experiencing a sea-change from fee for services to risk-base management. Health care is important to everyone. In Mass., it is north of one half of the state’s budget. My agency collects data from healthcare organizations and generates statistics. We track enrollment in plans and the conditions of those going to E.R. and feed that information to front line agencies. In Mass., we have a bi-partisan instinct. Romney and Kennedy worked together, Governor Patrick stepped in, and Governor Baker has continued the work on healthcare.

 Congresswoman Tsongas: What are the strategic initiatives your organizations are undertaking?

Sue Levine: Our first goal is to expand Lowell Community Health Center as the health care home for the underserved by increasing access to high quality health care and integrating the delivery of health care; the second is to reduce health disparities and enhance the overall health of Greater Lowell; and the third is to invest in our people to become the workplace of choice and to ensure the ongoing and consistent delivery of high quality health care. Strategically, all our care is provided under one roof.  Our current construction project is scheduled to be completed by January 2018 and will enable us to expand our services to include dental and vision services.
Norm Deschene: Lowell General Hospital has opened Circle Care Urgent Health facilities in Billerica, Dracut and Westford. These openings have reduced ER visits by 300 a year and have improved access to services at a reduced cost. More care needs to be delivered using a different model. The system now is based on fee-for-services. In an effort to stem that, commercial insurance has moved to risk-management. Efforts are under way to reimburse providers based on the value, not the volume, of care—including paying doctors to keep patients healthy. 
Our three organizations have applied to form an ACO for Medicaid patients in Lowell. Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services. We manage well-being and health. ACO will allow retooling of care and team care.
Sue Levine: LCHC’s 40 community health care workers go to homes and assess situations first hand. For example, an elderly woman in public housing is suffering from asthma. Our employees look at contributing factors. Has the filter in the A/C been changed, is there a flowering tree outside? We are able to take preventative steps to improve care and reduce costs.
Leanna Moran: Social services agencies will be brought into the health care mold to advise on the social factors involved in an individual’s health. We will begin to discover the cause behind the cause.
Congresswomen Tsongas: Are patients and the administration receptive, or is it nascent?
Ray Campbell: It’s all about changing incentives. As the state moves MassHealth towards an integrated care ACO model under the Baker administration, the Executive Office of Health and Human Services (EOHHS) expects to re-procure all MassHealth MCO contracts for an effective date of October 2017 beginning this fall. Democratic House Speaker Robert DeLeo and Democratic Senate Leader Stan Rosenberg are supportive. 

Congresswoman Tsongas: If you could fix the ACA, where would you start?

Norm Deschene: There are good aspects and unintended consequences that are challenges. Some employers feel they don’t have to pay for health coverage because their employees qualify for MassHealth. MassHealth reimburses LGH 68¢ on the $1.00 for costs, we make up the difference with commercial insurers. Is there a proper insurance alternative for employers? We need to drive consumerism. Nothing will change unless we look at how and where the expenses are. Things will improve when we move to transparency of costs. We have a situation unique to Massachusetts because of the brand and proximity to Boston, the Mecca of healthcare. But care costs much more in Boston.

Congresswoman Tsongas: Massachusetts created the template for health insurance, as a result employee-based coverage expanded. This changed with ACA. The intended Federal penalty to employers if they didn’t pay was never implemented.

Ray Campbell: The conversation has moved from the delivery system to patient interest. It is difficult to find out the cost of a procedure. We need to empower people with knowledge of cost differentials. 

Leanna Moran: We need to find a way to encourage Medicaid patients to monitor their health and be proactive.

Following a series of questions from the audience, the panel was asked about the Greater Lowell Health Alliance and the innovative thinking driving people towards wellness.

Sue Levine: That’s the mission of LCHC. The very first thing we do is patient education. We have partnerships across the city to keep people healthy. We work with the Greater Lowell Boys and Girls Club, Mill City Grows, UTEC, the Merrimack Valley Food Bank and CTI.

Norm Deschene: Every three years, we do a community health needs assessment. There is an aggressive non-smoking campaign, a walkability effort, we are pushing bike lanes, and trying to encourage healthy life-style choices.

Ray Campbell: We are broadening our information and looking at external data. We are looking at opioid addiction statistics and incarceration information to understand contributing factors.

Leanna Moran: This is an exciting time to be in Greater Lowell. The focus of the Greater Lowell Health Alliance will be working with the community to develop a Community Health Improvement Plan (CHIP), based on the priority areas identified in the 2016 Community Health Needs Assessment. A CHIP is used as roadmap for health improvement over a three- to five-year period and guides the investment of resources of all organizations that have a stake in improving health for the residents of Lowell and the surrounding communities.

Sue Levine: The LCHC is scrappy. We are committed to meeting patients where they are. We continually ask, “What does this patient need right here, right now.

John Power, Co-Chair, Lowell Plan Board of Directors: I’d like to thank the Congresswoman for chairing this panel and each of the panelists for the insights this morning. On a personal note, I was seeing a primary care physician in one of the Boston hospitals who recommended I see a doctor at Lowell General Hospital. Thank you all for coming to this session of the Lowell Plan’s Speakers Series.