As a loyal Bostonian, I don't seem to tire of all the talk of health reform efforts in Massachusetts and enjoy noting our successes. We've gone from a 10.3 percent uninsurance rate before reform, to covering over 97 percent just less than two years later. But passing a law and creating new insurance structures is only part of our success. Massachusetts not only built it -- it figured out how to make people come.

A recent Robert Wood Johnson Foundation study, The Secrets of Massachusetts' Success: Why 97 Percent of State Residents Have Health Coverage, explains why Massachusetts' subsidies have accomplished more than other states. Outreach and enrollment is essential. (Make that effective outreach and enrollment.)

So how did Massachusetts do it?

We'll include a brief refresher at the bottom of this post on components of the Massachusetts system. But we want to look first at how, according to the RWJF study, Massachusetts enrolled so many eligible, low-income residents in health insurance programs:

• Within 15 months after implementation, roughly one out of four newly insured state residents received subsidized coverage based on state data about household income, without any need to file traditional application forms. (These enrollees are considered "auto-converted" members.)
• A single application form and a single system of eligibility determination served multiple subsidy programs (Medicaid, CommCare, UCP etc.) making enrollment simple and seamless for consumers. The form is processed by a single statewide unit that then informs consumers which program they are eligible to enter.
• More than half of all successful applications for subsidized coverage were completed for consumers by community-based organizations and health care providers through the state's "Virtual Gateway" program. As consumers' authorized representatives, the agencies receive copies of state requests for additional documentation needed to establish eligibility. This enables the representatives to educate consumers about procedural requirements and ensure necessary follow-through. This makes the process easier, less costly and generates fewer application errors. (To encourage this, providers do not receive full reimbursement from the state until a patient's application for health coverage is completed.)
• Massachusetts initiated an intensive public education campaign.

In light of national and state health reform efforts, policymakers may want to brush up on the Massachusetts health reform model.  The Massachusetts approach -- using data already compiled to automatically enroll qualified residents, streamlining and simplifying the application process and launching an education blitz -- did it well.

And here's that promised summary on Massachusetts' coverage:

• Medicaid coverage (called "MassHealth") was extended to all children 300 percent of the federal poverty level. (In 2009, the Massachusetts FPL is $18,310 for a household of three and $22,050 for a household of four.)
• Massachusetts established a quasi-governmental organization called the Commonwealth Health Insurance Connector Authority ( the "Connector"). It administers the Commonwealth Care and Commonwealth Choice health insurance programs and state health reform laws.
• Commonwealth Care provides comprehensive insurance coverage and generous subsidies to adults who are ineligible for Medicaid and whose incomes are at or below 300 percent FPL.
• Commonwealth Choice is an insurance exchange that makes affordable health insurance plans available to individuals and small businesses.
• Massachusetts instituted an individual mandate (but the mandate does not apply to children and adults with incomes below 150 FPL).
• The Health Safety Net program (replacing the Uncompensated Care Pool) pays for uncompensated care.