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Highly regarded for its work with state Medicaid programs and with public and private sector providers, Sellers Dorsey (formerly Sellers Feinberg Associates) focuses on meeting the health care challenges of the 21st century by creating transformational change in health care programs. As the nation’s premier consulting firm that specializes in revenue optimization, Sellers Dorsey works with health care providers to maximize resources to undertake health care reform and expand coverage for the uninsured.
Overview
In April 2006, Gov. Mitt Romney of Massachusetts signed a new health plan into law that will cover an estimated 500,000 people who currently have no health insurance. As lead consultants to Gov. Romney on this groundbreaking health care reform initiative, Sellers Dorsey experts worked with a bipartisan team of state and federal lawmakers and stakeholders to develop a plan that reduces overall health care costs, increases provider reimbursements and improves coverage and care for the Commonwealth’s citizens.
Sellers Dorsey initially worked with Massachusetts’ public hospital system to help protect $385 million in federal funding the state received each year through an intergovernmental transfer. As efforts to protect this funding progressed, Sellers Dorsey began working for Gov. Mitt Romney to look for a solution that would allow him to expand health coverage for the uninsured while continuing to receive federal funding critical to the state Medicaid program.
As part of this team, Sellers Dorsey was instrumental in working with the Massachusetts’ Health and Human Services Secretary Tim Murphy and his department to develop, negotiate, and receive approval for a Section 1115 Waiver from the U.S. Department of Health and Human Services.
The Plan
The new health plan provides affordable, accessible coverage to nearly all citizens, helping them to receive the care they need to achieve and maintain good health, but equally important were efforts to contain provider costs, modernize the health delivery system, and reform the mandates placed on insurers. Participants were cognizant that true reform and universal coverage could not succeed unless each component was addressed in the final plan.
Insurance
While employers remain the cornerstone of insurance offered to individuals and families, a principle of personal responsibility that requires all uninsured residents to maintain an insurance policy became a key component of reform. The development of the Commonwealth Care Health Insurance Connector, a central clearinghouse that will link individuals to insurance plans and products and serve as a medium for employers and employees to purchase health insurance will be the mechanism to help fulfill the personal responsibility principle.
To further ensure individuals purchase insurance, the plan provides public subsidies for low income families on a sliding scale by income level, enabling them to obtain health care coverage similar to private plans offered by employers.
Residents with incomes less than 300% of the federal poverty level who are currently not eligible for Medicaid will receive government funded premium assistance for healthcare, and those above 300% of the federal poverty level can now purchase new lower cost policies in the private health insurance market through the Connector.
There are an estimated 100,000 uninsured citizens in Massachusetts that are eligible for Medicaid but have not applied. Now, while seeking care at a state hospital, this group can apply and be approved for Medicaid through an internet-based virtual gateway, enabling the state to take advantage of all federal medical funds available.
Among other objectives the legislation also puts a priority on care providers to reform their systems and improve efficiencies. This includes the collection and publication of information on the cost and quality of state hospitals, physicians, and treatments in order to promote the transparency of information that is essential for consumers to make informed health care decisions. The Blue Cross/Blue Shield Association of MA Foundation has committed significant resources to working with providers to develop and implement the use of electronic health records. In an effort to reduce medical errors and their associated costs, the plan calls for a significant commitment to the development of statewide computerized physician entry order systems so doctor’s care management instructions and prescriptions are correctly effectuated.
The Road Ahead
Prior to the legislation’s passage, Romney, Kennedy, and Sellers Dorsey took another important step toward reforming Medicaid and state health care by negotiating a federal waiver that will allow the Commonwealth to continue receiving millions in federal Medicaid funding over the next two years. This will ease implementation for the plan, which will begin on July 1, 2006, with full implementation expected by July 1, 2007.
Success of the reform plan has launched Massachusetts into the national spotlight with efforts by health care advocates from across the country seeking to enact similar reform. The Massachusetts plan has set a precedent and will serve as a model for other states’ ongoing efforts to reduce the number of uninsured individuals. Sellers Dorsey will continue to assist in this process and has been working with Michigan and Indiana to design and implement other large-scale health care reform initiatives.
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