The independent advocates’ letter asks CMMI in negotiations over the grant application to require the state to return to the more reasoned, progressive Medicaid plan in the December SIM “final plan” – to first pilot shared savings through the thoughtful, consensus-led Medicaid health neighborhood program for dual eligibles very close to implementation. This would allow the state to identify challenges, learn from them, test solutions and evaluate results -- improving the chances of sustainable success and limiting harm to people.
Monday, September 15, 2014
Twenty-two independent consumer advocates signed a letter sent Friday to CMMI voicing concerns about CT’s SIM application. While advocates have many concerns, the letter focuses on the sudden planned shift to shared savings payments in Medicaid. Concerns include the prospect that shared savings incentives could drive inappropriate underservice and that state’s quality and financial monitoring resources will not be able to detect harm to people or financial gaming of the system. Shared savings is a very new payment model that other, more mature, health systems in other states are struggling to implement. CT’s recent failed HUSKY managed care program was driven by similar financial incentives; since we moved away from those incentives quality of care is up, costs are down and more providers have joined the program.
Thursday, September 11, 2014
The Care Coordination committee of MAPOC has been given responsibility for oversight and advice on SIM’s controversial new plans for Medicaid, especially the shared savings payment model. The committee’s original mission remains as well – to track Medicaid’s successful patient-centered medical home program.
In yesterday’s meeting we heard more about continuing PCMH success. The number of participating practices is accelerating every quarter. Even as enrollment climbs with the ACA expansion, the percent of members served by a PCMH remains at 32%, matching growing capacity with growing demand. Unfortunately since the last report, a large hospital-affiliated practice decided not to renew PCMH certification citing financial reasons. It was reported that some payers increasingly prefer to reward large practices with advanced analytic and other capacities that support shared savings (as well as quality in some cases) at the expense of PCMH supports (which focus on quality and access to care, but do save as well).
The SIM update reiterated the intent, over advocates’ objections, to have the underservice and quality measures developed by SIM’s Equity & Access and Quality Committees apply to Medicaid. To improve chances of getting the federal SIM grant, the Quality Committee adopted Medicare ACO quality measures as the basis for the entire state population. Advocates have argued that Medicaid serves a very different population with different needs than Medicare or commercially insured populations. Advocates are concerned that the SIM committees are dominated by commercial insurers, who no longer have a role in the state’s Medicaid program, and little Medicaid consumer representation. We were told that the PCMH SIM committee, that includes Medicaid expertise, can review the SIM committees’ decisions, but cannot use a more appropriate set of standards.
Monday, September 8, 2014
An Op-Ed published in today’s CT News Junkie debunks the persistent, old (pre-ACA) myth that state spending on Medicaid is “out of control”. Unfortunately that myth is driving SIM policymakers into a risky shared savings payment model that is unproven, ill conceived and wouldn’t make much difference in the state budget even if it worked.
Friday, September 5, 2014
Because CT dropped insurers from our Medicaid plan three years ago, we are not subject to the ACA tax on insurers saving state taxpayers more than a billion dollars over the next decade. The ACA tax on fully-insured plans is due for the first time September 30 and will cost fully-insured states $700 million just this year. Twelve other states without Medicaid insurers are also spared this tax. Medicaid programs in NY, RI and NJ will pay over $2,000 per member over the next decade in ACA taxes. In a satisfying twist, several states that did not expand Medicaid under the ACA are paying the tax to fund our expansion.
Thursday, September 4, 2014
September CT Health Policy Webquiz.
Wednesday, September 3, 2014
Starting to recover from the bomb thrown by SIM leaders in to CT’s Medicaid success, CT’s progress toward health reform moved up slightly to 28.4% this month – the first rise in two months. The progress resulted from detailed, and better, quality measures from Medicaid and CID’s insurance rate review that lowered insurers’ excessive increases for 2015. Consumer engagement and troubling Medicaid reimbursement issues held progress back, as does continuing concerns about SIM plans. The progress meter is part of the CT Health Reform Dashboard.
Tuesday, September 2, 2014
A cool new calculator from CT Mirror allows visitors to compute coverage costs across health plans with just a few clicks. It is way too much fun to play with. The tool is part of the Mirror’s new Health Care Users Guide. Highly recommended.