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星期二, 1月 28, 2020

Governor Baker, Secretary Sudders Testify in Support of Administration’s Comprehensive Health Care Legislation

Governor Baker, Secretary Sudders Testify in Support of Administration’s Comprehensive Health Care Legislation

BOSTON – Governor Charlie Baker and Health and Human Services Secretary Marylou Sudders today testified in support of the Baker-Polito Administration’s comprehensive health care legislation. The legislation, titled An Act to improve health care by investing in VALUE, aims to improve outcomes for patients, increase access to care and bring down costs.

Testimony as prepared for delivery:

Governor Baker:

“Chair Friedman, Vice Chair Cullinane, Vice Chair Chandler, members of the committee: Thank you for the opportunity to provide testimony in support of H. 4134, An Act to Improve Health Care by Investing in VALUE.

“The legislation filed by the Administration is aimed at preparing our health care system to address pressing current issues AND face the future.

“The legislation is all about investing in value, with the goal of improving outcomes for patients, increasing access to care and bringing down costs.

“Overall as a state, we have seen modest success in slowing the rate of cost growth.  Commercial spending growth in MA has been below the national rate every year since 2013.

“However, for many residents, the cost of health insurance coverage continues to increase. Massachusetts has the 3rd highest average family premiums and has among the highest (7th) employer-sponsored insurance premiums in the US.

“23% of Massachusetts middle-class families spend more than a quarter of all earnings on health care.

“We are getting squeezed at both ends with no relief in sight. Is this new?

“The situation we’re confronting has been decades in the making. It’s complicated and there is no silver bullet to solve it.

“The legislation we have proposed includes big, not marginal, reforms in five key areas:

·       Prioritizing investments in primary care and behavioral health
·       Improving access to high-quality, coordinated care
·       Supporting community health care providers, including community hospitals and community health centers
·       Managing health care costs and increasing affordability
·       Promoting insurance market reforms 

“For the past 50 years, the U.S. health care system has been focused primarily on promoting and supporting the technological advancement of medicine.

“That focus has cured disease, enhanced therapies, and saved lives. But even as that progress has continued, our health care system has failed to appreciate the changing nature of illness, and the systemic gaps in care delivery that have been created by this approach.

“We’ve seen it across the nation – and here in Massachusetts—with the opioid epidemic. A system that financially incentivizes writing a prescription over supportive and sustained therapy yielded an addiction epidemic of gargantuan proportions. This is a problem.

“For far too long, we have neglected preventive services that keep individuals out of our emergency rooms. Services like primary and behavioral health care, and investments in addiction care and supports for older adults.

“We can no longer afford to ignore this. The nature of illness has changed. Chronic illnesses are far more prevalent than they used to be, and we are living longer.

“For a variety of reasons, addiction and behavioral health issues are far more challenging than they were in the past, and we increasingly recognize how they are intertwined with physical illnesses.

“And, we continue to have a primary care shortage that was identified decades ago.
This is unsustainable. Simply put, our health care system is not designed to serve our changing patient population and health care needs. 

“Changing a system requires more than increasing rates – we must proactively prioritize and incentivize services that prevent people from getting sick in the first place. We must invest in team-based approaches that treat the “whole individual” and intervene earlier.

“Our system should reward health care organizations that invest in a comprehensive set of physical and behavioral health services.

“Our proposal flips the script.

“This legislation is designed to create financial incentives for health care providers and payers to reprioritize their service delivery and payment decisions. It promotes system-wide investment in primary care and behavioral health services that are undervalued in today’s payment models and delivery system. Massachusetts has had significant success in attaining near-universal insurance coverage for residents of the commonwealth, and has started to see modest success in controlling overall cost growth.

“We’re proud of that success, but there is more to do – patients and their families continue to face barriers to accessing necessary care; while individual consumers and employers are burdened by growing premiums and out-of-pocket costs that consistently outpace the rate of inflation.

“We believe this bill builds on the strengths of our current system and past legislative reforms, while addressing the areas in which it falls short.

“Before getting into some of the details - While some proposals of this legislation are new, there’s also familiar proposals and areas of common ground including: 
·       Surprise billing
·       Facility fees
·       Prescription drug spending, including the regulation of PBMs
·       Scope of practice, particularly advanced practice nursing
·       Telemedicine
·       Urgent care centers
·       Supporting our community hospitals and community health centers
·       Achieving parity

“Some people say it’s really hard to get to “yes” in this space. I understand that. But we are experiencing unprecedented challenges and stresses in the system. We can find common ground.
  
“Investing in primary care and behavioral health will increase access, particularly early identification and treatment.

“Today, less than 15% of total medical expenditures in Massachusetts are spent on primary care and outpatient behavioral health services combined. This must change.

“The legislation establishes spending targets for primary and behavioral health— requiring payers and providers to increase their spending on these services by 30 percent over three years—all within the parameters of the state’s overall health care benchmark.

“Performance against the proposed spending targets will be measured, and payers and providers held accountable through the framework established under chapter 224, the Commonwealth’s cost containment law.

“Provider and payer entities that do not achieve the target will be referred to the HPC and if determined appropriate, subject to a performance improvement plan.

“Recognizing health care provider systems and payers will have varying baselines, the legislation does not prescribe how systems must achieve the target.

“Performance against the targets will be measured off of the total medical expenditures (TME) of plan members and attributed patients for payers and providers, respectively. Using TME as a proxy for investment, we expect payers and providers to meet the target through modifications to price and utilization. Employing strategies such as:

“For providers:

·       Increasing access to primary care and behavioral health services through expanding practice hours and/or site locations
·       Modifying referral practices in a way that supports primary care and behavioral health clinicians spending more time with the patient, rather than a prompt referral to a specialist.
·       Reallocating negotiated rate increases in favor of primary care and behavioral health service lines and clinicians. 

“For payers:

·       Targeting rate increases toward primary care and behavioral health service lines and clinician reimbursement.
·       Modifying utilization management criteria and standards to promote time and therapy over transactional care. 

“What will this mean for payers and providers? Payers and providers will need to reprioritize the dollars in the system and care delivery strategies in favor of primary care and behavioral health services. To achieve the target within the state’s cost growth benchmark may mean holding other service lines flat financially or tapering growth in specialty services and technologies.

“The legislation also proposes reforms to increase access to high-quality, coordinated care, not only for behavioral health care but for other services for which we know access barriers and gaps in treatment exist.

“For example, we want to allow practitioners to work at the top of their license. Currently, we are one of the 12 most restrictive states for Nurse Practitioners and licensed psychiatric nurses.  Having nurses practice at the top of their license will increase access, particularly, but not exclusively for behavioral health.

“This is not a new idea. In fact, we worked on this 28 years ago when I was sitting in Secretary Sudders’ seat leading HHS.”

Secretary Sudders:

“Having spent my career in the behavioral health space and working alongside the Governor and our partners in the Legislature, I think we all can agree these reforms are necessary and a long time coming.

“First – more behavioral health practitioners need to accept insurance.

“Currently, approximately half of all licensed behavioral health care providers DO NOT accept insurance. Finding a practitioner that accepts one’s insurance is one of the biggest issues that I hear and one of the most significant barriers to treatment.

“This legislation proposes reforms to both encourage practitioners to accept insurance and remove other barriers to necessary behavioral health services.

“To address the administrative burdens associated with insurance contracting, we propose requiring all insurers, including MassHealth, to use a standardized credentialing application to be used by all insurers. Right now, practitioners are required to fill out multiple applications – sometimes for the same insurer, which can serve as a deterrent to network participation.

“We address rate inequities for behavioral health providers by having the Division of Insurance establish a rate floor for certain services based on the reimbursement rate for comparable services delivered by non-behavioral health, medical providers.

“The lack of behavioral health practitioners accepting insurance results in patients having to seek treatment from providers that are not in their insurance network, resulting in higher out-of-pocket costs. This happens far more often for behavioral health services than it does on the physical health side. To address this, we require payers to report to the DOI when their members are getting care from an out-of-network provider, which will inform DOI’s network adequacy review and determination.

“We’re also requiring insurers to reimburse non-licensed behavioral health professionals in training working in clinical settings under the supervision of a licensed practitioner, just as medical residents are reimbursed for services rendered while they are still in training, further signaling that behavioral health treatment is just as important as physical health. Currently, Medicaid is the only payer that reimburses for this.

“Anyone who has struggled with behavioral health issues knows that it isn’t just about access—it’s about timely access, and it’s about affordability.

“Eventually when someone is linked up with a therapist, they may be charged two co-pays for behavioral health appointments occurring in the same day; for example, seeing someone for CBT and someone for a medication check. Under our proposal, insurers are prohibited from denying coverage or imposing additional costs for same-day visits.

“We also know that behavioral health often goes hand in hand with substance use. In 11 of our hospital emergency departments throughout the Commonwealth an individual struggling with both substance use and behavioral health challenges may be paired up with a recovery coach – but each recovery coach’s training may be different since no agreed upon standard currently exists that is accepted by commercial insurance.

“Based off of recommendations from the legislatively created recovery coach commission, we propose the establishment of a state Board of Registration of Recovery Coaches to credential and standardize the recovery coach position to promote insurance reimbursement – while still protecting the personalized and unique perspective that recovery coaches offer.

“As the Governor already noted, the legislation also proposes reforms to increase access to high-quality, coordinated care. He mentioned how nurse practitioners would be able to practice at the top of their licenses. A long overdue reform. This legislation also:

·       Authorizes Massachusetts to join the Nurse Licensure Compact – currently we are one of fewer than 20 states that have not joined a multi-state nurse licensure compact that allows nurses to work across state lines – the New England states of Maine and New Hampshire have signed the compact;
·       Creates a mid-level dental provider position to provide basic dental services and expand access;
·       Aligns scope of practice for optometrists and podiatrists with other states;
·       Establishes a clear definition of telehealth services and requires insurers to cover certain telehealth services if the same service is covered in-person; and
·       Defines and licenses urgent care services, requires that they must accept MassHealth members, provide behavioral health services, and meet certain standards related to primary care.
  
“This bill recognizes the critical role that community hospitals and community health centers play in the health care system by providing patient-centered, high-value care to some of the Commonwealth’s most vulnerable population. 

“In recognition of the vital role these providers play and as part of our commitment to uncompensated care, on the date the bill was filed, we deposited $15 million into the Health Safety Net Trust Fund, which reimburses community health centers and hospitals for care provided to individuals who are uninsured or underinsured.

“The legislation proposes additional funding for community hospitals and health centers through a redesigned Community Hospital and Health Center Investment Trust Fund, with a specific focus on community hospitals and health care centers in need of extra support. Ongoing funding is derived from the existing CHIA transfer, and revenues generated from the drug manufacturer penalty and the proposed financial penalties (in lieu of a PIP) on health care entities that exceed the benchmark. 

“Our legislation addresses rising health care costs across the system, as well as for employers and individual purchasers, including important consumer protections to ensure patients are not left with extraordinary out-of-pocket costs.

“As you know, this year, together with your support, we took bold action to control drug costs in the MassHealth program. And, it is an effective tool. So far, we have successfully completed negotiations with 5 manufacturers on 11 drugs, resulting in $10 million net savings. This will continue to grow.

“Today we are building on those efforts to address pharmacy costs by ensuring the same level of accountability and cost controls in the commercial market. There are
5 key elements to the drug pricing cost containment proposal:

·       For drugs that have been in the market – impose fines on any drug that increases above inflation +2%.
·       For new drugs to market, bring them into the Health Policy Commission for drug pricing accountability.
·       Update the original provisions of Chapter 224 to include members of the pharmaceutical industry in the HPC Cost Trends Hearings.
·       Ensure that when you go to the pharmacy to pick up your prescription, that you are paying the lowest price for that drug.
·       Regulate the middle men, known as pharmacy benefits managers or PBMs, that we know add to drug costs. 

“Too often, we also hear stories about “surprise medical bills,” which happen after someone goes to the emergency room and is treated by an out-of-network provider without their knowledge. No one should be penalized for something they weren’t made aware of in the first place.

“In addition to the cost to the individual patient – it’s a drain on the system.

“That’s why this legislation not only prohibits surprise billing but also creates a process for establishing an out-of-network default rate, a policy that will ensure providers are adequately compensated for services rendered, reduce unnecessary costs associated with payment disputes, and encourage contracting between providers and insurers.

“Similarly, this legislation addresses facility fees, which are another source of unexpected costs to the consumer and often unwarranted costs to the system.
  
“Finally, we need to make health insurance more affordable.

“Wherever you travel – individuals, families, employers large and small, are talking about the cost of health care.

“Rising premiums and out-of-pocket costs are crowding out income gains and straining economic growth.

“Massachusetts has the lowest uninsured rate in the country – this is important. But we continue to be one of the most expensive states in the country for health care.

“A stable and affordable insurance market is key to maintaining our near-universal coverage levels.

“Small employers are the backbone of our economy here in Massachusetts – they also play a vital role in our health care market. 

“Yet we know that small employers experience higher year-over-year premium growth than other market segments.

“We propose providing our small employers with more affordable coverage options for their businesses and employees.

“Specifically, the legislation will ensure that high-value, affordable plans, such as those designed to steer patients to low-cost, high-quality providers, are easily accessible to small employers by promoting the availability and increasing the uptake of such plans.

“In addition to the proposed legislation, our Administration issued an executive order to create a commission tasked with conducting a comprehensive study of the individual and small group insurance market to understand the underlying trends that are contributing to growing costs for small and mid-size employers.

“The Commission is made up of insurers, employers, brokers and consumers to ensure that everyone has a seat at the table with recommendations due by April 30 of this year.

“This legislation is bold – it proposes to rebalance our entire health care system. Massachusetts is a hub for innovation and is home to incredible academic institutions, medical providers, and life sciences companies. Some of the greatest thinking in the space happens right here. This legislation is a prime example of health care innovation creative solutions. 

“Many of the reforms we have proposed will help reduce costs while maintaining quality care and delivering a more cost-effective, nimble and patient-centric health care system for the 21st century.

“Shifts like the ones we are proposing represent change, and change – especially with the size and scale of our proposal – creates discomfort. That is to be expected.

“But the question we want to leave you with today: Will these shifts enable our health care system to modernize and better address changing needs, prepare Massachusetts for the future and deliver greater value to individuals? The Governor and I believe the answer is a resounding “Yes.”

張宇安波士頓交響樂廳指揮首演 台灣之光驚艷波成

波士頓台大校友會部分出席者合影。(圖由波士頓台大校友會提供)
波士頓交響樂團助理指揮張宇安(前右)謝幕。(波士頓台大校友會提供)
                    (Boston Orange 周菊子整理報導) 有音樂界台灣之光聲譽的青年指揮家張宇安,118日首度在波士頓交響樂廳演出四場,曲目包括波士頓交響樂團委託台灣作曲家李志純創作,當晚做全球首演的「福爾摩沙三聯畫」。波士頓台大校友會有47人相約,與當日出席觀眾同讚嘆,這音樂真美。
波士頓交響樂廳。(波士頓台大校友會提供)

             今年33歲的張宇安來自台灣澎湖,從台師大音樂系國樂組主修笛子畢業後轉學西樂指揮,進了國際知名的音樂家搖籃-德國柏林音樂學院,接受指揮培訓,除了器樂(Blasinstrument)、擊樂(Schlagzeug)、指揮(Dirigieren)以及伴奏(Korrepetition)之外,還學習歌劇、體會人聲與各類器樂的基礎。
            2016年,張宇安獲第七屆羅馬尼亞布加勒斯特國際指揮大賽首獎,活躍於歐洲樂壇,備受好評,許多樂團大師都認為他是國際交響樂界的明日之星。
位列美國五大交響樂團之一的波士頓交響樂團,2019年中約聘張宇安出任助理指揮,就是就是因為該團新指揮Andris Nelsons聽了他申請參加探戈塢(Tanglewood)音樂節的錄影帶,竟不由自主地隨之哼唱,之後主動約他參加該團助理指揮甄選,並在四名參加甄選者中選擇了他來簽下一紙為期兩年合約。
去年九月上任波士頓交響樂團助理指揮以來,張宇安備受讚譽,今年118日首次在波士頓交響樂廳演出,指揮波士頓交響樂團和鋼琴家Till Fellner演奏李志純應波士頓交響樂團之邀,創作的福爾摩沙三聯畫,以及莫札特的C大調第25號鋼琴協奏曲,作品編號k.503,柴可夫斯基的波蘭第三號交響曲。
波士頓台大校友會有將近50人,那晚冒雪出席,聽著台灣原住民、福佬及客家音樂,在來自台灣澎湖的張宇安指揮統領中,由全美五大交響樂團之一的波士頓交響樂團及美國的鋼琴家,在全世界十大最佳音樂廳中排名第二的波士頓交響樂廳演奏出來,心中的激動溢於言表。
曾任波士頓台大校友會會長的吳杏玫表示,當晚出席的校友,都大讚張宇安的指揮才華及表現。波士頓地區知名音樂活動策辦人,也是中華表演藝術基金會會長的譚嘉陵,駐波士頓台北經文處科技組組長謝水龍等,這晚也都是自己買票出席的座上嘉賓。
台大校友們對於張宇安的並非科班出身,但從高中時迷國樂,以社團為家,進入師大學國樂,在研究所期間大量指揮台灣作曲家作品,於2011年受邀參加美國當代音樂節做開幕演出指揮,獲邀留在美國Peabody音樂學院就讀,可免試入學,並兼任Baltimore 交響樂團的指揮助理,卻決定去報考柏林音樂學院,還在第一次報考失敗後,再接再厲,終於大放異彩,2016年贏得第七屆羅馬尼亞布加勒斯特國際指揮大賽首獎的特殊經歷,尤其讚譽有佳,直稱這是台灣囝仔的典範。

波士頓古典樂廣播電台WCRB 99.5在網路上貼出了這場音樂會的錄音,https://www.classicalwcrb.org/post/yu-changs-subscription-debut#stream/0

星期一, 1月 27, 2020

MFA 賀建館150週年 2月1日出席農曆新年慶會 可得一年免費會員


Boston Orange波士頓美術博物館(MFA)為慶祝建館150週年,並期許更多人能更接近藝術,走進該館,刻正舉辦各項活動。21日的慶祝農曆新年活動,將給入館訪客免費註冊成一年會員的機會。
波士頓美術博物館建於187024日。該館為慶祝建館150週年,安排有一系列活動。為鼓勵更多人進博物館,接近藝術美學,將在該館的11各年度社區活動和三個季節性的波士頓美術博物館深夜秀 (MFA Late Nites)中,給到訪者免費註冊成為會員一年的機會。
波士頓美術博物館館長Matthew Teitelbaum表示,向前展望,波士頓美術博物館必須因應博物館在社會中角色的不斷改變,在成為一個真正包容機構上更加努力,並致力於以新的緊迫感因應時代問題。
波士頓美術博物館從1870年創建到成為一個全球性收藏機構的擴展過程,將在慶祝150週年的為期一年展覽中做重點展示,包括展現在歷史上強大,卻被誤解的尼羅河上王國的現在的古代努比亞(Ancient Nubia Now)”,翁氏家族收藏的中國繪畫:家庭及朋友,明(1368-1644)(1644-1911)兩朝大師作品,以及和倫敦皇家藝術學院合作的”Lucian Freud:自畫像等等。
在波士頓美術博物館的建館150年間,該館和地方社區也有了更緊密聯繫,推出會員第一年免費活動,邀請每一個人把波士頓美術博物館變成他們自己的。在2020年的一整年之間,波士頓美術博物館會和社區人士及地方藝術家合作創造各種慶祝活動,從青少年製作的美國有色人種藝術家20世紀藝術到社區壁畫項目等。
波士頓美術博物館的150週年慶典由美國銀行贊助。
在慶祝150週年的這一年期間,波士頓美術博物館推出各種會員計畫,以鼓勵更多人和該館建立更深厚關係,包括在該館的11個年度社區慶祝活動和三個季節性MFA Late Nites中,提供註冊成為第一年免費會員的機會;推出作品由該館收藏,刻仍在世藝術家可終生入場免費的福利,在MFA150週年期間和該館合作的藝術家,可得一年會員資格的獎勵等。
有機會獲得波士頓美術博物館(MFA)免費一年會員資格的11項活動,除了120日的馬丁路德金日,21日的農曆新年慶祝外,還有318日的Nowruz43日的MFA深夜,525日的陣亡將士紀念日,617日的六月節,6月份的MFA深夜秀,夏季的高地街基金會的免費趣週五,9月的ASL深夜秀,拉丁傳統夜,1012日的土著人民節,10月的MFA深夜秀,11月的排燈節(Diwali)12月的光明節(Hanukkah)

Enhancing the Power of Art and Artists with a Renewed Focus on the Community in Which We Live
BOSTON (September 12, 2019)—The Museum of Fine Arts, Boston (MFA), announced today a slate of initiatives for its 150th anniversary in 2020, driven by a deepened commitment to inclusion, community and generosity. The yearlong celebration aims to bring more people closer to art and the MFA—signaling aspirations for the Museum’s future.
“The MFA’s 150th anniversary is a moment to honor our past and, more critically, anticipate our future. The Museum was founded with a spirit of generosity and belief in the power of art and artists—values that remain among the pillars of today’s MFA,” said Matthew Teitelbaum, Ann and Graham Gund Director. “As we look ahead, we must also address the changing role of museums in society, amplifying our efforts toward becoming a truly inclusive institution and committing to a new sense of urgency in engaging with the issues of our time.”
A group of Boston’s civic leaders created the Museum in 1870 as a public place for discovery, the enjoyment of art and celebration of artists. Since then, the MFA has grown to house a global collection, which will be highlighted during the 150th anniversary year in exhibitions ranging from Ancient Nubia Now, shining a light on the powerful, yet historically misinterpreted kingdoms on the Nile, to the Weng Family Collection of Chinese Painting: Family and Friends, featuring works by some of the greatest masters from the Ming (1368–1644) and Qing (1644–1911) dynasties, to Lucian Freud: The Self-Portraits, organized in partnership with the Royal Academy of Arts in London. In its 150th year, the Museum will also forge deeper connections with the local community, launching a free first-year membership program—an invitation to everyone to make the MFA their own. Throughout 2020, the Museum will engage community members and local artists as co-creators on various opportunities for convening and celebration, from a teen-curated exhibition of 20th-century art by artists of color from the Americas to a community mural project—initiatives that lay foundations for future ambitions.
The 150th Anniversary Celebration is sponsored by Bank of America.
Free Memberships for Community Members and Artists
The MFA will introduce a variety of membership initiatives during its anniversary year, in an effort to invite and engage a wide range of audiences to build deeper relationships with the Museum:
·        Signup opportunities for free first-year memberships will be offered to visitors at 11 annual community celebrations and three seasonal MFA Late Nites taking place in 2020. These memberships will allow access to the Museum for a full year. 
·        The MFA will inaugurate an ongoing program of lifetime admission benefits for all living artists represented in its collection, as well as gift one-year memberships to artists who partner with the Museum on exhibitions, programs and events during the anniversary year.
·        Additional benefits will be offered throughout the year to existing members in appreciation of their ongoing support—such as allowing them to bring more friends and family to the MFA—further empowering these longtime supporters as ambassadors for the Museum in their own communities.
For nearly two decades, the MFA’s annual community celebrations—expanded in the fall of 2019 to include Latinx Heritage Night and Indigenous Peoples’ Day—have featured activities and performances that represent the art, history and global influences throughout Greater Boston. All of the community celebrations, as well as the MFA Late Nites—seasonal after-hours celebrations introduced in the fall of 2017—are co-created with valued community partners, artists and performers, highlighting external perspectives and local expertise. The free first-year membership initiative will invite all attendees of these popular events to return to the MFA often and with others, with the goal of fostering a sense of belonging at the Museum year-round. The full schedule of signup opportunities in 2020 includes:
·        Martin Luther King Jr. Day, January 20, 2020
·        Lunar New Year Celebration, February 1, 2020
·        Nowruz, March 18, 2020
·        MFA Late Nites, April 3, 2020
·        Memorial Day, May 25, 2020
·        Juneteenth, June 17, 2020
·        MFA Late Nites, June 2020
·        Highland Street Foundation Free Fun Friday, Summer 2020
·        ASL Night, September 2020
·        Latinx Heritage Night, September 2020
·        Indigenous Peoples’ Day, October 12, 2020
·        MFA Late Nites, October 2020
·        Diwali, November 2020
·        Hanukkah, December 2020