By Sarah Birnbaum | Thursday, November 11, 2010
Nov. 11, 2010
BOSTON — Federal health care reform is starting to trickle down to Bay State businesses. By January, employers will need to comply with a new set of regulations and start providing new health benefits. To get ready, the state is partnering with business groups, hosting forums around the commonwealth to prepare employers for changes in the law. But even as they present imminent changes, there's still a lot of uncertainty around certain provisions of the law.
Sandy Reynolds, Vice President of the business advocacy group AssociatAT ed Industries of Massachusetts (AIM), hosted the Boston informational session. Although many of the provisions of the federal health care bill are slated to go into effect in 2014, Reynolds said there are immediate changes that employers should be aware of. For instance, as of two months ago, employers have to provide time and a private place where nursing mothers can pump or breastfeed.
Many preventative services like routine checkups, and flu-shots have to be covered without copayments.
“Well-child care, immunizations, preventative visits to the doctor, colonoscopies are on the list," Reynolds said. "Mammograms are on the list. It’s a long list.”
Because there are no more copayments for these benefits, Reynolds said that employers should be prepared to see premiums go up by 1.5 – 3%.
But Eileen McAnneny, AIM’s chief lobbyist, said it won’t stop there. She said there are a number of hidden costs to employers in the federal health care bill.
“There are significant new taxes on health insurers, on medical devices, on pharmaceutical companies. All of them indicated that they will pass along those costs to premium," McAnneny said. "So in the short term, we’re going to see a bump up in premiums.”
While cost is a big concern, so is uncertainty. With the new Republican majority in the House, federal health care reform is up in the air. While repeal is unlikely, certain provisions might go away. And reportedly Republicans are looking to block funding to prevent states from implementing the measures.
One attendee at the forum asked what all that would mean for Massachusetts -- and Reynolds wasn't sure. “That’s beyond the scope of my capability to address,” she said.
But she said that employers need to stay informed by contacting state agencies and trade groups or by going to the government's main health care reform website.
The next informational forum will be on November 16th in Hyannis.
By Sean Corcoran | Tuesday, November 9, 2010
Nov. 9, 2010
With no cure on the horizon and few treatments available, the government spends about $170 billion annually caring for Alzheimer's patients. By the year 2050, that cost is expected to rise to $1 trillion annually, with about one million new Azheimer's patients being added each year.
In the second part of our series, "Venture Philanthropy: A Business Approach To Curing Alzheimer's Disease," Sean Corcoran reports on a group of local business leaders whose frustration with the slow pace of government-sponsored research has led them to use their venture capital experience to coordinate some of the nation's top doctors in a search for a way to stop Alzheimer's.
BOSTON -- In a nondescript building in the Charlestown Navy Yard, Dr. Rudy Tanzi, a Mass General researcher and professor of Neurology at Harvard Medical School, stands in a large lab filled with bays, benches and young research assistants hard at work. Behind Tanzi is a line of half a dozen or so machines that look like small cash registers.
"This is where we amplify the human DNA. We put the human DNA on chips, and these machines here, you put the chip in this slot and close it up," Tanzi explains. "And the machine adds different liquids to the chip to process it, to actually look at the variants in the DNA and start elucidating the differences."
Using these gene chips, the machines sort through the genetic information from hundreds of families whose members have Alzheimer's Disease -- an important step in the process of determining what genes play a role in Alzheimers -- either advancing the disease or preventing it.
"And then you put it in, this is an oven, it's just a simple oven, and you put the chips in here and they turn around in this carousel and they bake," Tanzi continues.
The chips are then read by a computer that displays the individuals's particular genome -- all the genetic information that was passed down from their parents. Researchers compare the genomes of brothers, sisters and cousins to determine why, genetically, some family members got the Alzheimer's and others didn't.
"And this is the most beautiful research that you can do because you basically are getting new clues that are totally unpredictable, you are getting new genes and new proteins that are sending you in totally new biological pathways that you would have never thought of that could be involved with Alzheimer's," Tanzi said.
"This is the most beautiful research you can do because you basically are getting new clues that are totally unpredictable."
-- Dr. Richard Tanzi
Tanzi calls this search for new genes the Alzheimer's Genome Project. When he started in 2006, only four genes had been linked to Alzheimer's -- and Tanzi had co-discovered three of them.
Those first four genes led to significant understanding about how Alzheimer's works, and they also led to new drugs to help dampen its effects. Tanzi was confident there were other genes involved in Alzheimer's, each one a potential new drug target.
The problem was that finding them would cost millions. And such a risky and expensive project was unlikely to be funded by the federal government or even private foundations.
"I was thinking, how do I ever raise enough money to be able to scan the whole human genome? It was kind of frustrating because here you knew you were able to scan the whole human genome in an unbiased manner to find the rest of the Alzhimer's genes, and I knew that 70 of the recent genes remain missing, but it was going to cost millions, a couple million dollars to do the experiment, and then along came my white knights!" Tanzi said.
Tanzi met those 'white knights' about five years ago. They were representatives from three prominent Boston-linked families: The Rappaport family of Nantucket, the Morbys of Martha's Vineyard and the McCance Family of Boston. The group's founding families are mostly venture capitalists who made their fortunes identifying the world's great visionaries and then supporting them as they built some of the most transformative companies of the 20th century. Now, they're turning to address Alzheimer's, largely because they see it as the best way to use their earned fortunes to help humankind.
Together, they would form a group called the Cure Alzheimer's Fund and become Tanzi's biggest supporters and his primary funders. Tanzi told them about the cash-register-like DNA machines just coming on the market, and he talked about the recently completed Human Genome Project, a map of humankind's 25,000 to 35,000 genes. The families believed Tanzi when he said genes are the compass to finding a cure or a preventative for Alzheimer's.
Now, Tanzi has been looking for four years, and he's identified more than 100 additional genes implicated in the disease. He is painstakingly testing the most important ones for undeniable proof of their role.
"So amongst the ones we found, beyond the original four, we have one, called Adam 10, where we did the whole package with Cure Alzheimer's Fund support. We found the genetic information that implicated the gene, we found defects in the gene, and we have shown using animal models -- mouse models -- how these defects in this gene causes Alzheimer's disease. And now we can think about drug discovery," Tanzi said.
"I knew that 70 of the recent genes remain missing, and it was going to cost millions... then along came my white knights!"
-- Dr. Richard Tanzi
Before investing in Tanzi, the founding families asked him and other medical investigators to create a comprehensive research plan, or roadmap, that would lead to finding a drug that can stop the pathology of Alzheimer's at its earliest point.
Jeff Morby, founder and chairman of the Cure Alzheimer's Fund, says with Tanzi taking the lead, they've recruited a consortium of top-flight doctors, the best and brightest they could find from labs across the country, to do the work their plan requires.
"The roadmap defines the things we are going to fund in more or less priority fashion. So as we discover new insights into the science of Alzheimer's, we are constantly revising the roadmap," Morby said. "And this is part of the venture capital approach to venture philanthropy that we're talking about."
Dr. Anne Young, chief of neurology at Mass General Hospital, says the families behind Cure Alzheimer's Fund have enabled Tanzi and a host of hand-selected other doctors to take risks and chances with their research, supporting projects other funders likely would be reluctant to touch.
"Dr. Tanzi finished the entire screen of the genome for genes. And he's got a whole repertoire of genes, each one of which is a drug target for curing Alzheimer's," Young said. "And now it's simply a matter of working through those end models and testing whether you can interfere with it and change the disease. This is so different from what we had 10 years ago. It is a breakthrough to have that kind of approach."
Young, Tanzi and others point to the limited amount of federal dollars being put into Alzheimer's research as a real problem. Less than $500 million a year is granted to Alzheimer's investigators, compared to billions given to other diseases. Alzheimer's research is not science constrained, they say, it's budget constrained.
"I think we have a lot of really good avenues to take, they just have to be taken. We need the funds and we need to go there. It's like a roadmap is there. I always think of it as the Yellow Brick Road," Young said. "First you have to go through the field of poppies and the enchanted forest."
Now, Young said, the researchers know where they're going. "It's no longer like 20 years ago when we didn't know what we were grasping at. We have genes now. We have drug targets."
"It's important to understand we can move fast, and we pick the best researchers."
-- Jeff Morby
The group isn't just doing genetics. It funds a variety of experiments looking for ways to detect symptoms early; and even methods of administering the drugs they expect will be developed from the information they gather. For example, one of their doctors has found a way to monitor a single neuron in the brain of a mouse to see what impact a medication will have on the functioning of that neuron, allowing scientists to test potential medications.
Another study, Morby says, involves going through the brains of dead Alzheimer's patients and finding where the damage has taken place and then correlating it with the genomic information.
"This person has damage to the hypocampus and he has this kind of gene, we can say, okay, this kind of gene and this damage are related," Morby said.
In addition to raising private donations via their website, as well as attracting some federal research dollars, the now-four founding families have spent more than $10 million of their own fortunes on research. $10 million in five years may not sound like a lot of money for such successful families -- but that's by design, says Henry McCance, another founding family member and the Chairman Emeritus of Greylock Partners, one of the nation's premier venture capital firms. McCance says one of the tactics venture capitalists use is to invest slowly.
"(At) Greylock when we do a startup project, we put enough money in to get to an important milestone or development, and then we reassess the project," McCance said. "And if the momentum is good and if the opportunity looks as sound as we originally expected and the management team has grown, and all sorts of other factors, than we will, if you pardon the phrase, we will double down on our investment. We'll enthusiastically put more money behind."
Even with McCance ready to reinvest, the problem Cure Alzheimer's Fund faces is the approximately $3 million a year the founders are putting into the organization is not enough to cover everything they think needs to be done to find a cure.
So they're contacting billionaires, and putting out calls to their colleagues, business competitors, other foundations and universities. It's time for a Man on the Moon project to stop Alzheimer's, they say, before the sheer numbers of demented people overwhelms the nation's healthcare system.
By Sean Corcoran | Monday, November 8, 2010
Nov. 8, 2010
For more than five million patients and their estimated ten million caregivers, Alzheimer's disease is a scourge, a memory-stealing, brain-clogging affliction that costs the United States more than $170 billion a year, though its true impact on the lives of American families is incalculable.
In the first installment of our 2-part series, "Venture Philanthropy: An Investor's Approach to Curing Alzheimer's," reporter Sean Corcoran introduces us to a small group of local business leaders who are using their proven investment techniques — and their personal fortunes — to assemble what they believe are the world's most promising researchers to slow, stop or reverse the disease.
By Andrea Smardon | Monday, November 1, 2010
Nov. 1, 2010
BOSTON -- The state Supreme Judicial Court hears oral arguments Monday in a case involving legal immigrants who feel they've been unfairly treated by the state regarding their access to subsidized health insurance.
Lawyers for four immigrants have filed a class-action suit that charges that the state violated their constitutional rights by dropping them from the Commonwealth Care insurance program last year. In a budget-cutting move, the state contracted with a for-profit insurance company to provide cheaper coverage for this population. The deal saved the state $90 million.
Regardless of the outcome of the lawsuit, the deal may be a preview into the future of health insurance for more Massachusetts residents.
Maria Reyes sits on a loveseat in her small, one-bedroom apartment in Everett, rifling through a plastic container filled with medications. “These two medicines I have to take two times a day, and this one pill a day,” Reyes counts off. “And these three – I have to take two pills per day for each one.”
Reyes has six different prescriptions. She takes them because her thyroid was removed when she had surgery for throat cancer. And she has diabetes. She says she needs the medication to live, but when she runs out, she doesn’t have the money to get more.
For Immigrants, A New Program
Reyes hasn’t seen a specialist for a year. The last time she went to see her doctor at Somerville Hospital, she was told that her Commonwealth Care insurance no longer covered her there. Eight days later, she was told that she was enrolled in the Commonwealth Care Bridge program, and she should get her care in East Boston.
“When they sent me away from this hospital, I cried because I had really good doctors in that hospital,” Reyes said.
When Reyes was in Commonwealth Care, she didn’t have to pay for doctor’s visits. But on her new program, Celticare, that’s changed. “They told me if I want to see the specialist I have to pay $25. If I’m very sick and I go to the ER – I have to pay 25 and I can’t afford,” Reyes said.
There are about 23,000 immigrants like Reyes enrolled in the Bridge program. They’re called Aliens with Special Status (AWSS), and they’re all legal immigrants, though not citizens -- most of whom have had green cards for less than five years. Amid budget cuts last year, state lawmakers wanted to drop this group from subsidized insurance entirely because the federal government doesn’t reimburse states for their care.
Under pressure from Gov. Deval Patrick, lawmakers agreed to fund limited coverage – but only allocated a budget for a third of what was originally projected to insure the population. Put out for bid, the only insurance provider that said it could offer coverage at the reduced price was Celticare, a subsidiary of the for-profit company Centene.
Part of Celticare’s approach is to use a selective network of providers, so some patients had to change doctors.
Ruth Hertzman-Miller is a doctor at Somerville Hospital, a part of the Cambridge Health Alliance – which lost about 1,500 patients to the Bridge program. She says she and her colleagues were concerned about what was going to happen to these patients.
“Here we were as primary care doctors taking care of a subset of patients – who first of all couldn’t see us anymore – and who we were starting to hear stories. It wasn’t clear how good their access to a new physician was going to be,” Miller said. “So we just had a concern about what’s going to happen to my patients when their medical care gets disrupted in this way.”
Dr. Hertzman-Miller and two residents conducted their own independent study. They called all the providers in the Celticare network within a five-mile radius. They found that less than a third of the primary care providers were taking new patients, and there was an average wait of 33 days.
Dr. Hertzman-Miller says her concern about a private company like Celticare is that it has an incentive to keeps costs down by limiting the care it provides. She says she fears that the company is using the Bridge program to make inroads into the Massachusetts insurance market.
“So I think there’s a distinct possibility that somebody looked at this strategically and said hey, let’s get into the business of providing care to these members, we won’t have to provide that much care and it will allow us to get into the market,” Hertzman-Miller explains.
Executives at Celticare strongly dispute Dr. Hertzman Miller’s claims. CEO Richard Lynch says her data is incomplete, and that the number of providers available is significantly more than her data showed.
"We Were The Only Ones Who Stepped Up"
Celticare commissioned its own study in March. Lynch says a majority of its members reported they were satisfied with their coverage, and 90 percent of patients who saw a physician were happy with the coverage they got.
“These numbers are in line with numbers we see in surveys for health care coverage across the country. Primary care access in Mass. and across the country is something we know we can improve on, we can all improve on,” Lynch said.
He added that Celticare patients may be experiencing the same frustrations – like long waits and co-pays – that patients experience across the board. “Is it possible that our members experienced something similar to what other members are experiencing in other health plans, absolutely yes. Our job is to look at creative solutions to that access problem,” Lynch said.
Lynch points out that this population would not have any health insurance at all if Celticare didn’t step in to do the job.
“The Bridge program was a situation that was presented to all of the health plans in CommCare in Mass. And we stepped up together with our provider partners to help provide a solution there… and we were the only ones who stepped up to provide that kind of coverage,” Lynch said.
“We thought it would be a good opportunity to showcase what we could do… that we could provide fairly comprehensive coverage to a vulnerable population and do it for less,” Lynch added.
Lynch says Celticare could not have provided the level of coverage it does at its price price on its own. It was a collaborative effort with its health care providers and the state.
The Discrimination Case
Now, the state is being called to defend itself in a class action lawsuit brought by the four immigrants who lost access to Commonwealh Care insurance. Matt Selig, Executive Director of the Health Law Advocates, says that the plaintiffs were denied their constitutional right to equal treatment under state law when they were dropped from its insurance program. Selig says the Bridge program doesn’t absolve the state.
“The case we filed is about discrimination. The fact that our plaintiffs have been provided some assistance through the Bridge program isn’t a valid defense for the Commonwealth in this case,” Selig said. “They’re receiving not as good coverage as they would under the Comm Care program so they’re being discriminated against as a result of that.”
Glen Shor is the Executive Director at the Connector Authority, which oversees state insurance programs. He declined to comment on the lawsuit, but he defended the Bridge program.
“The Bridge program is comprehensive coverage. It certainly meets our network adequacy standards. The benefits and cost sharing is comparable though not identical to Commonwealth Care coverage,” Shor said.
Shor says the Bridge alternative provides a meaningful alternative to no care at all for legal immigrants. “Would we prefer ultimately to serve this population with Commonwealth Care? Absolutely,” Shor said. “But we stared at the very real prospect is that this population would have no coverage.”
The Celticare "Experiment"
Shor points out that, in 2014, federal resources will become available to cover this population of legal immigrants. In the mean time, funding for the program is only secured through the end of this year. Shor says whatever happens, the program has been a valuable learning experience for the state.
“The experience with Celticare will be educational for the commonwealth. One benefit of this experience is having the opportunity to experiment with selective networks and learn from the experience,”
But from Maria Reyes’ perspective, the change has amounted to a failed experiment.
“The only thing that I ask is, ‘Please take this insurance, and give me the insurance that I have before,’” Reyes said. “And my favorite is Somerville hospital and I want to go back there. It was the first hospital I went to when I first came to this country.”
If the plaintiffs prevail in the lawsuit against the state, the legislature may be forced to return legal immigrants like Reyes to the rolls on Commonwealth Care insurance. But regardless of the outcome of the case, the Bridge program may be a preview of what’s to come in state-subsidized insurance. As Glen Shor at the Connector Authority says, the Celticare experiment will inform lawmakers’ future health policy decisions.
By NPR Staff and ProPublica | Tuesday, October 19, 2010
By Liz Kowalczyk | Monday, October 18, 2010
|Find out if your doctor is taking payments from drug companies.|