The Rappaport Center for Law and Public Policy continued its fall webinar series September 15 with a panel discussion on the topic of Covid-19, specifically the Massachusetts government’s response and its impact on public health. Successes and areas where more action is needed were addressed. Cooperation between insurers and state agencies as well as telehealth capacities were seen as key factors in the successes.
Elisabeth J. Medvedow, executive director of BC Law’s Rappaport Center, welcomed the panelists before turning the discussion over to moderator Michael Caljouw (above, center), vice president for government and regulatory affairs at Blue Cross Blue Shield of Massachusetts (BCBSMA) and the longest standing member of the Rappaport Center Advisory Board.
Caljouw began with five words that ring true for many people in these unprecedented times: “I wish we weren’t here.”
His statement was echoed by both other panelists during the discussion, exposing just how challenging this crisis has been for those attempting to find solutions.
Cindy Friedman, Massachusetts State Senator for the 4th Middlesex district, explained how the search for a solution started back in February, when conversations between the legislature and the healthcare industry began taking place. “Ours was, in the beginning, much more of an oversight role, over what is going on and what needs to go on. We spent a lot of time passing information back and forth among people,” she said.
Communication across departments and industries was key to getting things moving. “Having the command center was just critical, just to have not only a central place but a single person,” Friedman said. “[Massachusetts Secretary of Health and Human Services] Marylou Sudders is both a bulldog and a rock star. I wouldn’t wish that job on anyone, but that was so critical because there was a place where we could at least centralize information and feel like we were getting information back and forth.”
Gary Anderson, commissioner of the Massachusetts Division of Insurance (DOI), said his administration assisted by distributing information regarding Covid-19 as it relates to public health and insurance. “We’ve issued approximately 23 or 24 pandemic related bulletins,” he said. “We usually issue about 10 every year.”
The panel made clear that while communication and information-sharing are important pieces to the puzzle, other, more complex ones have been difficult to find and fit into place. “There are no good decisions here. Everyone should understand that. There are the best bad decisions and the worst bad decisions,” Friedman said.
Anderson brought up the complexity of this crisis saying, “So much of this is intertwined and the decisions that we make on one side impact another, and so we have to be mindful of that.”
Although the challenges are many, panelists explained how certain efforts, specifically the implementation of telehealth, have been helpful.
“There are two pieces that came out of telehealth. One was that it allowed healthcare to continue,” Friedman said. “What that has allowed us to do is actually look at the system and say, here it is in all its glory, what works and what doesn’t work, what should we be focused on, how do we continue to do the best of telehealth, and yet control it in a way that works for patient care.”
An executive order issued by Governor Charlie Baker in early spring put telehealth into practice in an effort to reduce the number of patients coming to hospitals for in-person care. “During the height of the pandemic, about 80 percent to 90 percent of all care was telehealth-related, and it provided a very important life preserver, life raft for folks who were stuck at home and wanted to access services,” Caljouw said. “It’s not a panacea. It’s certainly not going to be the answer in every situation.”
With the possibility of a second wave of the coronavirus hitting the US, there is still concern over hospitals being overwhelmed with patients. Friedman believes we can avoid that dilemma by accelerating nursing licenses. “What I would hope to be able to do is have all advanced practice nurses working to the top of their licenses,” Friedman said. “What we’ve seen, through the pandemic, is that this is a good, right thing to do.”
A major point of emphasis was Covid-19’s impact on behavioral healthcare as well as benefits that many children and parents depend on, such as school lunch and employee healthcare. “We were struck in the face, hit upside the head, with how integrated all of our systems are and need to be,” Friedman said. “You pull one piece out of that and everything starts to crumble.” She went on to offer her two biggest takeaways from this crisis: schools feed children and employers pay for health. “If we don’t wake up and try to figure out how we better share the responsibility of some very fundamental things like food, healthcare, and housing, we don’t have a stable community, state, or country. That is what keeps me up at night,” Friedman said.
The panelists were optimistic about the way things have been going in Massachusetts. “I think we’ve done an extraordinary job doing business in these conditions,” Friedman said. “I think this is another example in the commonwealth, of which there are many, of what leadership means.”
Caljouw added, “we are different here in Massachusetts. This level of collaboration is something that a lot of states do not have.”
Anderson agreed: “We really only find good solutions when we do it together. As challenging as that can be sometimes because we don’t always agree on approaches, I think we have a shared goal to serve folks in the commonwealth, so we are fortunate that we see that.”
Photo, from left: Gary Anderson, Michael Caljouw, and Cindy Friedman