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The Blue Cross Blue Shield of Massachusetts Foundation has awarded more than $575,000 in grants to four Massachusetts organizations to conduct policy research projects focused on health care costs in the Commonwealth.

Moderating the growth of health care spending is critical to sustaining the gains that Massachusetts has made in access to care and insurance coverage since 2006. Each of the projects will contribute vital data and analysis to fill knowledge gaps around health care spending and identify opportunities for cost savings in the state. The research will provide timely guidance to Massachusetts public policymakers, payers, and provider organizations as they look to develop, expand, and improve their cost containment efforts.

Cost containment is a national issue, yet significant responsibility for identifying and implementing cost saving opportunities is expected to continue to fall to the states. With the passage of Chapter 224 of the Acts of 2012, which sets statewide health care cost growth targets, Massachusetts has the opportunity to lead in these efforts. The Blue Cross Blue Shield of Massachusetts Foundation is one of the few funders tackling this important issue.

“We know there are tremendous opportunities for making health care more efficient and affordable in Massachusetts,” said Celeste Lee, Interim President of the Blue Cross Blue Shield of Massachusetts Foundation. “These grants will help health care leaders understand, at a more actionable level of detail, some of the best opportunities for reducing spending while maintaining and improving health care quality and outcomes.” 

The Cost and Affordability Policy and Research Grants provide up to two years of grant support to research organizations. Using Massachusetts-specific data, the research teams are exploring a variety of topics relating to hospital readmissions; high-cost patients; opportunities for health gains and cost savings through the use of cost effectiveness research; and variations and best practices around hospital admissions originating in the emergency department. A complete listing of grantees with brief descriptions of their work appears below.

About the Blue Cross Blue Shield of Massachusetts Foundation
The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to expand access to health care. It focuses on collaborating with public and private stakeholders to develop measurable and sustainable solutions that benefit uninsured, vulnerable, and low-income individuals and families in the Commonwealth.

The Foundation was established in 2001 with an endowment from Blue Cross Blue Shield of Massachusetts. It operates separately from the company and is governed by its own Board of Directors.

2013 Grants
Brief project descriptions

1. Project Co-Directors Arnold Epstein and Amy Boutwell, Harvard School of Public Health ($149,945)
In their project “Analysis of the Massachusetts All-Payer Claims Database to Describe the Epidemiology of Readmissions,” the research team will use the Massachusetts All-Payer Claims Database (APCD) to better understand patterns of hospital readmissions in Massachusetts. Most research on readmissions has been conducted using Medicare data or on data sets that describe only inpatient hospital encounters. By using the APCD, this research will shed new light on the diagnoses and patterns of care associated with readmissions in Massachusetts for all populations. This analysis could help providers develop and focus work around preventing avoidable readmissions.

2. Project Director Ashish Jha, Harvard School of Public Health ($136,580)
The research team will use the APCD in their project titled “Understanding High-Cost Patients in Massachusetts” to provide in-depth analysis of the small percentage of patients who consume a disproportionately large share of health care spending in the state. By gaining a more detailed understanding of high-cost patients—their diagnoses, co-morbidities, demographic factors, and providers—the researchers hope to help inform the development and targeting of potential cost containment policies, practices, and payment models for Massachusetts.

3. Project Director Natalia Olchanski, Tufts Medical Center ($150,000)
In their project titled “Best Opportunities for Improving Massachusetts Health within Budget Constraints,” the research team will use published cost effectiveness research and Massachusetts-specific data on current health care use to identify opportunities to reduce the use of overused low-value care and increase the use of underused high-value care.  Their simulation model will allow health care leaders to estimate total cost savings and health gains that could be achieved by reallocating resources from inefficient to efficient interventions.   

4. Project Director Jeremiah Schuur, Brigham and Women’s Hospital ($139,099)
Inpatient admissions that originate in the emergency department (ED) result in a significant portion of total health care spending each year, yet there is both wide variation in admission patterns and little understanding of best practices for post-ED care management and potential cost savings. In their project “Identifying Best Practices to Reduce Hospital Admission from the Emergency Department,” the research team will complete an in-depth study of three common conditions leading to admissions from the ED. By analyzing top-performing hospitals, the researchers will develop strategies and best practices around improving care and reducing costs.

The Board of Directors of the Blue Cross Blue Shield of Massachusetts Foundation today announced that Audrey Shelto of Newton will become the Foundation’s next President.

“The Board is thrilled to have found someone so uniquely qualified to lead the Foundation at this critical time in health care,” said Philip W. Johnston, the chairman of the Foundation Board. “Not only does Audrey have three decades of leadership experience in government, health care and human services, but she also brings a great familiarity with the Foundation’s mission to expand access to care for vulnerable and low income people in the Commonwealth.” Johnston noted that Shelto was a key player in the Foundation’s early history serving initially as a consultant and later as Interim President in 2005. During that time, Shelto played significant roles in the creation of the Foundation’s initial policy and grant making programs and its Roadmap to Coverage initiative which led to the state’s landmark 2006 health reform law.

In response to her selection, Shelto said she is “deeply honored by the privilege of leading an organization so highly regarded and respected for the work it’s done to ensure that all Massachusetts residents, including the most disadvantaged, have access to high quality, safe and affordable care.” 

Shelto’s 30-year career includes leadership positions in state government at the Executive Office of Administration and Finance and as Associate Commissioner at the Department of Mental Health. Her private sector experience includes senior management roles at Neighborhood Health Plan, where she served as Chief Operating Officer and at Blue Cross Blue Shield of Massachusetts (BCBSMA) where she has worked since 2007, leading a wide variety of medical cost management initiatives. She has also worked as a health care consultant and has advised many of the state’s leading hospitals, community health centers and human service agencies.  She was the Executive Director of the Mayoral Commission that resulted in the creation of Boston Medical Center and the Boston Public Health Commission.  She also developed Healthcare Administrative Services, a provider and health plan sponsored organization dedicated to reducing health care administrative costs. Shelto graduated summa cum laude from the University of Connecticut and holds a Master’s Degree in Management from The Heller School for Social Policy and Management at Brandeis University. 

Shelto’s appointment drew strong praise from prominent Massachusetts health care community leaders:  

"Audrey has a rare ability to convene representatives from diverse groups across the health care field and ferret out the hidden shared perspectives and priorities. This is one of the important roles philanthropy can play. I saw her in action when she successfully worked with me on the Eastern Massachusetts Healthcare Initiative, and I know she's the right person for this job.” David Blumenthal, M.D., President, The Commonwealth Fund.

“Audrey has been involved in nearly every major reform effort in Massachusetts in the past 30 years including policy initiatives she helped lead to improve services for those with chronic mental illness. I look forward to working with her in this new role and continuing the strong partnership with the Blue Cross Foundation as the community works together to develop meaningful solutions to today’s biggest health care challenges.”  Stuart Altman, Professor of National Health Policy, The Heller School for Social Policy and Management at Brandeis University & Chair of the Massachusetts Health Policy Commission.

“She is the perfect person for this role. Audrey brings extraordinary depth and experience in all the dimensions of the Foundation’s work, particularly grant making and health policy.” Nancy Turnbull, Associate Dean for Educational Programs & Senior Lecturer on Health Policy, Harvard School of Public Health.

“Audrey has a special combination of deep policy knowledge and on-the-ground experience working with underserved populations like those we serve at community health centers. She blends an analytical mind with a passion for people and was instrumental in helping us develop our strategic plan.” Jack Cradock, President, East Boston Neighborhood Health Center.

Shelto will assume her new responsibilities after a short transition period. 

About the Blue Cross Blue Shield of Massachusetts Foundation
The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to expand access to health care. It focuses on collaborating with public and private stakeholders to develop measurable and sustainable solutions that benefit uninsured, vulnerable, and low-income individuals and families in the Commonwealth. The Foundation was established in 2001 with an endowment from Blue Cross Blue Shield of Massachusetts. It operates separately from the company and is governed by its own Board of Directors.

The Blue Cross Blue Shield of Massachusetts Foundation has appointed Kaitlyn Kenney Walsh as Director of Policy & Research. Ms. Kenney Walsh will be responsible for managing the Foundation’s policy work related to affordability, which includes in-depth research on public and private efforts to contain health care costs, monitoring the implementation of the national Affordable Care Act as well as Massachusetts health reform, and the movement to find more efficient and effective ways to expand access and meet the complex health care needs of low-income, vulnerable populations.

Since 2007, Kenney Walsh has been at the Commonwealth Health Insurance Connector Authority, most recently as Director of Policy and Research and Coordinator of National Health Care Reform.  As a member of the senior management team, she had responsibility for developing and implementing strategy and long term planning for the Health Connector.  A significant part of her role was in identifying the implications of national health care reform for the Commonwealth and its residents.  “Kaitlyn possesses an exceptional blend of expertise in healthcare policy analysis and development, a deep knowledge of the healthcare industry, including financing, access, and delivery systems as well as awareness of the specific issues facing our Commonwealth,” said Audrey Shelto, President of the Blue Cross Blue Shield of Massachusetts Foundation. “Her expertise will help ensure that the Foundation’s research is designed to gain community-wide support for innovative and lasting solutions.”

Kenney Walsh joins Celeste Lee, Kate Nordahl and Jessica Larochelle as members of the Foundation’s leadership team. Lee oversees all of the Foundation's grant programs. In 2012, the Foundation awarded grants totaling over $3.5 million to community organizations across Massachusetts. Nordahl is director of the Massachusetts Medicaid Policy Institute, a Foundation program devoted to broadening public understanding of MassHealth, the public insurance program that includes both Medicaid and the Children’s Health Insurance Program (CHIP) and Larochelle directs the evaluation of grants and identifies trends to inform the Foundation’s work.

About the Blue Cross Blue Shield of Massachusetts Foundation
The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to expand access to health care. It focuses on collaborating with public and private stakeholders to develop measurable and sustainable solutions that benefit uninsured, vulnerable, and low-income individuals and families in the Commonwealth. The Foundation was established in 2001 with an endowment from Blue Cross Blue Shield of Massachusetts. It operates separately from the company and is governed by its own Board of Directors.

The Blue Cross Blue Shield of Massachusetts Foundation has awarded $1.3 million in grants to 26 community organizations across the Commonwealth of Massachusetts whose missions are dedicated to promoting accessible and affordable health care for vulnerable and low-income residents. The grants range from $40,000 to $75,000 per year for two years.

"With the implementation of the Affordable Care Act (ACA) underway, the Foundation’s support of organizations on the front lines is more important than ever,” said Audrey Shelto, President. “These organizations all have a clear strategy to impact access or affordability, a history of collaboration with other groups on important issues such as the state’s dual eligibles initiative, Chapter 224, and strong track records in consumer engagement and support. We are pleased to renew many of our prior grantees and welcome the Codman Square Health Center, Community Action of the Franklin, Hampshire and North Quabbin Regions, Community Health Programs, Inc. and the Fishing Partnership Health Plan to the cohort.”

The grants were made in two of the Foundation’s program areas, Connecting Consumers with Care and Strengthening the Voice for Access, both of which were implemented in 2001 when the Foundation first began its grant making efforts. 

Connecting Consumers with Care provides up to two years of programmatic support to organizations that are engaged in comprehensive outreach and enrollment services, an enhanced approach to educating consumers on effective navigation of the health care system, and strategic collaboration with the advocacy community to identify and address barriers that prevent consumers from easily accessing coverage and care.

Strengthening the Voice for Access provides up to two years of core operating support to organizations that are strengthening community-based policy activities, increasing citizen participation in public policy development, and promoting collaboration among statewide policy and advocacy organizations on coverage and affordability.

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About the Blue Cross Blue Shield of Massachusetts Foundation
The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to expand access to health care. It focuses on collaborating with public and private stakeholders to develop measurable and sustainable solutions that benefit uninsured, vulnerable, and low-income individuals and families in the Commonwealth. The Foundation was established in 2001 with an endowment from Blue Cross Blue Shield of Massachusetts. It operates separately from the company and is governed by its own Board of Directors.

BCBSMA Foundation 2013 Grants – Connecting Consumers with Care & Strengthening the Voice for Access

Connecting Consumers with Care:
Boston Public Health Commission
Brockton Neighborhood Health Center
Codman Square Health Center 
Community Action Committee of Cape Cod and Islands
Community Action of the Franklin, Hampshire, & North Quabbin Regions
Community Health Center of Franklin County
Community Health Connections
Community Health Programs
County of Dukes County/Vineyard Health Care Access Program 
Ecu-Health Care
Family Health Center of Worcester
Fishing Partnership Health Plan
Hilltown Community Health Centers
Joint Committee for Children’s Health Care in Everett 
Lynn Community Health Center
Whittier Street Health Center
Connecting Consumers with Care Funding Total: $640,000

Strengthening the Voice for Access:
Boston Center for Independent Living (BCIL)
Disability Policy Consortium, Inc. (DPC)
Greater Boston Interfaith Organization (GBIO)
Health Care for All (HCFA)
Health Law Advocates (HLA)
Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA)
Massachusetts Law Reform Institute (MLRI)
Massachusetts League of Community Health Centers
Massachusetts Public Health Association (MPHA)
Massachusetts Senior Action Council
Strengthening the Voice for Access Funding Total: $695,000