Massachusetts Health & Hospital Association

INSIDE THE ISSUE

> Lauf Elected Board Chair
> Gov. to MHA: Focus on Mission
> Salute to Case Managers
> Hospital Advocates & Heroes
> The Hegarty Award
> Prior Authorizations
> Transition

MONDAY REPORT

Michael Lauf Elected Chair of MHA’s Board of Trustees
CCHC President & CEO and MHA Board Chair Michael Lauf. (All photos by Michael Last)

Michael Lauf, president and CEO of Cape Cod Healthcare, was elected as the 84th Chair of MHA’s Board of Trustees at MHA’s Annual Meeting last Thursday. Lauf succeeds Kevin Tabb, M.D., president and CEO of Beth Israel Lahey Health.

In the coming year, MHA and its board will build upon Massachusetts’ world-renowned legacy for healthcare innovation. Its priorities will include advancing state-of-the-art care outside the hospital, reimagining what an empowered healthcare profession looks like, and closing care disparities in new and creative ways.

“Our patients are at the center of all we do. From large academic medical centers to smaller community hospitals, serving our patient populations with high-quality care is our purpose,” Lauf said. “Massachusetts thrives on the strength of its diverse healthcare system and the pride its providers take in working together toward one common mission, with that patient-centric approach at the forefront. There is no challenge too big and no opportunity too bold for Massachusetts healthcare.”

Lauf, who holds an MBA from Saint Francis University and an BA from the University of Pittsburgh, has led Cape Cod Healthcare (CCHC) since 2010. Prior to joining CCHC, Lauf served as COO of Bristol Medical Center in Tennessee, and held a variety of positions for Conemaugh Health System in Pennsylvania, including president and CEO of Conemaugh’s Miners Medical Center. From 1994 to 1999, he worked on the staff of U.S. Representative John P. Murtha (D-Penn.).

“As one of the longest-serving hospital CEOs in the commonwealth, Mike exemplifies everything our healthcare community stands for: compassion, innovation, and a deep commitment to community,” said MHA President and CEO Steve Walsh. “Mike leads with conviction and a constant urgency to improve care, and that’s what makes him the perfect person to steer our board in the year ahead. We are grateful to have his voice at this pivotal time for patients and healthcare professionals.”

In addition to Lauf’s election as Board Chair, MHA welcomed new board members Abha Agrawal, M.D., president and CEO of Lawrence General Hospital; Peter D. Banko, president and CEO of Baystate Health; David Coggins, CEO of Encompass Health Rehabilitation Hospital of New England; Marcela del Carmen, M.D., president of Massachusetts General Hospital; John Fernandez, president and CEO of Brown University Health; Denise R. Jordan, Baystate Health Board of Trustees member; and CarolAnn Williams, president of Mass Eye and Ear.

Aimee Brewer, the president & CEO of Sturdy Health was elected as the newest member of the MHA Board’s Executive Committee. The rest of the Executive Committee for 2025 is Lauf; Anne Klibanski, M.D., president & CEO, Mass General Brigham; Michael Dandorph, president & CEO of Tufts Medicine; Kevin Tabb, M.D., the president & CEO of Beth Israel Lahey Health; Christine Schuster, R.N., the president & CEO of Emerson Health; and MHA’s Steve Walsh.

Governor: “If it hurts you guys, it hurts Massachusetts”
Gov. Healey addresses the MHA Anuual Meeting.

MHA held its 88th Annual Meeting in Boston last week while in Washington, the new Administration continued to issue executive orders and regulatory directives that were sowing uncertainty throughout the national healthcare system.

Executive orders targeting DEI initiatives and transgender care, among other things, as well as confusion around a blanket directive that appeared to temporarily halt federal funding of nearly all programs roiled the system.

Governor Maura Healey, addressing the more than 600 attendees at the meeting, attempted to allay some of the concerns.

“We are in a mission moment here for our state and for our country,” the governor said during her morning address last Thursday. “I think it’s up to us to define the issues and execute on them.”

Calling the Massachusetts healthcare community the state’s “North star” in terms of innovation, patient care, and competitiveness, the governor said, “You’re the reason that Massachusetts is number one for healthcare. You support the incredible research that unlocks cures, drives our innovation economy, and provides the jobs that our communities depend on.”

The governor also acknowledged that hospitals “are really under it” in terms of capacity, supply disruptions, workforce shortages, and tight finances. “I’m really your champion,” she assured the crowd.

Healey also acknowledged the rising cost of healthcare in the state and the nation and its effect on patients. She said her administration’s focus in the coming year would be on rebuilding the primary care system in the state to improve access, and to provide care sooner to patients before they become sicker and require more expensive care.

As for the disruptions coming from Washington, Governor Healey said Massachusetts will, of course, continue working with the federal government “but we won’t change who we are.” She said the state needs to “be strong in articulating the mission” in terms of continuing to care for children and the elderly, and fighting for reproductive and gender-affirming care.

“If it hurts you guys, it hurts Massachusetts,” the governor said.

Case Managers Receive Special Commendation

Massachusetts’ dedicated case managers, who are instrumental in coordinating each patients’ unique care needs through every step of their journey, received special recognition at the Annual Meeting. Their advocacy on behalf of patients in an increasingly complex healthcare system helps bridge divides, accelerates care transitions to other settings, and connects people with community resources after their hospital stay. At any given time, up to 2,000 patients are ready to be discharged but are stuck in hospitals because they cannot access the next level of care they need. Case managers are often the lead advocates on their behalf with insurance companies, post-acute care partners, and legal agencies.

Amada Ford, R.N., continuity of care manager at Lowell General Hospital, spoke of how case managers “do a little bit of everything” at hospitals, coordinating with different departments and acting as the main liaison on behalf of patients and families during their journey through the care continuum.

The pressures on them have increased given the capacity crunch at care facilities across the state and region. In recognition of their efforts to provide direction to patients navigating the system, Emerson Health President and CEO Christine Schuster, R.N. presented the case managers with compasses.

Healthcare Advocates and Heroes

Kate Walsh, the secretary of the Health & Human Services and former CEO of Boston Medical Center Health System, received MHA’s William L. Lane Hospital Advocate Award last Thursday. Her successor at BMC and an MHA Board Member, Dr. Alastair Bell, presented Walsh with the award.

The Lane Award embodies the spirit of William Lane, who served as a hospital CEO for more than 30 years and was among the most ardent advocates for hospitals in the commonwealth’s history. The award recognizes professional excellence, outstanding achievements, innovative accomplishments, extraordinary compassion in caring for patients, success in overcoming barriers, and exemplary advocacy on behalf of hospitals, patients, and the healthcare system as a whole.

MassHealth’s Mike Levine (left) and DPH’s Robbie Goldstein.

MHA presented its 2025 Health & Hospital Hero Award to what MHA President & CEO called “two very special recipients who are working together but who are doing very different things” – Department of Public Health Commissioner Dr. Robbie Goldstein, and Assistant Secretary for MassHealth Mike Levine.

Goldstein was credited with his work in helping to resolve the Steward Health Care crisis, assisting hospitals navigate the capacity crisis, and promoting the need for healthcare proxies to help ease care transitions, among many other actions Goldstein takes each day in his role.

Levine worked with MHA and hospital representatives on the historic Section 1115 Medicaid waiver that, Walsh said, shows the rest of the nation how to “walk the walk” when it comes to equity in healthcare. Walsh also credited Levine with helping build one of the “most progressive Medicaid programs on earth,” alluding to MassHealth’s leadership in embracing innovative care models.

“They don’t do things to us, they do things with us,” Walsh said, noting the “audacity” of Goldstein and Levine in taking bold actions to make the commonwealth’s healthcare system work better.

MHA’s Trustee Excellence in Leadership Award was presented the night before the annual meeting to Emerson Health Board Chair Gloria Clough, R.N., who recently was a member of MHA’s Board of Trustees from 2021 to 2024. Clough was credited with bringing the community and patient perspective to healthcare discussions and being a strong advocate for community hospitals and the healthcare workforce. Clough has been a member of the Emerson Board for more than 20 years.

Stephen J. Hegarty Award: Bobby Coughlin

In a one-on-one talk with MHA’s Steve Walsh, Bobby Coughlin recounted his lifelong struggle with cystic fibrosis and how the transformative medication Trikafta, approved for use in 2019, dramatically improved his life.

Coughlin was presented with MHA’s Stephen J. Hegarty Award, named after the late Steve Hegarty, who was president of MHA from 1986 to 1995 and a strong advocate for high-quality, accessible healthcare.

Coughlin said that because he has been afflicted with CF throughout his entire life, he has no point of comparison of what it would be like to be healthy. As he grew older, the hardest part of his journey, he said, has been coming to terms with things that he no longer can do – like playing hockey. “There comes a time when you realize you’re not an average kid growing up,” he said.

He credited the caregivers throughout his journey with keeping him upbeat, especially those at Boston Children’s Hospital. Because he liked the people who were caring for him, and because they were so kind to him, he did not mind his frequent trips to the hospital, Coughlin said. And that was his advice to the caregivers in the audience last Thursday: “Show compassion to your patients.”

In October 2019, the Food and Drug Administration approved Vertex’s drug Trikafta for cystic fibrosis patients 12 years and older. Coughlin said the drug has had remarkable benefits for him, and has given him and his family new hope. But Coughlin conceded he’s “not out of the woods” yet.

Former State Representative and former President of the Mass. Biotechnology Council Robert Coughlin presented his son with the Hegarty Award.

DOI Requests Information from Insurers on Prior Auths

In light of ongoing criticism about the burdens unwarranted prior authorization demands from health insurance companies place on patients and providers, the Massachusetts Division of Insurance has opened a review of the practice.

Division of Insurance Commissioner Michael Caljouw, addressing the MHA Annual Meeting last Thursday, discussed the request DOI had sent to insurers the previous week.

“Prior authorization processes are often cited as a source of clinical burden and of continuing member-patient confusion,” DOI noted in its letter. “They also vary widely across the market. While internal and external appeal rights exist, exercising these rights can be time-consuming and costly.” The letter goes on to note that “When prior authorization processes are implemented responsibly, member-patients access safe, clinically appropriate, evidence-based care, with appropriate limits on unsafe or low-value care inconsistent with existing clinical evidence.”

DOI’s letter asks the insurers for a detailed inventory of the specific items and services for which the health insurance company is using prior authorization; a list of items and services for which the health insurance carrier will retire or limit the use of prior authorization; discussion of how insurers will honor the prior auth a new patient received from a previous insurer; how it is meeting requirements to extend the length of authorizations from primary care, chronic care, and behavioral health care; and how insurers are responding to providers urgent prior auth requests that require a decision within 24 hours.

DOI’s actions follow an op-ed in the Boston Globe last week entitled “Prior authorization is a scam. I know because I helped create it” from the former Commissioner of Health & Hospitals for the City of Boston David L. Rosenbloom, who is now professor emeritus at Boston University School of Public Health.

“Insurance companies have lied to their customers about how their practices protect patients and save money,” Rosenbloom wrote. “They don’t. Health insurance deny-and-delay practices block access to needed care and shift costs to patients and providers, while increasing insurance company profits.”

Last week, KFF, the independent healthcare research and news group, published a study showing that Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023, in contrast to traditional Medicare that requires prior auths for just a limited set of services.

“In 2023, there were nearly 2 prior authorization determinations on average per Medicare Advantage enrollee, similar to the amount in 2019,” KFF wrote. “In contrast, in 2023, about 1 prior authorization review was submitted per 100 traditional Medicare beneficiaries – a rate of about 0.01 per person — which reflects the limited set of services subject to prior authorization in traditional Medicare.”

Prior authorizations are often overturned – but only after they delay care and only after lengthy, time-consuming, and costly reviews.

“Though a small share of prior authorization denials were appealed to Medicare Advantage insurers, most appeals (81.7%) were partially or fully overturned in 2023,” KFF wrote. “That compares to less than one-third (29%) of appeals overturned in traditional Medicare in 2022. These requests represent medical care that was ordered by a health care provider and ultimately deemed necessary but was potentially delayed because of the additional step of appealing the initial prior authorization decision. Such delays may have negative effects on a person’s health.”

MHA began tracking hospital challenges with prior authorization and the effect on administrative burden – and its analysis aligns with these national findings. In its November 2023 report “Better Care, Lower Costs: How Massachusetts Can Lead on Sensible Insurance Reform,” MHA found that 80% of initial denials are due to administrative reasons, including prior authorization. The report found that the vast majority of the denials are eventually overturned.

Transition

Kevin Whitney, R.N., is the new president and chief operating officer of Cooley Dickinson Hospital, effective March 15. Whitney currently serves as the vice president of Community Operations for the MGB Community Division. In addition, since May 2024, he has been serving as interim vice president, Patient Care Services and chief nursing officer for Cooley Dickinson. From 2017 through 2022, Whitney served as the senior vice president, Patient Care Services and CNO for Newton-Wellesley Hospital. Whitney earned his Doctor of Nursing Practice, Executive Leadership from the MGH Institute of Health Professions; a Master of Arts, Health Care Administration, from Framingham State University; a BS in Nursing from the University of Massachusetts Lowell, and an Associate of Science in Paramedic Technology from Northeastern University.

John LoDico, Editor