Friday, January 30, 2015

New to the Book Club -- How Not to Be Wrong

The title of the latest addition to the CT Health Policy Project Book Club, How Not to Be Wrong: The Power of Mathematical Thinking, sold this book but the content delivered on the promise. It was entertaining and funny – not what you expect from a book about math. The author dives into fascinating questions using math concepts including how long until every American is obese (the dangers of extrapolation), and perspectives on genetic influences on schizophrenia, and rare serious side effects of birth control pills (what statistical significance is and what it isn’t).

Thursday, January 29, 2015

CT employer coverage eroded over last decade, well before ACA implementation

A new report by SHADAC finds that 11.3% fewer CT firms offered health benefits to workers in 2012/2013 than eight years before, following national trends. Most of that loss happened in the last four years (8.8%) following the economic downturn, but well before implementation of the Affordable Care Act. Eligibility for coverage (among employers who offer coverage) didn’t change significantly in CT over the eight years, but take-up rates slid by 7.1%. That slide was likely driven by rising premiums which grew by 45% for singles and 48% for families. Workers at small firms were hardest hit – they are less than half as likely to be offered coverage and even that rate dropped 17.1% over the eight years. Also following national trends, part-time CT workers are less than half as likely to be eligible for coverage at work although that percentage didn’t change significantly.  While far more likely to be offered coverage, workers at large firms lost ground over the eight years both in offers and take up rates.

Wednesday, January 28, 2015

CT exchange members more likely to get financial assistance and slightly older than other states

The latest federal ACA enrollment report finds that AccessHealthCT, CT’s health insurance exchange, received 76,460 total applications between Nov. 15th and Jan. 16th. 162,921 state residents were found eligible for Medicaid. Of the 142,287 applicants eligible for exchange coverage, 77% are also eligible for financial assistance – higher than the 70% average across all state-based exchanges. 24% of people who’ve made a plan selection in CT are ages 18 to 34. This is lower than the state-based exchange average (26%) and below our neighboring states (MA 29%, NY 28%, RI 25%).

Tuesday, January 27, 2015

Budget Update: more interim budget cuts, calls for long term fix, Medicaid deficit due to temporary issues

In response to a growing budget shortfall for this year, last week the Governor ordered $31.5 million in budget rescissions. This is the Governor’s second round of cuts for this fiscal year. Health-related cuts included $8.4 m from DDS, $1.3 m from DMHAS, $602,435 from school-based health clinics, $71,515 from Healthy Start, and $1.3m from UConn Health Center. Republican leaders are concerned that continuing rescissions are keeping the deficit just under the statutory level requiring a deficit mitigation plan be submitted to the legislature.

OPM is reporting that Medicaid spending is $120 m over budget. It is our understanding that the shortfall is due to one-time issues including CMS settlement payments from difficulties categorizing eligibility, and uncertainty over relevant dates (service vs. payment) affecting reimbursement in the first Medicaid expansion year. The state is responsible for half the costs of care for enrollees in pre-ACA coverage categories, in contrast to newly eligible enrollees whose costs are 100% reimbursed by the federal government trough 2016, slipping modestly to 90% eventually. Reports of higher than expected enrollment in pre-ACA HUSKY categories have reversed in recent months. Also adding to the Medicaid shortfall was an optimistic fraud recovery estimate in the original budget passed last Spring. Hospital retroactive settlements are up over last year, but this will also be resolved when the state moves to a DRG-based payment system.

All the issues adding to the shortfall will be resolved soon and should not precipitate calls that Medicaid spending is “out of control”. Because of quality and value improvements in the program, per person spending in the program is stable, saving about $150m in state Medicaid funds compared to per person health cost increases for all Americans

Friday, January 23, 2015

FDA Advisory Committee recommends new orphan anti-infective drug

Yesterday’s FDA Anti-Infective Drug Advisory Committee meeting considered evidence about the safety and effectiveness of ISA, a new drug to treat a rare fungal infection threatening the lives of people with severe illnesses. The condition affects a few thousand Americans each year suffering from weakened immune systems due to conditions such as HIV, stem cell transplants, or cancer. Without treatment virtually all these patients would die. We heard very compelling public testimony from an affected patient, a doctor calling for more treatment options, and the father of a young boy who died from a fungal infection, not from his cancer. There are few other drug options to fight these infections and they are very imperfect. Because these conditions are rare, there is not a lot of clinical data about the effectiveness of the drug but it is promising. The committee voted to recommend that the FDA approve the medication for these uses, but with warnings about use in children, pregnant and nursing mothers. The committee emphasized the need for more studies including more information on an interesting ethnic variation in the drug’s physiology.

Wednesday, January 21, 2015

Medicaid deficit rises to $120 million, but causes are unclear

The Governor announced yesterday that new cuts to the state budget will be necessary due to the rising state deficit. A large part of that deficit is in the Medicaid program, but the causes are unclear. Per person costs in the program are stable, even declining slightly since the switch away from financial risk-bearing organizations – which has saved the state many millions compared to past trends and other states – and likely will continue to deliver savings sustainably into the future. It is unclear how much of the current deficiency is temporary and administrative. OPM’s monthly letter points to higher than expected enrollment (but most of that is still fully reimbursed with federal funds), resolving enrollment category issues, higher than expected hospital settlements, and medication initiative estimates. The letter does not give details on the deficiency causes. Advocates are concerned that potential cuts to program eligibility or provider rates, meant to address the deficiency, will be counter-productive -- undermining recent success in the program and reversing CT’s progress toward meaningful coverage for every state resident.

Tuesday, January 20, 2015

Medicaid update – impressive quality dashboard demo

At Friday’s Medicaid Council meeting, DSS demonstrated their upcoming HUSKY Health Data Dashboard. When it goes live the dashboard will give visitors drill-down access to a wealth of quality and access data across the program including outcomes, member and provider experience, provider enrollment, spending and utilization, as well as special projects. All Medicaid services will be included in the dashboard – medical, behavioral health, dental, non-emergency transportation, pharmacy, and long term services and supports. Because the state no longer fragments the program among managed care organizations, we avoid all those apples-to-oranges disclaimers that kept policymakers in the dark for over a decade. The data will be available in pre-set charts as well as downloadable aggregate data. I am particularly interested in the ability to parse spending increases by category of service and price vs. utilization influences. There were objections to a suggestion that providers receive identifiable information on Medicaid members not affiliated with a provider for outreach purposes. While we acknowledge the benefits of encouraging connections to the health system, release of identifiable data raises concerns of adverse selection, especially given DSS’s controversial plan to introduce provider risk into the program a year from now.