The Codcast: Dreyfus highlights Blue Cross experiments

Andrew Dreyfus, the CEO of Blue Cross Blue Shield of Massachusetts, is excited about a series of initiatives the state’s largest health insurer is pursuing to improve care while simultaneously treating patients in less costly settings.

One initiative, a pilot project with South Shore Hospital, rewards the facility if it succeeds in admitting fewer patients and doing fewer procedures. Dreyfus, appearing on the “Health or Consequences” Codcast with Paul Hattis, an associate professor at the Tufts University Medical School (co-host John McDonough of the Harvard Chan School of Public Health was on jury duty), said the goal of the pilot project is to reverse the incentives that currently reward hospitals for seeing more patients and doing more procedures.

“In a traditional system, the role of the EMT is to go to a person’s house or another setting, stabilize the patient, and bring them to the hospital – always bring them to the hospital,” he said. “That’s the incentive. Here some of the EMTs associated with the hospital are going to be looking at is this a situation where we can help manage the patient, keep them in their homes, improve their care, without burdening the system with an expensive hospitalization.”

Dreyfus said other hospitals are interested in participating and more pilots will be launched next year.

Dreyfus said health care itself is not the key determinant of good health. Other factors, including a patient’s lifestyle, diet, education, and housing situation, are more important. To address these so-called social determinants of health, Blue Cross Blue Shield is funding an initiative called Dot Rx, which encourages physicians to take a more holistic approach to the health and wellness of families in Dorchester by prescribing good food and exercise.

The key participants in the program are the Codman Square Health Center; Daily Table, a grocer in Dorchester; the Dorchester YMCA; Healthworks Community Fitness; Outdoors Rx, a program of the Appalachian Mountain Club; and Union Capital Boston.

Blue Cross Blue Shield is also trying to incentivize patients to choose lower-cost health providers by writing them a check when they choose a low-cost option rather than just lowering their copay. The insurer’s Smart Shopper program lumps health providers into tiers and encourages patients to shop and compare.

A number of big for-profit players are venturing into the Massachusetts health insurance arena, including CVS, which recently acquired Aetna; Cigna, which owns Express Scripts; and UnitedHealth Group, with its Optum subsidiary.

“Health care probably deserves some disruption,” Dreyfus said, but he worries that all the new players are publicly traded companies that are primarily accountable to their shareholders. Dreyfus said Massachusetts has long benefited from collaboration among nonprofit insurers such as Blue Cross Blue Shield and Harvard Pilgrim; he says nonprofit collaboration is a key reason universal health care succeeded in Massachusetts.

“I’m not sure those kind of collaborations exist in any other state and I would worry that if the publicly traded plans became the dominant face of health care in Massachusetts we might lose something special,” he said.

Looking ahead to legislative action this year on Beacon Hill, Dreyfus said he is hopeful lawmakers will address surprise billing (when patients are hit with high, unexpected out-of-network charges) and expanded roles for nurse and dental health practitioners. As for the rising cost of pharmaceuticals, Dreyfus said he is unsure what the state should do. He said he believes 50 percent of all pharmaceutical spending in the next year or two will go for new, expensive specialty drugs with dramatic potential to save lives.

“It’s hard for state government to impose any price controls,” he said.

Dreyfus said he believes health care should be a right available to everyone, but he acknowledges how to provide and pay for it is unclear. Dreyfus said many think a government-run health care system is the best way to go, but he thinks a public-private approach, along the lines of what is seen in countries such as Germany and Switzerland, may be the best approach.

“We are going to have the debate and I welcome it,” he said.

BRUCE MOHL


BEACON HILL

The state’s school funding problem is most acute in low-income communities, according to Marie-Frances Rivera and Colin Jones of the Massachusetts Budget and Policy Center. (CommonWealth)

The millionaire tax is back in play on Beacon Hill. (CommonWealth)

A Berkshire Eagle editorial calls on Gov. Charlie Baker to cover the shortfall in the federal Low Income Heating Assistance Program.

MUNICIPAL MATTERS

David Tisel of the Somerville Community Corporation warns that more housing alone won’t solve the state’s housing crisis. He says legal rights for tenants must be part of the solution. (CommonWealth)

As many as 50 police officers are facing the possibility of being laid off in Methuen. (Eagle-Tribune)

A Quincy city councilor will propose that the city adopt a 3 percent “community impact fee” on short-term rentals authorized by the new state law that took effect last month. (Patriot Ledger)

A new  MassINC report spotlights blight in many of the state’s poorest communities. (MassLive)

WASHINGTON/NATIONAL/INTERNATIONAL

A more complicated picture emerged of the encounter that has gone viral between an older Native American man and student from a Kentucky Catholic high school sporting a red “Make America Great Again” cap. (New York Times) Local Trump backers complain that they are regularly taunted for wearing “MAGA” gear. (Boston Herald)

A Herald editorial rips Democrats for not even offering a counteroffer to Trump’s proposal for reopening shuttered government services.

Affordable housing ranks as the top concern of big city mayors across the country. (Boston Globe)

Lowell Sun columnist Peter Lucas says it’s fun watching US Rep. Alexandria Ocasio-Cortez and Ayanna Pressley — fun like watching Rome burn.

ELECTIONS

Sen. Elizabeth Warren welcomes fellow senator Kamala Harris into the presidential sweepstakes. (Boston Globe) At least four top-tier women candidates are poised to seek the Democratic presidential nomination, setting up tough choice for those whose priority is to try to elect the country’s first female president. (Boston Globe)

BUSINESS/ECONOMY

Amy Schectman, president and CEO of 2Life Communities, says aging in community — not aging in place — is the best way to approach old age. (CommonWealth)

Yesterday was opening day at Fall River’s first recreational marijuana store. (Herald News)

Concerns about flooding and sea level rise are eroding home values in coastal communities in the state, according to a report to be released today. (Boston Globe)

EDUCATION

Editorials over the weekend in the Standard-Times and Globe voiced support for the novel proposal unveiled last week to allow Alma del Mar charter school to open a new campus in New Bedford that would draw students from a defined neighborhood through the district school assignment system.

The Massachusetts Board of Higher Education is considering identifying failing colleges. (WBUR)

HEALTH/HEALTH CARE

Lia Spiliotis, the CEO of Community Health Programs, wants to remake health care by redefining what good health means. (CommonWealth)

Alliberthe Elysee, a member of the Boston Teachers Union, warns that Boston is falling short on inclusion classrooms. (CommonWealth)

One-time Globe editorial writer — and one-time die hard Patriots fan — Alex Kingsbury, now at the New York Times, explains why he wasn’t going to be watching Sunday’s AFC championship game.

ARTS/CULTURE

Netflix says its streaming service now accounts for 10 percent of TV viewing time. (Recode)

Efforts to erect a memorial in Boston to Martin and Coretta Scott King got a big boost with pledges of $500,000 from The Boston Foundation and $250,000 from MLK alma mater Boston University. (Boston Globe)

TRANSPORTATION

Rachel Adele Dec and Drew Latimer say simple reforms could have a profound on T rider commutes. (CommonWealth)

Boston’s port needs attention, according to Jill Valdes Horwood of Boston Harbor Now and James Aloisi. (CommonWealth)

ENERGY/ENVIRONMENT

With recycling costs spiking, Framingham shifts money around in its budget to cover a $171,500 shortfall. (MetroWest Daily News)

WBUR explains the pay for performance approach ISO New England uses in managing the regional power grid.

Greenland’s melting ice nears a tipping point, scientists say. (New York Times)

CASINOS

Red Sox legend David Ortiz has signed on as a goodwill ambassador for Foxwoods in Connecticut. (MassLive)

CRIMINAL JUSTICE/COURTS

Suffolk district attorney Rachael Rollins blasted federal Immigration and Customs Enforcement officials for arresting a suspect who arrived at Suffolk Superior Court earlier this month to face cocaine trafficking charges, saying such action will have a “chilling effect” on people’s willingness to show up in court. (Boston Globe) Rollins has been followed for months by a film crew planning a Netflix documentary on her campaign and start as DA. (Boston Herald)

Some smaller police departments are abandoning plans to deploy body-worn cameras on officers, citing the costs as the reason. (Washington Post)

Police are searching for a 23-year-old Jamaica Plain woman who left a Faneuil Hall bar with a man about 11 p.m. and hasn’t been seen since. (Salem News)

MEDIA

Media Nation’s Dan Kennedy analyzes the tainted Buzzfeed news blockbuster.