Monday, December 11, 2017

Heated debate – healthcare vs. health care

Have you ever wondered if health care should be one word or two? Apparently it is currently two words, according to the Associated Press, but the debate is heating up. Each side has strong support and even stronger feelings about the subject. I always thought that the CT Health Policy Project used two words, but a site search finds that we aren’t always consistent. Rest assured, that will be rectified going forward.

Tuesday, December 5, 2017

Medicaid update: PCMH+ limping along, bad news for HUSKY parents, and Medicare cuts loom

PCMH+, CT Medicaid’s experimental move back into financial risk that now impacts just over 100,000 people, survived the budget cuts – sort of. The PCMH+ budget was cut from $500,000 (state costs) last year to $300,000 this year, but the SIM federal grant has been devoting a lot of resources to the initiative. We have no idea what CT’s SIM program is spending on this, or on anything actually. Contracts for the current nine ACOs have been extended to March. It is still expected there will be an RFP for a new round to add another 250,000 people to the program. No meaningful evaluation of the impact on the first 100,000 will not be available until well after March. In a webinar last month, Mercer reported on their administrative evaluation of the program, which only looked at policies and procedures, not outcomes, health impact or costs in the program. They did interview two consumers from each ACO, but the consumers were chosen by the ACO, not randomly chosen. Mercer’s evaluation addressed only a couple of independent advocates’ concerns, and found only a few, minor problems with the program. We don’t know how much this evaluation cost the state.

At last month’s Medicaid Council meeting, as required by law, DSS reported on the fate of the last group of 18,903 HUSKY parents who lost coverage in the budget cuts of 2015. The federally-required reassessment of the members found that 7,694 (40.7%) remained eligible under a different category. But as of October 25th, only 2,387 (12.6%) were covered by Access Health CT, CT’s health insurance exchange, leaving 8,822 working parents (46.7%) without coverage and likely uninsured. This doesn’t bode well for the 9,200 more HUSKY parents cut off the program in the latest budget.

Friday’s MAPOC meeting at 9:30 am in Room 1D of the LOB will focus on the over 100,000 low income seniors and people with disabilities that are losing Medicaid subsidies to pay their Medicare costs.

Monday, November 20, 2017

Chartbook: CT drugs costs high and growing fast

14.4% of our state’s economy was devoted to health care services in 2014, slightly below the US average, according to a new Chartbook on CT Health Spending. Based on newly released data from CMS actuaries, the analysis finds that CT health costs per person are not surprisingly high but we out-perform most other states in controlling the rate of increase, particularly for Medicaid members. Since 2009, Medicare and Medicaid have been paying more of CT’s health care bills than private insurance. Over half of CT health spending is consumed by hospitals and physicians/clinics, but drug costs are the largest driver of growing health costs. Per person drug costs for CT residents are the second highest in the nation and rising at the third highest rate among states.

Thursday, November 9, 2017

CT trains lots of doctors but we don’t keep them

A new report on physician workforce finds that CT is a hub for training physicians, both medical school and residency training but we are falling behind in retaining those graduates. The report from the Association of American Medical Colleges finds that physician capacity in CT now is is good ranking 6th highest among states in the number of physicians per population, and 10th in primary care. But the future is less rosy. Our physicians are slightly older than the rest of the nation, and we are not retaining students who study and train here. CT ranks 4th among states in medical residency slots per population, 3rd in primary care, and about average in medical school slots. But we are very poor at keeping those students practicing in our state, ranking 42nd overall. Successful states have proactive policies to retain and attract physicians to serve their residents including assistance with student debt that averages $180,000 for new graduates, opening new schools, which CT has done, funding residency slots, and recruiting physicians with local roots.

Wednesday, November 1, 2017

November CT Health Reform Dashboard – status quo, again and again and again

Like the last two months, November’s CT’s Health Reform Dashboard has changed little. Growing and understandable mistrust remains at the core of problems in CT. Medicaid policy development and implementation is still mired in mistrust, incomprehensible and misleading consumer “notices”, rushing ahead without data, quality problems, and a lack of transparency while state officials refuse to answer questions. CT’s Health IT quagmire gets worse. The state budget is terrible causing thousands more working parents to lose coverage. At the federal level, ACA protections and supports are in jeopardy, Medicaid is not secure, and the budget is also terrible. The Health Care Cabinet workgroups continue digging into our work to control drug costs in CT, but we need to up the game and be sure reforms address the total cost of medications to the entire system. Consumers understand that we pay the entire bill – premiums, taxes, and lost wages – not just out-of-pocket costs. Saving in one area just adds costs in another – and we end up paying more in the end anyway.

Monday, October 30, 2017

Nominations open for New England comparative effectiveness voting panel

The New England Comparative Effectiveness Public Advisory Council is seeking nominations for new members. New England CEPAC is a group of clinicians, economists, and patient/consumer representatives that meets three times each year to take a deep dive into the evidence on the effectiveness and value of new drugs, devices and delivery system innovations. At the public meetings, CEPAC hears from experts, patients affected by the condition being discussed, and other stakeholders. CEPAC then votes publicly on the merits and value for the New England region of the studied treatments. CEPAC, and two similar councils in other regions, are programs of the Institute for Clinical and Economic Research, an independent nonprofit institute that produces reports on the evidence for effectiveness of new drugs and other health services. ICER’s reports are used by a growing list of public and private payers in maximizing value for every health care dollar. To ensure independence, CEPA members must meet ICER’s conflict of interest policies. Nominations can be sent to on or before December 1st at 5pm. Please send a CV and letter to interest. Both organization-sponsored and self-nominations are welcome.

Wednesday, October 25, 2017

CT gets a C for pre-term births

A new report highlights CT’s disappointing performance in reducing pre-term births and ensuring our state’s newest citizens have a healthy start. Almost one in ten (9.4%) CT births happen before 37 weeks, ranking us 31st among states. Hartford County was worst at 10.1%; Litchfield was best at 7.7%. There is wide disparity in pre-term birth rates across race/ethnicity in CT. 12.2% of black births in our state are pre-term compared with 8.6% of whites. CT’s record on preterm births is in contrast to Monday’s report highlighting our state’s enlightened Medicaid policy on access to HepC treatment. CT still has significant room for improvement in health and healthcare.