BCBSFound Annual Report 2013

advancing reform

Blue Cross Blue Shield of Massachusetts Foundation

Landmark Center 401 Park Drive, Boston, MA 02215 | 617. 246. 3744 | BlueCrossFoundation.org

Access, Advocacy, and Innovation

2010 Annual report

sarah iselin is the President of the Blue Cross Blue Shield of Massachusetts Foundation.

“We’re supporting organizations using innovative approaches to overcome barriers to coverage and care, help patients control chronic disease, bring coordinated care to fragmented lives, and ensure that the consumer voice is heard in the debate over cost containment.�

Sarah Iselin

Dear friends and community partners: This year’s annual report coincides with a notable milestone for the Blue Cross Blue Shield of Massachusetts Foundation and also for the Commonwealth of Massachusetts. It’s the Foundation’s tenth anniversary, and the landmark Massachusetts health care reform law is five years old. As the Foundation begins its second decade, we look back with pride on the contributions we and our community partners have made to the state’s reform efforts.

Today, Massachusetts has the lowest rate of uninsured residents in the nation by far, with gains in coverage and access to care that have weathered a sustained economic recession.

With all that Massachusetts has achieved, there’s still plenty of work to do. Our state’s most vulnerable residents continue to face significant obstacles to getting and maintaining the coverage and care they need. Too often, their encounters with the health care system are fragmented and uncoordinated. And there’s no question that the unrelenting rise in the cost of health care has made it increasingly difficult to sustain, and build upon, the extraordinary gains Massachusetts has made since 2006. The call to action for the Foundation and our community partners is clear: we need to focus more of our attention and resources on finding ways to make health care less costly, without sacrificing access or quality.

“The call to action is clear: we need to focus more of our attention and resources on finding ways to make health care less costly, without sacrificing access or quality.”

Despite the enormity of the cost challenge, there is already a lot of great work going on in communities across the state, including exciting initiatives undertaken by many of our grantee organizations. In that spirit, this year’s annual report features a few of the many organizations that are working tirelessly to improve access to needed care in ways that will also provide better value and better outcomes. More specifically, we’re shining the spotlight on innovative approaches grantee organizations are using to overcome barriers to coverage and care, help patients control chronic disease, bring coordinated care to fragmented lives, and ensure that the consumer voice is heard in the debate over cost containment.

I’m delighted that this year’s report also includes the perspectives of four people who were intimately involved in creating the Foundation a decade ago. They and many other friends and supporters helped define the mission that continues to be the focus of every member of the Foundation’s staff – to expand access to health care for low-income and vulnerable individuals and families.

With thanks and best wishes,

Sarah Iselin President 1

Breaking down barriers to coverage and care Despite the success of Massachusetts health reform, the state’s most disadvantaged residents still face barriers that keep them from getting the coverage and care they need, including unstable living conditions, chronic medical problems, limited English proficiency, and a lack of transportation. Many of the state’s community health centers, which care for uninsured and underserved residents regardless of income, have developed intensive, personalized service programs to help their clients overcome these obstacles and make their way through the complexities of the health care system.

In Worcester, the Edward M. Kennedy Community Health Center has used a grant from the Foundation to hire a bilingual social services case manager to work with disadvantaged patients. Dr. Michele Pici, the health center’s medical director, says the economic downturn has caused a sharp increase in people losing housing and employment and, subsequently, health insurance. In response, the health center has developed a comprehensive triage system to assess the basic areas of patients’ lives that affect their health and well-being, such as housing, utilities, transportation, food security, and personal safety. In addition, the staff routinely assess their clients’ insurance status to identify problems that may cause future lapses in their coverage.

“Prevention results in better patient health outcomes and is cost-effective. In many cases, our social services case managers are able to prevent emergency room visits by identifying and helping with issues that could keep patients from adhering to their care plans.”

Dr. Michele Pici medical director, Edward M. Kennedy Community Health Center

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bring down barriers Case Management In Action Mario and his wife Maria, both in their early 40s, live in Worcester. Mario needs ongoing treatment for a chronic liver condition and depression, but he and Maria are limited English speakers and were intimidated by the insurance system. After a comprehensive social services assessment by a case manager at the Edward M. Kennedy Community Health Center, Mario and Maria have access to services that are vital to their health and well-being.

Insurance: Their health insurance had lapsed.

Their case manager referred them to an onsite Legal Services attorney who helped them reenroll in a subsidized health insurance plan.

Living conditions: They pay half of their income for their rental apartment, which meant they were unable to pay for utilities and often went hungry. They have received food, fuel, and clothing assistance through the health center’s partner agencies.

Transportation: They don’t have a car or access to public transportation. The health center provides van service from their home to their appointments.

“Intensive case management makes it easier for our clinicians to focus patient visits on important medical issues rather than on psychosocial assistance and support.”

Mario and Maria say they are relieved to have a case manager who speaks their language and who can help them navigate within the system.

Mario continues to keep his appointments and is regularly taking his medications, which he gets at the health center’s pharmacy even when he cannot afford the co-payment.

“The navigator team has a presence in the community as well as in the health center, and they work in synergy with our primary care team and patients. Since the program began, we have been able to link many more uninsured individuals to care.�

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Lowell Community Health Center

has added bilingual “system navigators” to enhance services for its large and growing Southeast Asian clientele. In addition to helping patients apply for health coverage and connect to needed care, the navigators offer longer-term case management for those with chronic conditions, counseling them on issues related to their disease, treatment, and desirable lifestyle changes. The health center’s medical team often turns to the navigators for their cultural and community knowledge, which enhances the clinicians’ ability to communicate with their patients and treat them in a culturally appropriate way.

Community outreach is another key component of the health center’s effort to engage with the city’s many immigrant population groups. For example, the center works closely with the Lowell Adult Education Center to offer blood sugar and blood pressure screening, depression screening, HIV counseling and testing, health education, and insurance information to all English for Speakers of Other Languages (ESOL) and General Educational Development (GED) students. During the academic year, the center’s staff screen an average of 100 participants at each monthly session.

“With system navigators who are bilingual and bi-cultural, we are able to greatly reduce risks associated with language barriers or a lack of health literacy.”

Sheila Och Director of Community Health Promotion, Lowell Community Health Center

Edward M. Kennedy Community Health Center (formerly Great Brook Valley Health Center) was among the Foundation’s first grantees in 2001.

Lowell Community Health Center is currently the beneficiary of two, multiyear Foundation grants.

How has the Foundation’s work evolved compared with your expectations when it all started?

I think we developed a very good model by investing in sound, independent research and policy development; in outreach, education, and advocacy; and also in the community providers that care for our most disadvantaged neighbors. What I certainly didn’t foresee at the outset was the magnitude of the impact the Foundation would have, both through its grantmaking and also as a catalyst for Massachusetts health reform.

What are your thoughts about the Foundation’s future role in reform?

I’m very proud of the role the Foundation has played in ensuring access to health coverage to everyone regardless of income; now the challenge is how we continue to pay for it. The Foundation is in a good position to help with that as well, but tackling costs is a lot tougher.

Massachusetts is going to be watched very closely by national policymakers because we were way ahead of the rest of the country on the access issue.

“I’m very proud of the role the Foundation has played in providing health care access to everyone regardless of income; now the challenge is how we continue to pay for it.”

Despite natural differences, the state’s health care stakeholders seem to be quite unified around the reform law. What was it like in the Foundation’s early years?

Actually, as the discussions of health reform evolved, I found it interesting that so many of us around the table had been involved in state and national health reform efforts during the mid-1980s. There was a sense of unfinished business, since we hadn’t fulfilled the promise of universal coverage. I’m not sure it was on anyone’s individual radar screen when we first raised the issue, but all it took was a spark, and eventually everyone came together – Governor Romney and the Democratic legislative leaders, Senator Kennedy, the business community, consumer advocates – pretty much the entire health care community.

As we move to deal with the cost challenge, we need to do everything we can to make the system more cost-effective without sacrificing the great progress we’ve made on access.

I think the kind of organizations the Foundation supports through its grantmaking are key.

Community providers are on the front lines of care coordination, prevention, and helping people manage chronic illness, which are huge cost-related issues. There’s a lot of great work going on out there and the Foundation is in a unique position to help nurture it.

Philip Johnston “I think the kind of organizations the Foundation supports through its grantmaking are key. There’s a lot of great work going on out there and the Foundation is in a unique position to help nurture it.”

Philip Johnston has been chairman of the blue cross blue shield of massachusetts Foundation's board since its inception in 2001.

$38,000,000 Total grants awarded over the last decade

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Lessons Learned Greater New Bedford Community Health Center Patients need tools and education to make gradual lifestyle changes and adopt healthy practices.

Helping patients take small steps that bring small accomplishments is more successful and less costly than trying to bring about dramatic lifestyle changes.

Care management is very individualized – one size does not fit all. Start at the place where the client is and work with him or her from there.

Empowering a patient to make informed choices minimizes the use of approaches that would never be a good fit, thereby saving time and minimizing frequent failures.

Measurable indicators are useful for positive reinforcement. Praise successes and work to support the patients when setbacks occur.

“Our goal is to fully engage our patients in the management of their illness so that we can keep them as healthy as possible, rather than simply responding to the effects of illness.�

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Reducing the burden of chronic disease Chronic conditions such as diabetes, asthma, heart disease, and hypertension are among the most prevalent, costly, and preventable of all health problems. As the unrelenting increase in chronic disease demonstrates, success is hard to come by under the best of circumstances. Imagine how much harder it would be to control your condition if you were also dealing with poverty or the lack of health insurance. And imagine trying to manage the complexities of self-monitoring and properly dosing your medications if you were not fluent in English.

In the city of New Bedford, which has some of the highest unemployment and poverty rates in Massachusetts, the prevalence of chronic disease is far above statewide averages. Faced with this challenge, the Greater New Bedford Community Health Center has undertaken a multi-year initiative to improve the organization, continuity, and completeness of care for its patients with chronic disease. According to Peter Georgeopoulos, president and CEO, the health center has completely revamped its approach to chronic disease management by incorporating evidence-based protocols, dedicated case managers, and a care coordinator.

“Care coordination has allowed for a much more thorough review of our patients’ needs, which means we can better support them in self-management and with programs that help them succeed. Once they have experienced success, patients are much more willing to take the next step, which leads to more success.�

Peter Georgeopoulos president and Ceo, Greater New Bedford Community Health Center

“We have learned that communication and coordination of services are key to reaching underserved populations.”

Dr. Myechia Minter-Jordan chief medical officer, The Dimock Center

At The Dimock Center in Boston, about ten percent of the adult patient population is living with diabetes and many are Hispanic, so the center has hired a bilingual patient navigator to assist its diabetic patients. When a provider sees lab results that are abnormal for a diabetic patient, the patient is referred to the health navigator. She works with the patient and the center’s in-house pharmacist, who is a certified diabetes educator, to assess whether there are issues preventing the patient from fully participating in managing the disease. There might be a problem related to diet or medication compliance, for instance, or the use of a home monitoring device. Each patient’s case is then presented in the care team’s multidisciplinary meetings, and a plan of action is established.

If the patient is uninsured, the navigator collaborates with the center’s financial counselor to help with an application for coverage.

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“Having a patient navigator involved with the clinical team allows referrals and follow-up care to occur smoothly and gives patients an expert, culturally-competent resource for handling questions and concerns about their care. The result has been improved rates of compliance as well as improved clinical outcomes and reductions in unnecessary emergency room use.�

The Dimock Center (formerly Dimock Community Health Center) has been a Foundation grantee since 2001.

Greater New Bedford Community Health Center received its first Foundation grant a year later. Both are currently receiving support from the Innovation Fund for the Uninsured grant program.

Helen R. Caulton-Harris Helen R. Caulton-Harris is Director of Health and Human Services for the City of Springfield. She has been a member of the Blue cross blue shield of massachusetts Foundation board of directors since its inception.

1,064 Number of grants awarded to organizations across Massachusetts over the last decade

“The Foundation’s funding support has encouraged greater collaboration and community involvement in Western Massachusetts, especially around planning strategies to address health disparities and cultural competency.�

When you think back to the earliest meetings of the board, what did you hope the Foundation could accomplish?

Our expectation was that the Foundation would be a catalyst for expanding access to health care for our state’s most underserved residents, and that we would offer financial support to organizations that were at the forefront. The early grants were intentionally modest because the Foundation was trying to find its voice and establish itself in the grantmaking community. It was also important to make sure it was supporting initiatives that were really needed and would make a difference. Since community health centers were already so involved in caring for the uninsured and addressing health disparities, they were naturally some of the earliest grantees.

health and HIV/AIDS services to some of the area’s most disadvantaged residents. Their current grant supports work on a program to address health disparities related to high rates of pregnancy among Latina teens.

What can the Foundation do to address the challenge of rising health-care costs?

I think the Foundation has played an important role in our state whenever it has focused its mission on policy. For instance, the Roadmap to Coverage was pivotal in moving the 2006 health reform legislation forward. One of the Foundation’s great strengths has been the ability to bring people to the table who haven’t had an opportunity to be heard, and involve them in developing solutions.

“One of the Foundation’s great strengths has been the ability to bring people to the table who haven’t had an opportunity to be heard, and involve them in developing solutions.”

What kind of impact has the Foundation had in your part of the state, Western Massachusetts?

The Foundation’s funding support has encouraged greater collaboration and community involvement in Western Massachusetts, especially around planning strategies to address health disparities and cultural competency.

In addition, the Foundation has built important relationships with key organizations like Tapestry Health, which provides reproductive

I expect that to happen with the issue of affordability, and the Foundation can also support organizations that have found innovative ways to improve access and care while containing costs.

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bringing coordinated care

to fragmented lives

Few individuals face greater challenges in gaining access to needed care than those coping with homelessness or chronic mental illness. They often lack health insurance because of their living situation or illness; the disorganized state of their lives complicates their ability to connect with primary care and preventive services; and societal stigma can undermine the motivation they need to stick with recommended treatment plans or lifestyle changes.

For two community health centers that care for large numbers of low-income, homeless and mentally ill patients, a concept called the “primary care medical home” offers hope for dramatically improving continuity, coordination and quality of care. The idea is to bring people into a highly personalized system of care that provides or arranges for virtually all of their needs: routine care and prevention, specialty care and ancillary services, and help with everyday living.

HealthFirst Family Care Center

in Fall River has used a multi-year Foundation grant to develop its Care Coordination for the Homeless project, which includes community outreach, easy access to appointments, and close coordination between primary and specialty care. The center has also developed partnerships with shelters and soup kitchens and with other organizations that provide housing assistance, job search services, substance abuse treatment, and support for victims of domestic violence.

“It’s a well-known fact that many homeless people choose to go without any type of preventive health care. With our model, a provider and a well-known and beloved community outreach worker take to the streets to build relationships and encourage our homeless neighbors to seek care.”

Julie Almond CEO, HealthFirst Family care center

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HealthFirst Family Care Center in Fall River was one of the first Foundation grantees in 2001, in the Connecting Consumers with Care grant program.

Brookline Community Mental Health Center has received support from the Foundation every year since 2002.

“In this way, we’ve been able to refer women for mammography screenings, treat foot ulcers before they become infected, get blood pressures under control before a stroke happens, link folks to dental care, and get them into drug abuse treatment. We firmly believe the program’s focus on prevention and treating the whole person is not just the ideal way to provide care – it also reduces costs.”

“We see a lot of what we call the high utilization-low quality paradox. Many of our patients have frequent contact with doctors, but very poor outcomes in terms of functioning and life expectancy.�

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Healthy Lives Wellness Group Rebuilding Communication, Confidence, and Health “Jason” joined the Healthy Lives Wellness Group despite many misgivings. He has type 2 diabetes, obesity, and chronic schizophrenia.

He is socially isolated and has few contacts except for weekly visits to his therapist at the Brookline Community Mental Health Center.

Jason also sees his primary care physician for various complaints but says he often has trouble understanding what his doctor is recommending. For some time, he has wanted to change his lifestyle and diet, but gets very discouraged. Once he decided to join the Healthy Lives program, Jason chose a few discrete goals to focus on. In addition, the program’s coordinator has joined him in his visits to his primary care doctor, and is serving as a “translator” to help Jason and his physician communicate more effectively.

“By using the same best practices that proved so successful in the medical home model, our program brings access and quality together in a way that we believe will improve client outcomes and reduce system costs.”

Dr. Henry White clinical director, Brookline Community Mental Health Center

Just west of Boston, the Brookline Community Mental Health Center is creating the state’s first “mental health home” to help low-income, uninsured individuals gain access to coordinated, integrated medical and mental health care, regardless of their ability to pay. Dr. Henry White, the health center’s clinical director, says the “Healthy Lives” program is designed to improve health outcomes for chronically mentally ill adults through an innovative combination of three evidence-based strategies: care coordination with primary care providers, health and wellness activities, and disease management.

William Van Faasen created the blue cross blue shield of massachusetts Foundation in 2001 while he was president and CEO of Blue Cross Blue Shield of Massachusetts.

“Back in 2000, I went to the company’s board of directors with the idea that we should make an ongoing commitment to support the kind of grassroots efforts that could make access to care possible for everyone.”

william van faAsen

How did the Foundation come about?

The history of Blue Cross Blue Shield of Massachusetts was very much rooted in the idea that high-quality health insurance should be available to the entire community. Back in 2000, I went to the company’s board of directors with the idea that we should make an ongoing commitment to support grassroots efforts that could make access to care possible for everyone.

The board agreed to create the Foundation as an independently governed charitable organization and to get it started with an endowment of $55 million. In the grand scheme of things, I think the Foundation’s grants have made a real difference in organizations, communities, and people’s lives.

hospitals, consumer groups, health plans, business, politicians – but everyone was falling back on convenient excuses about why the community hadn’t made more progress. We were at a standstill. So we said, let’s just pledge to one another that we’re going to figure this out. In the end, everyone gained something from the 2006 reform bill and everyone also had to give a little.

And what will be the tipping point for dealing with health care costs?

A year ago it seemed like there was very little momentum around the issue of affordability.

I’m amazed at how much attitudes have changed since then, and I think it’s because

The cost problem will be a lot tougher to solve than coverage, but I think the Foundation can be a catalyst and a laboratory for good ideas.

What do you think was the tipping point for getting the state’s health care interests engaged in expanding coverage for the uninsured?

My experience was that there were so many smart people with such well-developed ideas, getting them to leave their preconceived ideas at the door and engage in a meaningful community inquiry was pretty hard. At one of the earliest Foundation-run summits, all the players were in the room – physicians,

of widespread community dissatisfaction – bordering on outrage – about the unsustainable rate of increase in health care spending. The cost problem will be a lot tougher to solve than coverage, but I think the Foundation can be a catalyst and a laboratory for good ideas.

330

111

Number of organizations that have received grants from the Foundation over the past decade

Number of health care professionals who have participated in the Massachusetts Institute for Community Health Leadership

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Adding the consumers voice

to the cost containment debate

Of the many groups that represented the interests of health care consumers and patients as the Massachusetts health reform law was debated, enacted, and implemented, two have played especially important roles. Health Care For All (HCFA), whose work includes advocacy, policy analysis, public education, and consumer assistance, has long been one of the nation’s leading consumer advocacy organizations. The Greater Boston Interfaith Organization (GBIO), which includes congregations that span religious, racial, ethnic, and class lines in communities across eastern Massachusetts, has drawn upon the real-life experiences of its members to demonstrate the importance of access to affordable health care. Now, with efforts to contain health care costs gaining momentum in Massachusetts, GBIO is working to ensure that the interests of consumers are fully represented as possible solutions emerge.

Health Care For All was instrumental in launching the Massachusetts Campaign

For Better Care, which brings together a broad array of organizations concerned with public health, mental health, disabilities, and the needs of low-income people. Their goal is to help members of the public and policymakers understand what must be done to make high-quality care more affordable, cost-effective, coordinated, and equitable.

“The trend of simply piling more costs on consumers and small businesses cannot continue. We think the incentives need to be realigned, so that caregivers are focused on the patient first.

This means changing how we pay for health care.�

Brian Rosman research director, health care for all

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“We’re excited because, despite the complexity of cost issues, we’ve found there’s a strong consensus on the best way to make progress. The changes needed are much more difficult to explain than expanding access to coverage, but we’ve been able to forge a real coalition of shared interests that is having a positive effect.”

Amy Whitcomb slemmer executive director, health care for all

“What energizes GBIO members is the undeniable fact that health care costs are crowding out other things we care about, whether it is higher wages and more hiring by small businesses; better education, public safety and affordable housing for our communities; or the government subsidies that have allowed so many of our neighbors to connect with affordable coverage and needed care. Given our values and the breadth of our membership, we have no choice but to act.�

Reverend Hurmon Hamilton president, Greater Boston Interfaith Organization

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The Greater Boston Interfaith Organization is using its network of congregations to build a team of community leaders who are willing to invest the time and effort needed to become fluent in health care cost issues. Reverend Hurmon Hamilton, who is president of GBIO and senior pastor of Roxbury Presbyterian Church in Boston, warns that if a solution is not found soon, rising costs will undercut the health reforms in which GBIO and others have invested so much time and energy.

The first hurdle GBIO had to get over was to help people understand the complexities of health care costs, which are wrapped up in the rules and bureaucracies of insurers, providers, and government. To get the conversation started, GBIO has held a series of workshops and research meetings that allow its members to question leaders from state agencies, hospitals, physician groups, and health plans.

“We want to stir up a statewide conversation about the high cost of health care and use it to influence the behavior of the health care industry.�

Cheri Andes Lead Organizer, Greater Boston Interfaith Organization

Health Care For All was awarded one of the first Strengthening the Voice for Access grants in 2001 and has received annual support from the Foundation ever since.

Greater Boston Interfaith Organization has been a Foundation grantee since 2005 when its members first became involved in health reform.

How did you view the purpose of the Foundation in the early years?

We didn’t just want to be a foundation that gave grants in a focused way; we wanted to help make public policy changes that would advance the Foundation’s mission and goals on behalf of uninsured residents and those facing barriers to care. It was also important to help strengthen the capacity of groups that advocate for low-income, disadvantaged people, help them get more organized, and develop an evidence base that supports action.

research and analysis that helped illuminate different approaches to reform, including potentially controversial issues like individual and employer mandates.

Bill Van Faasen suggested that we had to make the business case for change; to demonstrate we were already spending a lot of public and private money on uncompensated care for the uninsured, and that with not too much additional money we could get people insurance coverage instead. That proved to be the case.

“Even with generous start-up funding from the company, we felt we were being incredibly ambitious given the scope of the problem.”

Were you confident you could help solve this huge issue of how to expand access to coverage for the uninsured?

Even with generous start-up funding from the company, we felt we were being incredibly ambitious given the scope of the problem. It was a tough time because Medicaid and other state services were being cut; it wasn’t fertile ground for suggesting major new initiatives.

We started very simply by describing the circumstances of individuals and families who were uninsured. This made the issue much more real. Then we commissioned independent

Now that the state has achieved nearly universal coverage, what other issues would you like to see the Foundation tackle?

I think the Foundation can play a seminal role in protecting the gains the state has made in access to coverage. One of the most important ways is to help the community understand and make progress on affordability. We need a high-performing health care delivery system for the whole community, but when people face multiple barriers to getting care – financial, geographic, environmental, linguistic – there’s an even greater need for a system that’s coordinated, efficient, and effective.

102 Number of media professionals who have completed the Foundation’s Health Coverage Fellowship 24

“I think the Foundation can play a seminal role in protecting the gains the state has made in access to coverage.

One of the most important ways is to help the community understand and make progress on affordability.�

Andrew Dreyfus

Andrew Dreyfus was the first president of the blue cross blue shield of massachusetts Foundation, serving from 2001 to 2005 and is now president and cEO of blue cross blue shield of massachusetts.

A Look Back at 2010

The Massachusetts Medicaid Policy Institute has a new home, new leader

Community organizations receive more than $3 million in grants

The Massachusetts Medicaid Policy Institute (MMPI), which seeks to broaden understanding of the Massachusetts Medicaid program and its relationship to other programs that serve low-income residents, was folded into the Foundation in 2010. MMPI now operates as a major policy program within the Foundation, with shared resources directed at a common mission, rather than as a separately governed entity.

The Foundation awarded $1.25 million to eleven collaborative programs in the last installment of its three-year Closing the Gap on Health Care Disparities grants. Recipient coalitions are building capacity among health care providers and community members to address medical, cultural, and socioeconomic causes of health disparities. An additional $1.96 million was awarded to 50 community organizations dedicated to promoting the health care needs of uninsured and low-income residents through outreach and enrollment, patient navigation, coordination and continuity of care, advocacy, citizen participation, and policy development.

In fall 2010, Kate Nordahl was appointed director of MMPI after serving as assistant commissioner for the state’s Division of Health Care Finance and Policy. Her prior experience also included leadership positions with the Massachusetts Medicaid program. Recent MMPI reports include an analysis of how gaps in public health insurance can occur when members periodically have their eligibility re-determined, and an assessment of the crucial role Medicaid could play in implementing dramatic changes to the health care payment system.

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Health journalists gather for nine-day fellowship program Eleven outstanding print, radio, and television journalists from across the nation participated in the Foundation’s 2010 Health Coverage Fellowship. The fellowship is designed to expand the capacity of the media to cover issues related to health reform and access to care. Additional support was provided by the Maine Health Access Foundation, the Endowment for Health, the Foundation for a Healthy Kentucky, and the Hogg Foundation for Mental Health.

Sixteen emerging health care leaders begin intensive training The 2010-2011 class of the Massachusetts Institute for Community Health Leadership (MICHL) kicked off an 18-day program designed to help them identify and build the skills they will need to meet the challenges facing health care advocacy groups, provider organizations, and government agencies in Massachusetts.

The program focuses on experience-based learning, including project work, classroom training, and peerto-peer collaboration.

Conference and report highlight state and national health reform Hundreds of health care leaders attended a meeting convened by the Foundation and the Massachusetts Health Policy Forum to honor the late Senator Edward M. Kennedy and discuss how national health reform will affect Massachusetts. A keynote address was provided by Senator John F. Kerry. Panel discussions focused on a Foundation-sponsored report by Robert Seifert and Andrew Cohen of the Center for Health Law and Economics at the University of Massachusetts Medical School.

Statewide health reform survey continues to track coverage and access to care The latest Massachusetts Health Reform Survey, which has tracked the impact of reform since fall 2006, found that the higher rate of insurance coverage as a result of reform has led to improvements in access to an use of care, quality of care, and the affordability of care. The survey, commissioned by the Foundation and conducted by the Urban Institute, also found that racial and ethnic disparities in coverage have been reduced and, in some cases, eliminated under health reform.

Now online: everything you’d ever want to know about Massachusetts health reform The Foundation’s website now includes the first comprehensive clearinghouse of resources on Massachusetts health reform, with links to scores of documents, reports, and data sources. The site offers a unique, interactive tool that lets users explore all aspects of the Massachusetts heath care reform law, including up-to-date amendments, regulations and reports, and health reform “toolkits” to help other states plan, build, and implement components of the federal Patient Protection and Affordable Care Act.

A decade of funding FOR REFORM total grants 2001-2010: $37.6 million

(Diagram shows decade total and top three funding categories by region.)

to 330 different organizations foundation grantmaking priorities (in millions): $ 10.53 Improving the coordination of care for uninsured residents

$8.29

$ 10.43 Addressing health disparities and promoting cultural competence

million

$ 5.35 Strengthening advocacy on behalf of patients and consumers $ 4.27 Expanding access to health coverage and primary care $ 2.57 Fostering collaboration to improve children’s mental health services $ 1.27 Supporting grantees’ policy initiatives

strengthening advocacy

$ 3.19 Other grants

statewide organizations

METRO WEST & CENTRAL MA

$1.05

million addressing disparities

coordination of care

$1.35

MERRIMACK valley & NORTH SHORE

addressing disparities

$0.49

$0.94

$0.41

million

million expanding access

million coordination of care

$1.33 million

$1.27 million policy support

$3.43 million

western ma

$2.18 million addressing disparities

28

$2.35 million

$1.07 million Expanding access

greater boston

$4.18

million coordination of care

million expanding access

$1.14

million addressing disparities

$ 12.49 million

coordination of care

$0.11

se ma, cape & islands

million

million

million

million Expanding access

$ 3.05 $ 6.06

$5.35

addressing disparities

$4.59 million

$1.53

million children’s mental health

$ 4.28 million

coordination of care

$1.72 million

$1.07 million Expanding access

grants awarded in 2010 African Community Health Initiatives AIDS Action Committee of Massachusetts Behavioral Health Network Berkshire Health Systems Boston Foundation for Sight Boston Health Care for the Homeless Program Boston Public Health Commission Boys and Girls Club of Wareham Bread and Roses Brockton Neighborhood Health Center Brookline Community Mental Health Center Cambridge Cares About AIDS Carroll Center for the Blind Carson Center for Human Services Casa Latina Center for New Americans Central Massachusetts Area Health Education Center (AHEC) Children Across America Children’s Hospital Boston Community Action Committee of Cape Cod & Islands, Inc. Community Connections, Inc. Community Health Center of Cape Cod Community Health Center of Franklin County Community Health Connections Family Health Centers Community Health Programs Crossroads for Kids Disability Policy Consortium Ecu-Health Care Families for Depression Awareness Family Health Center of Worcester Food for the World, Inc. Gavin Foundation Edward M. Kennedy Community Health Center Greater Boston Interfaith Organization Greater Framingham Community Church Greater New Bedford Community Health Center Greater Waltham Arc, Inc.

Green Beginnings Institute Greenwood Street Medical Clinic Health Care For All Health Law Advocates HealthFirst Family Care Center Hearth HESSCO Elder Services Heywood Hospital Hilltown Community Health Centers Joint Committee for Children’s Health Care in Everett Joseph M. Smith Community Health Center Kid2Kid Laboure Center Latin American Health Institute Leominster Development Corporation Lowell Community Health Center Manet Community Health Center Massachusetts Alliance of Portuguese Speakers Massachusetts Association of Community Health Workers Massachusetts Association for School-Based Health Care Massachusetts Housing and Shelter Alliance Massachusetts Immigrant and Refugee Advocacy Coalition Massachusetts Law Reform Institute Massachusetts League of Community Health Centers Massachusetts Nonprofit Network Massachusetts Public Health Association Massachusetts Senior Action Council Mercy Hospital MetroWest Free Medical Program MetroWest Legal Services Mount Auburn Hospital Multicultural AIDS Coalition Neighbor to Neighbor Massachusetts Education Fund New England Eye Institute New Hope, Inc. NFI Massachusetts, Inc. Outer Cape Health Services

Parents Helping Parents, Inc. Partners for a Healthier Community People Acting in Community Endeavors Physicians for Human Rights Prisoners’ Legal Services Pro-Choice Massachusetts Foundation Programs For People, Inc. ServiceNet Shattuck Partners Stanley Street Treatment & Resources Tapestry Health Taunton Area Resource Center The Arc of Greater Fall River The Arc of Massachusetts The Dimock Center The Highlands Coalition The Nathan Hale Veterans Outreach Centers The Next Step Fund, Inc. The Springfield Institute United Teen Equality Center Vineyard Health Care Access Program Visiting Nurse and Community Health VNA of Middlesex-East & Visiting Nurse Hospice Voice and Future Fund Volunteers in Medicine Berkshires Wayside Youth & Family Support Network Whittier Street Health Center Women of Means YWCA Central Massachusetts YWCA Southeastern Massachusetts

financials From the Finance and Audit Committee The Blue Cross and Blue Shield of Massachusetts Foundation for Expanding Healthcare Access (the Foundation) distributed grants totaling $3.6 million in 2010. These grants were made possible by income generated from the Foundation portfolio and by the support from Blue Cross and Blue Shield of Massachusetts, Inc. (the Company) and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc., consisting of in-kind contributions totaling $1.1 million.

The Company’s in-kind contributions represent a significant amount of the Foundation’s operating costs including investment expenses, facility costs and other operating expenses.

The year ended December 31, 2010 was a rewarding one for the Foundation which reached $92.7 million in net assets. The Foundation Finance and Audit Committee modified the existing investment strategy to incorporate a more socially responsible investment approach.

A goal was established for the portfolio holdings to be approximately 75% tobacco free which was achieved through an orderly transition of the assets during the year.

The Foundation portfolio continued to exhibit consistent growth in 2010. The portfolio ended the year with a $10.1 million net unrealized and realized gain on investments after generating $2.7 million in investment income. For the year ended December 31, 2010, the portfolio generated a total return of 15.7%. During the year, the Foundation invested approximately 54% in equities, 22% in fixed income and cash equivalents, and 24% in alternative investments. We continue to believe that a well-diversified portfolio is appropriate for the Foundation’s investments.

Our thanks to the hardworking members of the Finance and Audit Committee, Blue Cross and Blue Shield of Massachusetts and its finance staff, and our investment consultants, New England Pension Consultants.

Submitted by, Milton Glass · Chair, Finance and Audit Committee Finance and Audit Committee: Milton Glass, Richard Lord, james Hunt, and Rob Restuccia

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Statements of Financial Position (Dollars in thousands)

Statements of Activities and Changes in Net Assets (Dollars in thousands)

December 31 2010

2009

Assets Cash and cash equivalents

$

Investments

86,156 85,970

3,204

$ 1,325

Investments receivable

6,720

30

92

68

Pledges Receivable Total assets

$ 96,172

$ 87,393

$ 2,139

Grants payable

$

2010

2009

Revenues and other support Contributions

$

Contributions in-kind

1,090

1,399

Contract service fee

12

50

Investment income

2,675

2,333

Net unrealized and realized gains on investments

Total revenues and other support

Liabilities and net assets

Years Ended December 31

236

$

437

10,068 16,254 14,081 20,473

44

Accounts payable and accrued expenses

342

327

Due to Blue Cross and Blue Shield of Massachusetts, Inc.

968

319

Federal excise tax liability

32

8

Total liabilities

3,481

698

Net assets—unrestricted Total liabilities and net assets

Expenses Grants

3,648

4,064

Professional services

2,531

2,398

Salaries and benefits

1,414

1,778

Conferences, conventions, and meetings

211

220

92,691 86,695

Occupancy and equipment maintenance

172

163

$ 96,172

Federal excise tax expense

55

46

Other administrative expenses

54

20

Total expenses

8,085

8,689

Excess of revenues and other support over expenses and change in net assets

5,996 11,784

Net assets at the beginning of year

86,695 74,911

Net assets at the end of year

$ 92,691

$ 87,393

$ 86,695

Board Members and Foundation Staff Board of Directors

Foundation Staff

Chairman Philip W. Johnston President, Philip W. Johnston Associates

Sarah Iselin President

Vice Chair Robert Meenan, M.D. Dean, Boston University School of Public Health Helen R. Caulton-Harris Director, Springfield Department of Health and Human Services Andrew Dreyfus President and CEO, Blue Cross Blue Shield of Massachusetts Barbara Ferrer, Ph.D., MPH, M.Ed Executive Director, Boston Public Health Commission Matt Fishman Vice President for Community Health, Partners HealthCare

H. Kristopher Bloch Policy Intern Jennifer Chow Grantmaking Program Manager Phillip Gonzalez Director of Grantmaking Elizabeth Guyott Executive Assistant Natasha Henry Administrative and Grants Coordinator

Milton Glass Chairman Emeritus, Blue Cross Blue Shield of Massachusetts

Kate Nordahl Director, Massachusetts Medicaid Policy Institute

James W. Hunt, Jr. President and CEO, Massachusetts League of Community Health Centers

Lindsey Tucker Policy Manager

Rachel Kaprielian Registrar of Motor Vehicles, Commonwealth of Massachusetts Nick Littlefield Partner, Foley Hoag LLP Richard C. Lord President and CEO, Associated Industries of Massachusetts John G. O’Brien President and CEO, UMass Memorial Health Care, Inc. Rob Restuccia Executive Director, Community Catalyst William C. Van Faasen Chairman of the Board, Blue Cross Blue Shield of Massachusetts Charlotte S. Yeh, M.D., FACEP Chief Medical Officer, AARP Regina Villa President, Regina Villa Associates (Board Service ended December 2010) Sarah Iselin (ex officio) President, Blue Cross Blue Shield of Massachusetts Foundation

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This annual report was printed on Mohawk Options paper, which is made with 100% postconsumer recycled fiber and wind-generated electricity. creative: ARGUS, boston copy writing: Alan Raymond photography: Sean Hennessy

sarah iselin is the President of the Blue Cross Blue Shield of Massachusetts Foundation.

“We’re supporting organizations using innovative approaches to overcome barriers to coverage and care, help patients control chronic disease, bring coordinated care to fragmented lives, and ensure that the consumer voice is heard in the debate over cost containment.�

Sarah Iselin

advancing reform

Blue Cross Blue Shield of Massachusetts Foundation

Landmark Center 401 Park Drive, Boston, MA 02215 | 617. 246. 3744 | BlueCrossFoundation.org

Access, Advocacy, and Innovation

2010 Annual report