By Joshua Archambault
May 9th, 2012
Before digging into the Senate bill this afternoon, I wanted to express my concern about early media coverage of the payment reform debate. The spotlight has become focused on 3 or 4 points, all contained in press releases.
No one can knowledgably comment on the Senate bill since they have not seen the full language- as they are still finalizing parts of it this morning.
It is easy to say the two bills look the same from the press release, but are they?
The debate over somewhat arbitrary cost growth goals is pointless, unless there is a debate about the mechanisms to get there. Did we forget that DHCFP data tells us 53% of employers are self-insured in our state and therefore not regulated at the state level?
I am worried, after talking with a number of health care industry folks over the last 4 or 5 days, that each is looking at their slice of the pie and failing to see the big picture… or even questioning how these proposals will play out in implementation.
On the flip side, I worry that folks on Beacon Hill see this debate more as an academic exercise or a political battle, and not establishing comprehensive and sensible reforms that engage consumers.
Early media reporting on the bill is very important because it is often the only coverage the public pays full attention to, and frames the debate for most public figures. Are we to accept the supposition that the only viable options are taxing providers or insurers– or both– and government intervention to correct past flawed government intervention?
Find me on twitter: @josharchambault
By Jim Stergios
May 8th, 2012
The 2010 Achievement Gap bill that was passed by both the House and the Senate and signed into law by Governor Patrick lifted the limits on charter schools and the number of students in them in districts that were failing to see improvements in student achievement. Rather than limiting the number of students to 9% in these largely urban districts, the law allowed up to 18% of students to attend charter schools.
The six-year period for the expansion up to 18 percent of students was not coincidental. It aligns with the six-year reimbursement schedule for districts, by which districts:
• receive 100% of the per-pupil funding for in the first year after a student leaves for a public charter;
• continues to be reimbursed for the “phantom” student in years 2 through 6 at 25% of the student’s per-pupil funding.
That’s a lot of extra state funding, which is in part why many parents and district educators in Lowell feared negative impacts from the closure of a charter school in the city a couple of years back.
So, what to make of today’s front page Globe story ballyhooing the state’s decision to release 1,000 charter seats in Boston and 360 in Lawrence as a “charter school cap lift?
Is that good news and something to be pleased about? Yes, on the practical impact, but not so much on the politics and policy of the decision.
On the practical impact, there is plenty of evidence of the strength of Massachusetts’ public charter schools, and even greater evidence of the strength of public charters in Boston. Massachusetts’ and Boston’s charters are in fact pretty unique in the level of consistency they have, which is testimony to the good vetting process in place for many years (something that needs closer scrutiny given reason to believe that political considerations have played a fairly significant role in charter approvals and rejections in Gloucester and Brockton).
So applaud the practical impact, with proven schools likely to expand in Boston and also in Lawrence.
On the politics, I can’t say that the release of the seats was a story for any reason except that the Commissioner of Education Mitchell Chester complied with the 2010 law. I am not grateful for that. He is expected to do that – it’s called the public trust.
The fact that he held up seats in the initial expansion was altogether understandable – but when the Department would make those seats available should never have been in question. It’s the law, and the fact is that the commissioner should have given a time certain for the release of the additional seats from the beginning.
Policy-wise, there is not much here. Lawrence has some of the worst-performing schools in the state—low student achievement in math, English, and science; scores that are not moving to anywhere close to acceptable levels; it has 30+% dropout rates. We know that’s not sustainable – and those facts affect most people and make them want to take real action, not just temporize and avoid responsibility.
But even from a purely financial perspective, the right policy is to take actions that have been proven successful. As Mark Vogler of the Lawrence Eagle Tribune recently reported:
Lawrence Public Schools’ annual payroll will go over $100 million for the first time in the city’s history in fiscal 2013.
A $4.8 million hike in overall salaries for the city’s 2,000 School Department employees — due to step increases negotiated before the state placed the district in receivership — accounts for more than half of the $8.3 million increase in the proposed education budget for the 2013 fiscal year that begins July 1.
Nearly that entire eye-popping amount is paid for by the state. In addition, the state Board of Education stripped the local school committee of most of its powers and put the district in receivership, naming former Boston Public Schools official Jeffrey C. Riley Superintendent/Receiver. We own the problems of the Lawrence public school district.
Lawrence has some great charter schools, including the Lawrence Family Development Charter School and the Lawrence Community Day School. Given that, why are we just expanding 360 seats when there are 13,000 kids in the district?
Lawrence is Massachusetts’ “Katrina moment.” Let me put it another way to Massachusetts’ education officials: How would you respond to this crisis if your kids were in the Lawrence district schools?
They would respond just as the country did after Katrina, insisting on a new path for New Orleans schools – and one that has served the kids well, giving parents real choices and expanding charters to encompass nearly all the schools in the city. So here’s the question I asked a couple of weeks ago – and it’s a good one:
Lawrence has very good charter schools and could line up more charter operators very quickly. It also has the advantage of an existing network of high-quality parochial schools that could play a key role in changing the prospects of kids — not after the successful execution of a five- or ten-year improvement plan but immediately.
Do we really have to wait for an act of god before we act?
Crossposted at Boston.com’s Rock the Schoolhouse blog. Follow me on twitter at @jimstergios, or visit Pioneer’s website.
By Joshua Archambault
May 7th, 2012
The House version of payment reform creates a new mega agency, the Division of Health Care Cost and Quality. To be fair, the House collapses a few other state agencies into the new Division, but there is no question this entity is given far-reaching and broad regulatory power. The Division will be independent and “not subject to the supervision and control of any other” public entity. (Section 29, subsection 2(a))
The controversial federal Affordable Care Act drew negative attention for how many times the Secretary of HHS was instructed to act on major policy, roughly 700 times in 2,700 pages.
The House’s bill outdoes the ACA by requiring the division to take action 163 times in 178 pages, or almost once every page. The mandate approach results in 941 instances in which the House mandates action in the bill, by using the word “shall.”
A sample of the dizzying and expansive Division’s responsibilities includes but is not limited to:
- Assessing a number of penalties, fines, and surcharges. I counted 26 in the bill. Some are one-offs, others reoccurring and some are sticks to be utilized to guarantee compliance. Of course, most of the cost of these will be passed onto patients one way or another.
- Setting acceptable standards for alternative payment methodologies.
- Overseeing and being involved with alternative payment contracts.
- Developing quality metrics including parameters for clinical outcomes, but limiting insurer’s use of quality data outside of division approved metrics.
- Defining and overseeing accountable care organizations on many levels.
- Designing and managing the state-wide health technology infrastructure needed to meet the mandated 5-year window for Health IT.
- Monitoring and participating in workforce development and planning. Including multiple student loan forgiveness programs, and other recruitment and retaining programs to keep doctors in state or practicing in under-served areas.
- Setting out extensive mandated transparency mechanisms for consumer education on cost and quality data and trying to improve administrative simplification.
- Surveying patients annually for their perception of access to services, including many subgroups such as the homeless.
Yet many questions about implementation remain, and policymakers should look very closely at the following:
- Will transparency without the correct tools and incentives for consumers backfire? For many patients, high-cost correlates with higher quality. Of course the Attorney General’s report proved this theory wrong, but if you provide patients with cost data but their health plan is not set up to incentivize the use of low-cost high-quality providers, you will have many seeking out the most expensive folks. (The direct opposite goal of this legislation.)
- As the Division sets up uniform reporting of revenues, charges, costs, and utilization (that by statute will need to be in line with federal reporting standards) will the state follow the federal government’s ACA lead of 140,000 coding categories? For example, if you’ve been bitten by a turtle for the second time you would use code W5921XD.
- Will the Division have the expertise and technological knowledge to implement the many goals laid out in the legislation? Even with numerous expert advisory committees, many of the functions the Division will be conducting are replicating what the private sector currently does. One only has to look at the Health Care Cost and Quality Council to see an example of a great public advisory board that has struggled to produce a meaningful product that has wide market penetration. Policymakers should ask if is a good investment to ask a public entity to run so much, when you are trying to reduce spending.
- The issue of privacy and health information technology is complex and expensive. The bill currently waves its hand on this issue, and serious thought is required.
- What will the Division cost to run? The most likely smaller Connector costs roughly $30 million a year to run. How much more should we expect this mega-agency to cost?
- Finally, policymakers should take a serious look at the wide-ranging authority given to the Division. On multiple occasions, the Division is instructed to “take actions necessary to ensure….” or “promulgate regulations or guidelines to implement the findings of this section.” We must ask if we are comfortable with bureaucrats holding the reins to 18% of our state’s economy, that may not have the expertise, resources, or shared values that we do to balance the trade offs associated with government centered cost controls. They decide where billions of dollars will be directed or granted from trust funds. Do we trust their judgment and are we confident that industry influence will not sway these few government officials?
Much more to come.
Find me on twitter: @josharchambault
By Jim Stergios
May 5th, 2012
Massachusetts is a wealthy place. We are among the wealthiest states in the country, and the educational attainment of Massachusetts parents is well beyond that of parents in every other state. All this should point to high-powered students and schools in the Bay State.
In fact, “big thinkers” in education policy often point to those factors to explain why Massachusetts does so well on national and international assessments. In part, that’s true. But what these big thinkers fail to see is that Massachusetts not only has risen from around 11th in the country on the national assessments to number one, but also that the performance of all Massachusetts student groups has gone up. In fact, Massachusetts’ improvement in performance among Hispanic students is very much in line improvements in the states that have most concentrated on this issue, such as Florida (Florida’s improvement among Hispanics is a hair better and, ironically, they end up higher today in part because they started out ahead of Massachusetts due to pockets of highly educated immigrants).
Either way, the search for bragging rights is misplaced. We all have a lot to learn in terms of which state experiments have worked or not worked, for whom, and where our weaknesses persist. The Bay State’s weaknesses are clear: we need more focus on high achievers as well as low achievers, and we need to expand choice options for parents in those poor districts that have failed students for decades now through charters and an anything-it-takes approach.
Here are some basic facts on poverty in Massachusetts. Overall, we rank 8th among the states in household income. With the baseline of about 10 percent of the overall population living below the poverty line, around one in three students statewide qualify for free or reduced price lunches. The extent of poverty varies wildly, with FRPL eligibility by district ranging from a miniscule 0.1 percent to an eye-popping over 90 percent.
Poverty in Massachusetts is concentrated in urban areas, and only one state has a lower percentage of rural students qualifying for FRPL, but the percentage of the commonwealth’s urban students who qualify is higher than in 35 states. The highest poverty rates are in Suffolk and Hampden Counties, home to Boston and Springfield, where about one quarter of school-aged children are below the poverty line.
There are also pockets of rural poverty in Massachusetts. More than half the students qualify for free or reduced price lunches in the Greenfield, North Adams, Gill-Montague and Ware school districts. Orange, Athol-Royalston, Hawlemont, Ralph C. Mahar, Flordia, and Winchendon all have almost half their students on FRPL.
So let’s disaggregate the big, broad measures we too often use, and understand that we need to avoid lumping poor with poor, thinking that poverty makes for a monolithic set of individuals, motivations, aspirations, and challenges. Let’s ask:
How have urban and rural poor students fared, respectively, since the start of the landmark 1993 education reform act, which infused school with more money, set high academic standards, required testing of students, insisted on higher quality teachers determined by tests tied to the state’s standards, and introduced competition into the system through charter schools?
A recent report entitled Urban and Rural Poverty and Student Achievement in Massachusetts does just that. The author of the paper, Salem State professor Ken Ardon, begins:
Massachusetts still has a significant share of its population living in poverty – approximately 600,000 people in the Bay State live below the poverty line. While low-income families are often concentrated in urban areas, rural areas also have deep pockets of poverty.
A few takeaways from the paper:
- Using national assessment data, the poor overall in Massachusetts have improved fast on math than their counterparts around the country. The same is not true on English language arts.
- Using MCAS data, the scores of high and low-income students have risen in the Commonwealth, whether in urban, suburban or rural areas.
Finally, as Ardon notes, “Low-income rural students have made slightly larger gains than low-income urban students and modestly reduced the performance gap.” Why is that important? Just 10 years ago, the performance gap was larger in rural areas than in urban areas.
Today, the performance gap between low- and higher- income students is roughly the same in rural and urban areas of Massachusetts. That is, poor students have improved more rapidly and closed the achievement gap as measured by both the MCAS and graduation rates faster than their urban counterparts.
Finally, Ardon suggests that the difference in performance between low-income students in rural and urban areas may be attributable to the urban students being poorer and less likely to speak English.
Crossposted at Boston.com’s Rock the Schoolhouse. Follow me on twitter at @jimstergios, or visit Pioneer’s website.
By Joshua Archambault
May 4th, 2012
The next act of the Massachusetts health care reform drama is about to play out on Beacon Hill. As the same familiar characters return to the stage, the character who should be the hero of this drama, the patient, is nowhere to be found. Instead we are sitting down to a repeat performance.
The language of reform is promising, but the reality of implementation remains hazy. Over the next few days I will blog on why the House of Representatives’ bill left out the patient as part of the solution. However, for now, below are just a few questions to prime the pump for this discussion and for you to consider:
- How will western Massachusetts comply with the state mandate of e-medical records in 5 years when many areas don’t have internet?
- Is it possible for the Commonwealth to get rid of fee-for-service payments completely if Medicare is still paying in that manner?
- There are numerous new trust funds being established in this bill. What revenues (taxes) will be raised to fund them, and for how much each year?
Much more to come. Click here for the bill.
By Steve Poftak
May 4th, 2012
I won’t bury the lede — the UMASS law school has been recommended for provisional accreditation by the ABA’s Accreditation Committee. The next step will be a consideration of that recommendation by the ABA’s Council on Legal Education. A commenter on a related post claims that the Council has always accepted the recommendation of the Committee.
After receiving provisional accreditation, the school undergoes at least three years of review to move from provisional to full accreditation. That will be an ongoing challenge for the school but from the perspective of students, provisional accreditation gets them the right to take the bar in any state they want, so provisional is good enough right now.
As a longtime critic of the law school, I put aside my reservations for now and offer a tip of the pen to UMASS for coming this far — they’ve hit at least one (and the most important) milestone they laid out in their application. I still have serious reservations about the time and effort being expended by UMASS to address an area of the state workforce where we don’t lack for skilled employees or academic opportunities, but in a discussion strictly based on achieving stated milestones, they deserve credit.
Crossposted at Boston Daily.
By Jim Stergios
May 2nd, 2012
So let the games begin. Finally, the presidential candidates may get to education. For the greater part of a month, the presidential candidates have been sizing each other up, jabbing each other on jobs and the economy, who’s more in touch with the average voter, and all sorts of distractions like who is waging that war on women and whether the president should play politics with foreign policy (as if that’s anything new).
Given that education is a key factor affecting the country’s ability to create jobs–and that it is one of the key sectors of public employment–you would have thought that education would have made the dance card a little earlier in the process. But no.
Finally, we have engagement. Earlier today, Governor Romney “blasted” President Obama for the latter’s opposition to Washington D.C.’s 10-year-old opportunity scholarship program. As the Washington Times‘ Stephen Dinan notes,
Mitt Romney on Wednesday said it was “inexcusable” that President Obama tried to shut down the … voucher program that has sent thousands of the city’s students to private schools.
“The president shut that down. His party shut that down,” Mr. Romney said while campaigning at a small business in Chantilly, Va.
As Dinan further notes, despite broad popular support among DC parents, Mr. Obama has repeatedly
tried to end the program when he took office. In a compromise, he agreed to let students already in the program continue, but he ended funding for new applications.
When Republicans took control of the House last year, Speaker John A. Boehner fought to restart the program and included funding in the first yearlong spending bill Mr. Obama signed.
But the program remains in limbo, and Mr. Obama’s 2013 budget, submitted in January, doesn’t include any money for it.
Education may prove a tricky issue for Romney, who ironically oversaw the Commonwealth’s surge to become the top performing state in the nation. President Obama has a clear set of priorities, including nationalizing education standards, tests and curricula; controlled choice through modest expansion of charter schools; and teacher evaluations. Mr. Romney’s views are not fully public, though from his time in office in Massachusetts, we can glean lessons about what he will be on schools and learning.
During his time here, he supported strong academic standards that reached beyond math and English to include science and U.S. History, as well as the expansion of charter schools. Messaging will be made a little more difficult, because presidential elections are often about clear messaging, and Mr. Romney has in the past made supportive statement about elements of the President’s education plans.
Just what are the differences? Clearly parental choice that extends to private schools is one. I’ll be posting a few items on how their positions diverge over the coming week. The big message today is, perhaps, finally we will see the candidates engage on the critical issue of how we move the states and the country forward.
Crossposted at Boston.com’s Rock the Schoolhouse. Follow me on twitter at @jimstergios, or visit Pioneer’s website.
By Steve Poftak
May 2nd, 2012
Several months back, the egregious abuses at the Chelsea Housing Authority showed the weaknesses in oversight of municipal housing authorities. The fact that it got away with that abuse for so long, even after federal and state audits, should give one pause.
Now, the Medford Housing Authority is under scrutiny. This time, its not the Executive Director’s salary that’s in question. Rather, its his habit of hiring underqualified political favorites and widespread ‘irregularities’ in contracting. In addition, there are allegations of improper usage of funds by other employees.
And, once again, we have the troubling spectre of the entity which is supposed to provide oversight — the Board of Directors — unable or unwilling to do its job properly. This account from the Globe article does not fill one with confidence:
“You could never get a straight answer from him,’’ Luongo said, recalling that Covelle told the commissioners they had nothing to worry about when some members asked about the contracts that are now the subject of the audit.
Taxpayers are told that each municipality needs an individual housing authority to best serve local needs and these local authorities need millions in state funds on a yearly basis to care for their housing assets. Yet, there are multiple points of failure in the oversight process — politicized boards that don’t exercise proper fidicuary responsibility and are insulated from scrutiny being chief among them.
It’s time to do a root and branch review of how we manage public housing in this state — Are so many entities really necessary? Should they be constituted as independent authorities? Should they be governed differently? And how can we use the carrot of state funds (that are already flowing) to mandate correct management practices?
Crossposted at Boston Daily.
By Jim Stergios
May 1st, 2012
I’m conflicted about how to say this. Getting stuff done is about building relationships and trying to find ways to get along and in fact pulling the right people together toward a goal. But it is also about saying things straight and pulling no punches when what’s being debated matters a lot.
I often write about education standards because, unlike some other ed policy choices, standards impact the entire landscape of education. If used effectively to drive reform, they set the contours of classroom content, they constitute the basis for student tests, and they define the basis for teacher tests that ultimately play a bigger role on the quality of teaching in the Commonwealth than any professional development program afterward. If done right, I noted. I fully agree with Tom Loveless of the Brookings Institution who has been saying that in most instances higher standards don’t correlate with higher student achievement, but those states (like Massachusetts) that have used standards to drive the iron triangle of curricula, accountability and teacher quality, win big on student achievement.
Until 2007, Massachusetts used standards in just this way. And then we watered down our accountability system and our standards. Since 2007 Massachusetts student achievement has been flatlined at best. While you cannot draw a causal link to our students’ 2007 or even 2008 results, the continued flatlining since then does make me wonder what’s been lost in real achievement because of recent “reforms.”
Last week, I wrote about the conflictitis that plagues the longstanding group of DC-based advocates of national standards. The post focused largely on the façade of objectivity put up by Massachusetts Education Commissioner Mitch Chester in relying on three “outside” analyses of the national standards. The so-called independent analyses proved not to be so objective after all, given that they were all funded directly or indirectly by the Gates Foundation, which has bankrolled the entire national standards effort nationwide. So independent were these analyses that one of the firms (the Fordham Institute) conducting an “independent” review funded in part the work of another “independent” reviewer (the Massachusetts Business Alliance for Education).
After receiving the tip from a reader who looked at Fordham’s federal tax status filings, I have to admit that I realized that I find it hard to believe that these people wake up everyday and pretend to take themselves seriously.
But there are more conflicts than the ones listed in that post. Today, let’s focus on the role of Achieve, Inc, which used to work on collegial sharing of best practies and more recently has moved into a full-time advocate employing not just public argument (which is the rightful way to do advocacy) but also funding and other politically, legally, or ethically challenged methods to advance their cause. Like all the other “independent” reviewers involved in evaluating whether Massachusetts should adopt national standards, Achieve, Inc. has largely been funded by the Gates Foundation, the banker of record for national standards development, favorable evaluations and advocacy.
So it is odd (and conflicted) when the Massachusetts Ed Commissioner announces that he will rely upon Achieve’s evaluations as “independent,” as is Achieve’s use of money to advocate for its positions. Tough words, I know, but consider the evidence.
In March of 2009, just as the Obama Administration made its announcement to chart out “improvements” in state standards, Achieve appoints Massachusetts Governor Deval Patrick to its Board of Directors.
WASHINGTON – March 2, 2009 – Achieve today announced the appointment of Massachusetts Governor Deval Patrick to its Board of Directors, a group comprised exclusively of governors and top business leaders that is responsible for guiding Achieve in its mission to ensure that all U.S. students graduate from high school prepared for postsecondary success.
Is it independent to rely on a firm whose boss is also your boss? And given the Governor’s record at the time, this announcement signaled to friends of Achieve that they were going soft—or, perhaps more accurately, “soft skills”—on standards. At the time of this announcement, and months before his employer, the Fordham Institute, received a million dollars of its own from the Gates Foundation to promote national standards, Mike Petrilli blogged that Governor Patrick, with his weak record on academic standards and his opposition to strong school accountability, his embrace of 21st century skills, as well as the NEA’s support for national standards all constituted “the beginning of the end for Achieve”:
I can’t even begin to explain the confusion, disappointment, and exasperation I feel about Achieve right now, the organization that’s purportedly all about pushing states to raise standards. First there was the announcement last week that the National Education Association was joining the “common state standards” movement led by Achieve, the National Governors Association, and the Council of Chief State School Officers…
Then there’s today’s announcement that Massachusetts Governor Deval Patrick is joining Achieve’s board. This is the same Governor Patrick who has declared war on the Bay State’s academic standards and rigorous accountability system. (See this great Education Next article for background.)…Achieve, what are you doing, aiding and abetting what is obviously an effort to diminish standards, fuzzy up accountability, and push nebulous “skills” over literature, history, art, science, and math? Achieve, Achieve, why have you forsaken us?
It was bad enough from a policy perspective that Mitch Chester was chosen then to lead one of the two national testing consortia, PARCC, which is housed at Achieve. After all, Mitch has no record of improving standards and assessments in Massachusetts, the same in Ohio, and a record of diminishing standards in Connecticut (as evidenced by the collapse in Connecticut’s student reading scores on the NAEP test in subsequent years). But one of the key players in Massachusetts’ decision to adopt national standards, then-deputy education commissioner Jeff Nellhaus, was hired by Achieve/PARCC six months after Massachusetts’ vote to adopt national standards – a decision he influenced directly.
My point is not to say that Mitch Chester or Jeff Nellhaus, or the many other Massachusetts education officials and gubernatorial staff that benefited from later jobs with the Gates Foundation or Gates-funded entities, are unpleasant people. Hardly. They are so close to this stuff and so used to the way things work in the EduBlob that all this is par for the course.
Local supporters of the national standards and friends will argue that we should be relieved that Massachusetts’ officials are in positions of leadership in these efforts. I find that a huge sidestep to real questions about conflicts of interest and ethical violations.
That’s what ethics laws and mechanisms that ensure the public trust are for.
Governor Patrick likes to affirm that Massachusetts has “the toughest state ethics laws in the country.” That must make the revolving door of jobs, and the money and influence exerted on Massachusetts’ decision to adopt the national standards by the Gates Foundation, MBAE, Fordham, and Achieve one very big and improbably coincidence. No, no, there were no state ethics violations, no misuse of the public trust, no circumventing state legislative approval, no thorny federal legal issues, no private non-profits lobbying and benefitting from changes in state policy. And no cross-funding aong the independent reviewers.
For those of you who don’t find any of this troubling, then consider NewsCenter 5’s Sean Kelly report that in the middle of state deliberations over whether or not to adopt the Common Core standards, Massachusetts education commissioner Mitch Chester “took at least 12 trips costing $15,146. All of the trips [were] paid for, in part, by trade groups and special interest.”
As part of its story, NewsCenter 5 interviewed Pam Wilmot from CommonCause, a government watchdog group more often associated with the political left. She noted that “the appearance that there might be a conflict when you accept free or discounted travel from a party, particularly if they have an interest in the outcome of a decision is certainly there.”
NewsCenter 5 reported that “the top sponsors of Chester’s trips” were “two DC-based organizations, one of which was Achieve, Inc. The two pro-national standards funding groups paid for most of Chester’s travel to DC, Chicago, Arizona and London. “
If you are not troubled by any of this, then you are unwilling to consider evidence. Yes, the revolving door of jobs, money and perks is just one big coincidence.
Perhaps it’s also a coincidence (or perhaps just “one of those things”) that the Boston Public Schools hired
commissioner Mitchell Chester’s wife, Angela Sangeorge Feb. 22 [2010] as $128,570-a-year executive director for teaching and learning and director of literacy, [just] as the school system was mulling massive teacher, staff and custodian layoffs.
She “oversaw a staff of four literacy coaches and one reading teacher” in that job and then was removed from it by the BPS Superintendent Carol Johnson, to be placed in the Higginson-Lewis School, where she reviews the literacy curriculum for a single school (not the entire system anymore), but she still enjoys the same salary.
Yes, pleasant people one and all. Pleasant people who cannot see the conflicts they live and that affect their daily decisions. Pleasant people who take care of themselves, even as they block real solutions from being implemented in places like Lawrence where the dropout rate is north of 35 percent. Pleasant people who see the revolving door going around, and always find a way to slide through, even as they explain to parents in urban districts why they need to be patient and wait another 10 years for the adults in the system to coalesce around the grand education master plan that will at best yield modest improvement, which of course they will hype as victory.
Crossposted at Boston.com’s Rock the Schoolhouse. Follow me on twitter at @jimstergios, or visit Pioneer’s website.
By Joshua Archambault
April 25th, 2012
While Governor Patrick has been pleading with the Legislature to act on his February 2011 payment reform bill that would move our health care system towards global payments and accountable care organizations, his MassHealth (Medicaid) office has moved in the opposite direction. (You can read my testimony on the Governor’s bill here)
In March 2011, the MassHealth program changed their default enrollment policy for new enrollees that did not affirmatively select a managed care option–either one of the 5 Medicaid managed care organizations (MCO) or the Primary Care Clinician Plan (PCC).
Before the switch, if an individual, after being determined eligible for Medicaid, did not affirmatively select a managed care option, the MassHealth office would auto-enroll them into either one of the 5 Managed Care Organizations or the PCC Plan on an equal basis. While deemed part of the “program of managed care” by MassHealth, the PCC program reimburses participating providers based on a fee-for-service method of payment. MCOs, on the other hand receive a capitated payment that is calculated on a per member per month basis. This capitated payment puts the MCO at risk and covers the cost of caring for the entire member.
The original move to assign members to only the PCC Plan was initially referred to as a “temporary” policy aimed at preserving cash flow. Keeping members in the FFS PCC plan allows the state to avoid making the upfront capitation payment to MCOs and additionally, not have to pay for members enrolled in the PCC plan unless the member goes to the doctor. As one employee informed me, “sometimes these PPC plans end up being cheaper for the state due to lower utilization.”
The debate over how heavily the state should rely on MCOs has been ongoing for years in the Commonwealth. The topic has surfaced more recently as numerous states around the country have moved to fully embrace managed care in their Medicaid population including states as diverse as Florida and California.
CMS estimated that 39 million Medicaid beneficiaries in 2010 were in managed care, or more than 70 percent of all enrollees. That is a big change from just ten years ago when only 3 million beneficiaries were enrolled in managed care. Massachusetts has one of the lowest percentages of Medicaid enrollees in managed care of states that use managed care, 54% in 2010. By contrast, multiple states are moving to 100% managed care.
For full background, the MassHealth program has historically had some groups they have kept out of managed care and who are specifically placed on a fee-for-service coverage — those receiving long term care of any age, and members with Medicare and private insurance coverage.
The removal of the more diverse auto-enroll process is a clear change in policy that directly conflicts with the stated goals of the Administration for the broader health care market. As a result, an estimated 7,500 members per month are being put into the PCC program instead of one of the managed care organizations. So do the cost justifications support moving to PCC over managed care? No one knows! Not even the Legislature.
The Patrick Administration has never shown a willingness to fully engage in the debate over managed care, and as a result the Legislature has taken a number of actions to push the issue, and this year is no different. For example, see outside section 61 in the House budget, or Section 178 of Chapter 131 of the Acts of 2010, which established a Managed Care Advisory Committee. The study established in Chapter 131 has never been completed and moreover, the Administration has never even convened the Committee.
Pioneer has attempted to obtain additional information about the Administration’s decision making process on managed care but has been rejected on the grounds that the documents we requested are off limits because they are covered by the deliberative process exemption, which names as exempt from disclosure “inter-agency or intra-agency memoranda or letters relating to policy position being developed by the agency.” Which I assume covers every past and current report or analysis if you decide to stretch it broadly enough. Pioneer has appealed.
This is no small issue as MassHealth makes up ~36% of the state budget, and has continued to crowd out spending on other priorities like education and public safety. From a high level, the public policy response to this increase in enrollment and costs by the leaders of the Commonwealth has been to cut benefits and/or provider rates. However, the price setting taking place in the program will most likely have a limited life because of doctor’s concerns about under reimbursement. If doctors refuse to take new MassHealth patients—as they already are—the safety net will wither further.
I am not of the opinion that global payments or accountable care organizations will be the panacea to our health care situation, and the Attorney General’s landmark transparency report (finding 2) along with many new academic papers seem to support this skepticism. However as the Governor ultimately controls the MassHealth program and is pushing payment reform, one is left to wonder when he will be asked what the Medicaid office is up to.
Find me on twitter: @josharchambault
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