The Codcast

The Codcast feat. Developer Tom O'Brien by CommonWealth Beacon

With a portion of the state’s casino revenues, the Massachusetts Cultural Council is testing whether arts and culture can be prescribed just like medicine.

The organization is running three pilot projects where health providers, counselors, and social workers prescribe cultural activities for those with whom they work. The goal is to see whether going to the zoo, visiting a museum, or attending the symphony can have beneficial health impacts.

Anita Walker, the executive director of the Cultural Council, is convinced the experiment will work, in part because the health benefits of cultural activities have been documented in a number of studies. She’s using a portion of the revenues her agency receives from casino gambling to pay the cost of the pilot project prescriptions, but in the long run she hopes health insurers will come to see the health benefits of arts and culture and pick up the tab themselves.

Tunneling under the Charles River by CommonWealth Beacon

SOME OF THE STATE’S leading transit advocates are calling for extending the life of the existing MBTA Fiscal and Management Control Board for six months to a year and making buses free across the state.

On the TransitMatters Codcast hosted by CommonWealth magazine, Jim Aloisi, the former transportation secretary and TransitMatters board member; Josh Fairchild, the co-founder and president of TransitMatters; and Stacy Thompson, the executive director of Livable Streets, looked back at 2019 and forward to 2020. They predicted the Legislature would pass a transportation revenue package and assembled a wish list of fairly predictable initiatives they would like to see action on.

Partners vowing to end surprise billing by CommonWealth Beacon

The Codcast with Bill Weld by CommonWealth Beacon

Can Hampshire College rise, if not from the dead, from the higher ed death watch list?

Harvard Business School professor Clay Christensen has predicted that as many as half of all US colleges and universities will close or go bankrupt over the next decade, and a year ago it looked like Hampshire would be one of them.

The Amherst college, founded in 1970 with a commitment to rethinking traditional liberal arts education, said it was in dire financial straits and would be seeking a “strategic partner” to merge with. The college, which depends almost entirely on tuition revenue to operate, seemed to push itself closer to the fiscal cliff by then announcing it would not accept a new entering class this fall.

The news of Hampshire’s death, however, has been premature.

Students, faculty, and alumni rose up in protest against the planned merger, and within months the college president who said it was the only viable path had resigned, along with the leaders of the college board of trustees who backed the plan. The remaining college leaders declared they would instead mount an aggressive fundraising drive and pursue other reforms to remain an independent college.

Now charged with leading that effort is Ed Wingenbach, who arrived in August as Hampshire’s new president. For a guy facing a very tall task, the veteran college administrator -- most recently at Ripon College in Wisconsin -- sounded enthusiastic and upbeat as he talked about the challenge on The Codcast. The college has about 730 students after what Wingenbach calls the “self-induced crisis” of not enrolling a new class this fall. He says Hampshire will be back to 1,100 or 1,200 students within five years.

There’s a back to the future feel to some of the changes taking place in US health care, and Atrius Health, which provides care to some 740,000 patients, is a leading player in that effort in Massachusetts.

After years of soaring health care costs, there is growing interest in moving away from the fee-for-service model that has long dominated care, where providers are paid for each patient interaction or procedure. The trend now is toward giving health providers a set budget to care for patients over the course of a year. The idea is that it creates an incentive for providers to do all they can to maintain patient health, even if it means more spending on preventive services to prevent costlier outcomes down the road.

It harkens to the early days of managed care, when such a system was touted as a way to achieve the double-win of better health outcomes at lower cost. By the 1990s, however, HMOs were in retreat, faced with a public pounding as many big for-profit companies seemed more interested in managing costs by denying various services than promoting good health outcomes. The idea behind managed care, however, is enjoying a revival as the US health care system struggles to find ways to better coordinate care and control cost growth.

At Atrius, one of the state’s largest health networks, with more than 700 physicians and 400 non-physician providers, more than 80 percent of all revenue now comes from some sort of global payment structure that moves away from the traditional fee-for-service model.

“Which means we are directly aligned with our patients’ interests,” said Dr. Steven Strongwater, the CEO of Atrius, on this week’s episode of The Codcast. “We want to keep patients healthy and well and out of ERs and hospitals to lower their out-of-pocket costs, and to improve their outcomes, their patient experience, and safety.”

There is a struggle going on for the soul of the Massachusetts Republican Party between Trump loyalists who control the party apparatus and a more moderate brand of Republicanism espoused by Gov. Charlie Baker.

The state party is headed by Jim Lyons, a social and economic conservative who said in a recent email to state Republicans that President Trump’s economy is working for Massachusetts residents. “We learned on Election Day that even here in ‘blue’ Massachusetts, voters in our targeted areas are picking common sense over creeping socialism,” he said.

But the party is also headed by its top office-holder, Baker, who is no fan of Trump and practices a brand of politics that blends social liberalism, fiscal restraint, and a willingness to work cooperatively with the Democrats who dominate Beacon Hill. A relatively new super PAC affiliated with Baker spent money on behalf of Republicans and Democrats in the November municipal elections.

While Lyons and Baker refrain from attacking each other publicly, it’s clear they represent competing factions within the party. On the CommonWealth Codcast, two Republicans from those factions engaged in a sometimes testy debate about the struggle over the party’s direction.

The Greater Boston Chamber of Commerce’s “City to City” program sets out to take Boston civic and business leaders to other cities so they can expand their thinking on challenges at home by learning about policies and practices elsewhere. Walsh, who was part of the program’s trip earlier this month to Los Angeles, has clearly taken that mission to heart.

Appearing on The Codcast, Walsh repeatedly pointed to the “bold” move taken by Los Angeles leaders, who brought a countywide ballot question to voters asking them to raise the local sales tax to support major investments in the region’s transit infrastructure.

“That’s a bold idea,” Walsh said of the LA ballot effort. “We have to think bold here in Massachusetts, and I don’t think we think bold enough.”