Advancing Access & Affordability

2013 Annual Report

Message from the President

Dear Friends and Community Partners:

The Foundation started in 2001 with an emphasis on expanding access to health insurance, and we share your pride in how much our Commonwealth has accomplished in this area. Over the past few years, we’ve also provided millions of dollars in grants to initiatives that contain health care costs while improving access and quality of care.

But there is more to be done. Approximately 200,000 of our neighbors are still uninsured. Many who have coverage struggle to keep it. Others face economic, behavioral health, social, and cultural barriers to care.

This year’s report focuses on how the Foundation is addressing these ongoing challenges through research and policy analysis, strategic grant making, knowledge sharing, and collaboration.

We look forward to working with you in the months ahead.

With thanks and best wishes,

Audrey Shelto signature
Audrey Shelto
President

Gaining Insight

Gaining Insight

The Foundation’s work has always been guided by impartial and informative research and policy analysis, often conducted in collaboration with other organizations and experts. It is how we gain an accurate understanding of the health care environment, identify challenges and opportunities, monitor and report on the progress of policy initiatives, and set our sights on new initiatives.

The Burden of Health Care Costs

Massachusetts is two years into an ambitious policy initiative aimed at taming the state’s historically high health care costs. Consistent with the Foundation’s mission, we wanted to gain a better understanding of what is at stake for consumers. So we asked them.

We recently brought together an expert panel and a large, engaged audience to discuss our research on how health care costs affect Massachusetts consumers.

Even with nearly universal coverage in our state, 42.5 percent of adults say that health care costs were a problem for them during the previous year, and 16.4 percent say they went without needed medical care because of the amount they would have to pay out-of-pocket. Eighteen percent of adults face frequent difficulty paying their medical bills. As a result, the burden of health care costs is forcing many people to cut back on other kinds of spending, reduce the amount they save, or add to their credit card debt.

A report on the survey’s findings concluded:

“The cost containment and affordability initiatives now underway in Massachusetts, which look to solutions beyond shifting costs to consumers, are of critical importance to the long-term sustainability of the Commonwealth’s health care reforms.”

The findings are from a periodic, statewide survey the Foundation has conducted since 2006, in collaboration with the Robert Wood Johnson Foundation and the Urban Institute, to track the impact of Massachusetts’ health reform law on coverage, access to needed care, and quality. The clear message is that cost containment that offers relief to consumers must be a top priority.

“We need to finish the work of health reform by making high-quality care affordable as well as accessible. There’s reason to be optimistic now that Massachusetts has a comprehensive cost containment law on the books. We have the opportunity to lead on costs and show the rest of the country that a major collaborative effort can make real progress.”

—Phil Johnston
Chairman of the Board of the Blue Cross Blue Shield of Massachusetts Foundation

A Consumer’s Perspective

The issue of health care affordability is a priority for Marisa Melendez, both personally and professionally. Marisa lives with a chronic illness that requires costly medications to manage, and she is program director for the Greater Lawrence Community Action Council, an organization that helps connect low-income individuals and families with needed health care and coverage.

“...will I take my medicines as prescribed, or will I have to cut corners, which could be detrimental to my health?”

Closing Gaps in Coverage

The Foundation’s surveys of consumers confirm that gaps in health insurance coverage can increase the risk of financial problems and also make it far more likely that people will go without needed care. We also know that, for many low-income residents, coverage gaps can occur because of the complexity of federal and state administrative and eligibility requirements.

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Research sponsored by the Foundation’s Massachusetts Medicaid Policy Institute (MMPI) has monitored and reported on the state’s efforts to reduce administrative gaps—commonly known as “churn”—by simplifying the eligibility renewal process. The state’s Medicaid program, MassHealth, is a vital source of coverage for some 1.4 million low-income adults and children, and membership is expected to increase significantly under the Medicaid expansion provisions of the Affordable Care Act.

A 2013 MMPI report noted significant progress in addressing factors that might cause churn—for example, by waiving the requirement for certain categories of members, including elders, adults with disabilities, and children with severe disabilities; using data from other public programs to provide eligibility documentation; and making processing more efficient through technology and workflow improvements. We gained especially valuable insights from community organizations receiving support from our Connecting Consumers with Care grant program, which is aimed at helping individuals enroll in and maintain publicly subsidized coverage.

1.4 million

Adults and children were enrolled in MassHealth as of the end of 2013

1.7 million

MassHealth members are expected after full implementation of the Affordable Care Act

Health Care For All, a Foundation grantee, rallied consumer activists in support of legislation to eliminate financial barriers faced by many patients with chronic conditions.

The Value of Investing in Consumer Advocacy

Since the Foundation’s founding, we have provided grants to advocacy organizations focused on ensuring that consumer interests are well represented in the development and implementation of health care policies. Initially, our Strengthening the Voice for Access grants were given for specific programs related to expanding access, but in 2007, we made a strategic decision to invest in general operating support instead, and we recently completed an assessment of how this approach has supported our mission on behalf of low-income and vulnerable Massachusetts residents.

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An examination the 2011-2013 grant period found that consumer health advocates faced a wide array of challenges, including maintaining the state’s gains in coverage and access; keeping health care affordable; preparing for ACA implementation; and improving care for people with disabilities. Grantee organizations reported that, with general operating support from the Foundation, they were better equipped to respond to, anticipate, and help shape policy initiatives that will most affect their constituents.

Typically, recipients use our Strengthening grants to build organizational capacity and infrastructure, enhance community-based policy activities, increase citizen participation in public policy development, and promote collaboration around shared goals. We believe that meeting the access, cost, and quality needs of our most vulnerable neighbors requires a stable, strong and engaged consumer health advocacy community, and that general operating support is a very effective way for foundations like ours to invest in that outcome.

“We’re constantly faced with unforeseen issues and we can jump right on them, putting resources where they’re needed. We can be the eyes and ears of people who may not otherwise be represented.”

—Matt Selig
Health Law Associates

Sharpening Our Focus

Sharpening Our Focus

Over the past year, we have assessed the health care environment and sharpened our strategic focus to address some of the persistent gaps in care and coverage for low-income and vulnerable residents of the Commonwealth. Looking to the future, we want to ensure that the Foundation continues to have a substantial and sustained impact on the issues that are at the core of our mission.

Our Strategic Initiatives

We and our community partners are building on more than a decade of progress in Massachusetts, with a clear understanding that there is much more to be done. In particular, the work of the Foundation will focus on three priority areas: making health care more affordable for consumers; closing gaps in coverage and care, including access to behavioral health services; and understanding how non-medical investments affect health status, outcomes, and costs.

Here are some examples of the goals we have set for ourselves in each area:

Affordability for consumers

  • Advance the community’s understanding of what is behind the cost concerns reported by more than 40 percent of Massachusetts residents and what can be done to address them.
  • Monitor and evaluate the impact of the state’s cost containment strategies on low income and vulnerable consumers.

Gaps in coverage and care

  • Identify factors driving and strategies to address churn.
  • Identify the demographics of remaining uninsured and promote strategies to increase coverage.
  • Launch a focused behavioral health grant program.

Social spending and health

  • Explore how spending on non-medical services such as housing, nutritional support, and job training can improve health status and reduce medical costs.
  • Document existing models in Massachusetts for low-income and vulnerable subgroups that include services to address social determinants of health.

The Foundation will take on each of these challenges as we always have—by conducting rigorous and informative research and policy analysis; advancing public discussion and action through convenings, collaboration, and support of consumer advocacy; and awarding grants to organizations, programs, and projects that promote sustainable improvements in health care access and affordability.

A Grant Recipient’s Perspective

Each year, more than 10,000 low-income residents of Hyannis, Massachusetts, turn to the Community Action Committee of Cape Cod & Islands for services that can help them become more self sufficient, including affordable health insurance.

As Kelly Hewitt explains, our Connecting Consumers with Care grant program supports the nonprofit organization’s highly successful outreach, education, enrollment, and navigation efforts on behalf of its uninsured and underinsured clients.

“If you come here, we will follow up: Do you have access to a doctor? Did you make that appointment? So we make that connection with our consumers.”

A Policy Expert’s Perspective

When it comes to the workings of the U.S. health care system, very few people can match Stuart Altman for his breadth of experience and depth of knowledge.

Dr. Altman, a Professor of National Health Policy at Brandeis University, is an economist with nearly five decades of experience working on health policy issues in the public and private sectors. He also chairs the Board of the Massachusetts Health Policy Commission, a government-appointed body charged with establishing a statewide goal for reducing the growth in health care costs and monitoring progress through annual cost trend hearings.

We asked him to share his thoughts on making health care more affordable.

2013 Year in Review

2013 Year in Review

In many ways, 2013 was a year of transition for the Foundation, with a new president, additions to the staff in some key areas, and the development of a refreshed strategic plan, but we also continued to broaden our impact and influence through core programs, new projects, and targeted grantmaking.

Fellows meet with paramedics from Boston MedFlight, a critical care transport (CCT) service transporting seriously ill and injured patients throughout New England.

Health Coverage Fellowship

“A truly rewarding experience that has significantly enhanced my understanding of the health care industry.”

That is how one journalist summed up the Foundation’s 12th annual Health Coverage Fellowship program, which was designed to help print, radio, television, and online reporters and editors improve coverage of critical health care issues. As Larry Tye, a veteran reporter and author who directs the program, puts it, “The fellowship’s goals are to give participating journalists new stories to tell, new sources to tap, new ways to enrich their beats, new colleagues to consult, and a new professional mentor.”

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Over a nine-day period, the fellows meet with dozens of top health officials, practitioners, researchers, and patients and take field trips to see first-hand how the system works. For example, last year’s participants spent a night with street teams providing health care to the homeless, visited innovative treatment programs for mental disorders, and observed medical emergency response teams at work.

In 2013, the program received additional support from the Blue Shield of California Foundation, Connecticut Health Foundation, John S. and James L. Knight Foundation, Maine Health Access Foundation, New Hampshire’s Endowment for Health, and Universal Health Care Foundation of Connecticut.

11

Fellows

85

Guest experts, plus Doris, a palliative-care dog

8

Field trips

Massachusetts Institute for Community Health Leadership

The Massachusetts Institute for Community Health Leadership (MICHL) is an 18-day educational program that takes place over the course of nine months, with a curriculum that includes classroom work, peer-to-peer exchanges, and collaborative learning.

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The MICHL experience is designed to help participants develop practical, hands-on leadership skills that will enhance their effectiveness in addressing the many challenges and opportunities in today’s increasingly complex health care system. During the program, students develop and carry out projects that address significant health care issues affecting the state's uninsured and low-income residents.

The 2012-2013 class was the program’s seventh, bringing the total number of graduates to more than 130.

Rebecca Balder, Massachusetts Health Safety Net Office, Melinda Burri, Windsor Street Health Center, Paulette Renault-Caragianes, Somerville Health Department, Marta Chadwick, Brigham and Women’s Hospital, Kevin Coughlin, Greater Lowell Health Alliance, Holle Garvey, Sisters of Providence Health System, Katherine Howitt, Community Catalyst, Jacqueline Johnson, Caring Health Center, Stacey King, Cambridge Public Health Department

Joanna Kreil, Massachusetts League of Community Health Centers, Nancy Mahan, Bay Cove Human Services, Inc., Matthew McCall, The Home for Little Wanderers, Anne McHugh, Boston Public Health Commission, Lenore Tsikitas, Massachusetts Department of Public Health, Rossana Valencia, UMass Medical School, Jennifer Valenzuela, Health Leads, Alyssa Vangeli, Health Care For All, Cathy Wirth, Healthy Kids, Healthy Future

Members of the 2014-2015 MICHL class will be announced in August 2014.

The Massachusetts Health Care Delivery System Map

In 2013, the Foundation launched an online tool that enables users to track the complex and rapidly changing makeup of the Massachusetts health care delivery system. The Delivery System Map provides easy access to information about ownership relationships and major contracting relationships for the state’s acute care hospitals, hospital systems, medical groups, physician networks, and community health centers.

Explore the Delivery System Map

Image depicting an interaction with the Delivery System Map

We are currently updating the map to reflect 2013/14 changes and provide new and improved features.

“The BCBSMA Foundation delivery system map is an important resource for the HPC’s work on statewide care delivery and payment system reform. The tool lays out relationships between systems and facilities in a truly accessible way.”

—David Seltz
Executive Director, Massachusetts Health Policy Commission

“The Foundation’s delivery system map is a valuable tool that I wish every state had. It brings greater transparency to the rapidly evolving delivery system—and provides easy access to information about the state’s acute care hospitals, hospital systems, medical groups, physician networks, and community health centers.”

—Kathy Hempstead
Team Director and Senior Program Officer, Robert Wood Johnson Foundation

Our 2013 Grantmaking

In 2013, Foundation grants totaling more than $3.4 million supported dozens of community-based programs that promote sustainable improvements in health care access and affordability for low-income, vulnerable, and uninsured residents of Massachusetts. We organize our funding priorities into defined program areas, and each area has specific guidelines that describe the Foundation’s goals and the application process for that program.

Making Health Care Affordable: Grants support innovative initiatives that demonstrate substantive cost containment while maintaining or improving access and quality of care.

Connecting Consumers with Care: Grants support programs at community organizations and health centers that help consumers enroll in and maintain health coverage, navigate the health care system, and connect with providers.

Strengthening the Voice for Access: Grants provide core operating support to Massachusetts organizations that serve vulnerable populations by advocating for health care coverage and affordability.

The Catalyst Fund: With funding from Blue Cross Blue Shield of Massachusetts employee donations, one-time grants help community organizations strengthen their capacity to expand health care access.

Special Initiatives: Grants support organizations undertaking new activities that expand access to health care or coverage, increase health-related information and knowledge, or evaluate programs.

Policy and Research: Grants support research, policy analysis, and evaluation on health care access and cost.

Geographic Distribution of Grant Funding

Financial Results

Statements of Activities and Change in Net Assets

(Dollars in thousands) Year ended December 31
Revenues and other support 2013 2012
Total revenues and other support 17,030 18,715
Contributions $461 $5,446
Contributions in-kind 1,099 1,350
Investment income 1,676 1,953
Net unrealized and realized gains on investments 13,974 9,966
Expenses 2013 2012
Total expenses 7,406 7,991
Grants 3,434 3,512
Professional services 1,778 2,285
Salaries and benefits 1,508 1,322
Conferences, conventions, and meetings 132 236
Occupancy and equipment maintenance 165 188
Federal excise tax expenses 309 376
Other administrative expenses 80 72
Net assets at the end of the year $111,391 $101,767
Excess of revenues and other support over expenses and change in net assets 9,624 10,724
Net assets at the beginning of the year 101,767 91,043

Board & Staff

Board of Directors

  • Philip W. Johnston, Chair
  • Robert Meenan, M.D., Vice-chair
  • Andrew Dreyfus
  • Barbara Ferrer, Ph.D.
  • Matthew C. Fishman
  • Milton Glass
  • James W. Hunt, Jr.
  • Rachel Kaprielian
  • Mary Kay Leonard
  • Nick Littlefield
  • Richard C. Lord
  • Dana Gelb Safran, ScD
  • Rob Restuccia
  • Charlotte S. Yeh, MD, FACEP

Staff

  • Audrey Shelto President
  • Julie Burns Senior Director, Communications
  • Elizabeth Guyott Executive Assistant
  • Kaitlyn Kenney Walsh Director, Policy and Research
  • Jessica Larochelle Director, Evaluation and Strategic Initiatives
  • Celeste Lee Senior Director, Grantmaking
  • Jennifer Lee Program Manager, Grantmaking
  • Evelyn Monteiro Administrative and Grants Coordinator
  • Kate Nordahl Senior Director, Mass Medicaid Policy Institute
  • Elisabeth Rodman Policy Analyst

Grantees

Catalyst Fund

  • Cambridge Community Center
  • Carroll Center for the Blind, Inc.
  • Cerebral Palsy Council of Greater New Bedford
  • Children’s Advocacy Center of Bristol County
  • Codman Square Health Center
  • Community Health Programs, Inc.
  • Cooperative Elder Services, Inc.
  • Dismas House of Massachusetts, Inc.
  • Families for Depression Awareness
  • Greater Boston Guild for the Blind
  • Healing Abuse Working for Change
  • Helping Communities in Crisis
  • Hilltown Community Health Centers, Inc.
  • Joseph M. Smith Community Health Center
  • MAB Community Services
  • Martha’s Vineyard Community Services, Inc.
  • MetroWest Free Medical Program
  • Multicultural Wellness Center
  • Pathways to Wellness, Inc.
  • Resilient Sisterhood Project (RSP)
  • River Valley Counseling Center
  • Roca, Inc.
  • Saheli Support and Friendship South Asian Women
  • Seven Hills Extended Care at Groton
  • South Boston Community Health Center
  • Stanley Street Treatment & Resources, Inc
  • Supportive Living, Inc.
  • Talking Information Center
  • The Good Shepherd’s Maria Droste Services
  • Visiting Nurse Association of Greater Lowell, Inc.
  • Volunteers in Medicine
  • Willie Ross School for the Deaf, Inc.
  • YWCA of Southeastern Massachusetts

Connecting Consumers with Care

  • Boston Public Health Commission
  • Brockton Neighborhood Health Center
  • Codman Square Health Center
  • Community Action Committee of Cape Cod & Islands
  • Community Action of Franklin, Hampshire and North Quabbin Regions
  • Community Health Center of Franklin County
  • Community Health Connections Inc.
  • Community Health Programs, Inc.
  • County of Dukes County
  • Ecu-Health Care, Inc.
  • Family Health Center of Worcester, Inc.
  • Fishing Partnership Health Plan
  • Hilltown Community Health Centers, Inc.
  • Joint Committee for Children’s Health Care in Everett
  • Lynn Community Health Center
  • Whittier Street Health Center

Making Health Care Affordable

  • Alliance Foundation for Community Health
  • Boston Medical Center
  • Brockton Neighborhood Health Center
  • Brookline Community Mental Health Center
  • Community Healthlink
  • Greater Lawrence Family Health Center
  • Holyoke Health Center
  • Judge Baker Children’s Center
  • Lynn Community Health Center
  • Mercy Medical Center
  • Steppingstone, Inc.
  • Visiting Nurse Association of Greater Lowell, Inc.

Policy Grants

  • Boston Public Health Commission
  • Brandeis University
  • Commonwealth Care Health Insurance Connector Authority
  • Innovation Network, Inc.
  • Northeastern University
  • The Massachusetts Health Policy Forum

Special Initiative Grants

  • Family Service of Greater Boston
  • Foundation for Art & Healing
  • Health Care For All
  • Health Leads
  • Justice Resource Institute
  • Massachusetts Association of Community Health Workers
  • Pathways to Wellness, Inc.
  • Southcoast Health Systems

Strengthening the Voice for Access

  • Boston Center for Independent Living
  • Disability Policy Consortium
  • Greater Boston Interfaith Organization
  • Health Care For All
  • Health Law Advocates
  • Massachusetts Immigrant and Refugee Advocacy Coalition
  • Massachusetts Law Reform Institute, Inc.
  • Massachusetts League of Community Health Centers
  • Massachusetts Public Health Association, Inc.
  • Massachusetts Senior Action Council

Thank You

Thank you so much for taking the time to learn about the Foundation’s progress and our continued focus on our mission to expand access to health care for vulnerable and low-income people in the Commonwealth.

Annual Report 2013