Wednesday, October 22, 2014

National Medicaid Managed Care conference hears CT best practices

Attendees at the 2014 Medicaid Managed Care Congress this week in Washington heard about CT’s impressive success in bucking trends moving from the common capitated MCO model to a patient-centered care coordination-based ASO model. The Project was honored to participate and share CT’s secrets to success including our study on barriers to provider participation, quality improvements, rising provider participation, and stable per member costs despite significant enrollment growth. I also shared how CT is not resting our laurels, but is building on that success to develop health neighborhoods to coordinate care, improve quality and control costs for CT’s dually eligible residents. There was a lot of interest in the data demonstrating our success, and the policymaking process we used to get there. We also heard excting success stories from other states, including NY’s impressive data systems and early shared savings lessons from Oregon and Louisiana.

Friday, October 17, 2014

CID 2014 managed care report card online

The CT Insurance Dept. has released their annual consumer report card on health insurers.  In its 9th year, the report card compares managed care plans offered in CT across 15 categories of performance including number of providers by county, controlling high blood pressure, cancer screening rates, prenatal care, and drug spending. An incredible resource, the report also includes enrollment numbers by plan, NCQA quality ratings, worksheets for consumers to compare plans on important features, and very useful customer service contact info.

Wednesday, October 15, 2014

SIM decision to use national PCMH standards affirmed – again

At last night’s SIM Practice Transformation committee meeting, consumer advocates were able to halt erosion of national standards for patient-centered medical homes (PCMHs). Following research and best practices and resisting misinformation, in June the committee voted to use nationally recognized NCQA standards for PCMHs in SIM. NCQA-recognized PCMHs are the foundation of CT Medicaid’s remarkable success in lowering costs, improving quality and engaging new providers in the program. Unfortunately, there have been more recent efforts in the committee to erode that decision. Last night’s meeting was frustrating to watch as much policymaking was based on misleading anecdotes, random conversations, and lack of understanding of health policies – thankfully advocates did their homework and cited published research to make their case. Eventually SIM staff reaffirmed that NCQA standards will be the “framework” and “backbone” for PCMH standard setting in SIM. It is important to note that Massachusetts has reportedly reversed their decision to create state-specific PCMH standards.

The committee also heard from AmeriCares Free Clinics that provide coordinated, high quality care to thousands of uninsured low-income state residents left out of ACA expansions. AmeriCares would like to earn PCMH status to further improve the quality of their care, despite the fact that they do not bill to payers and will not be rewarded financially. AmeriCares asked to be included in the SIM glide path providing technical assistance to earning PCMH status, despite the fact that they do not bill to Medicaid. Staff agreed to keep open the possibility for free clinics to apply for the funding, but priority will still go to the large Medicaid shared savings networks.

Tuesday, October 14, 2014

Webinar -- Provider Payment Reform Options: Aspiration Meets Reality

Join Bob Berenson, MD of the Urban Institute for a CTHPP webinar November 18th at 1pm as he explains health care payment reform options. Dr. Berenson has long health policy experience, both inside and outside government. He served as Director of Medicare Payment Policy at CMS. His work focuses on quality measurement/improvement and Medicare shared savings. In the webinar Dr. Berenson will focus particularly on shared savings models as CT is considering for both the Medicaid/Medicare health neighborhood pilots and the much more ambitious SIM plan. Click here to register for the Nov. 18th webinar.

Friday, October 10, 2014

Medicaid quality up, costs stable since switch to ASO

We got lots of good news at today’s Medicaid Council meeting. New financial reports show that since October of 2013 HUSKY enrollment has grown 20% but spending has grown only 13.6%. Per person spending on HUSKY Part D, which includes the former SAGA members and the newly eligible childless adults from the ACA, has actually decreased slightly. We expected pent-up demand for services to increase that number for a short time; this may indicate that it is a healthier population that has enrolled. Another report, a prĂ©cis, summarizes the considerable innovations in the program since the shift from capitated managed care plans to an ASO model, including exciting new data. The program now benefits from predictive modeling and tracking of health measures that can help providers deliver the right care to the right person at the right time. We also heard about improvement in the ConnectCT enrollment system – average wait time on the phone to talk with a benefit center is down from 78 minutes in August to 66 minutes last month. DSS talked about plans to bring that down further. We also heard about the behavioral health program’s efforts to improve access to care.

Tuesday, October 7, 2014

October CT Health Policy Webquiz: NCQA rankings of CT health plans

Test your knowledge about the latest NCQA quality rankings of CT health plans . Take the

Monday, October 6, 2014

Candidates for Governor on health care

To help with your decision Nov. 4th, the CT Mirror has done a great job of describing Malloy record and Foley’s positions on health care if elected.