Wednesday, May 6, 2015

CT conference on SIM payment reforms in other states

Yesterday the CT Health Foundation hosted an interesting conference highlighting SIM plans from leading states – VT, OR, MN, and ME. The conference started and ended with reports from CT’s DSS about our significant Medicaid successes in improving quality and access while controlling costs – and how that progress was only possible when we shifted from a financial risk, fully-insured model to one that focuses on care coordination and quality.

So it was unfortunate that the underlying assumption of the conference, stated often, was that the only way to move toward value-based purchasing is “moving up” the ladder of financial risk toward full capitation (at least they put those more risky models in orange on the slide). This is despite the opposite evidence from our own state. Nothing is simple and even economists are coming around to understand that theoretical incentives and financial risk are not the only drivers of health care spending or quality – not even close. In fact, CT’s Medicaid experience shows they can get in the way.

We heard a lot about other states’ payment reforms and impressive work to tie payments to quality. These states, and their SIM planners, deserve the credit and recognition for their accomplishments.  They have been at this a long time and have engaged all stakeholders in transparent, thoughtful planning processes. One best practice that resonated with the audience is that you should never underestimate the number of conversations needed and the need for clear communications and expectations. They all emphasized that reform won’t happen if everyone isn’t on board. Lisa Letourneau from Maine acknowledged that shared savings along isn’t going to really transform care. These states moved into reforms gradually, testing their progress at each step, and revising accordingly. However these states are different from CT in important ways that make a direct translation of their lessons to our state risky. I also know that while it was great to hear from state SIM officials and consultants from those states, we would have gotten a richer description of the challenges and lessons if the voices of consumers, advocates, legislators, and providers from those states had been included. 


The conversation also would have benefitted from a discussion of CT’s collaborative plans to build health neighborhoods for our state’s dual eligible beneficiaries – a model of thoughtful policymaking that includes shared savings but with good consumer protections and strong quality backstops. But overall, there was a lot of good information for CT.

Tuesday, May 5, 2015

May web quiz on CT adult health risk factors

Test your knowledge of health risks among CT adults. Take the May CT Health Policy Webquiz.

Monday, May 4, 2015

CT Medicaid/CHIP programs lost 11,019 members between January and February

A new CMS report found that enrollment in CT’s Medicaid and CHIP programs dropped by 11,019 (-1.5%) from January to February of this year. This is very usual, especially among states that have chosen to expand Medicaid under the ACA. Among expansion states, Medicaid/CHIP enrollment averaged 0.98% growth; even non-expansion states saw an average 0.43% expansion in enrollment. Four in ten CT Medicaid/CHIP members is now a child (40.56%), down from 55% at the end of 2013. Now you know the answers to the June webquiz.

Friday, May 1, 2015

CT health reform progress moving backward again this month

CT’s progress toward health reform dropped from to 27.0% this month mainly because of SIM setbacks again, but the Appropriations Committee’s vote to reverse many proposed budget cuts is a ray of hope to maintain Medicaid’s progress. A six-month delay to SIM’s rush into risky shared savings models is a good start to begin thoughtful Medicaid reform. Ethics, conflict of interest, and secrecy problems continue to circle SIM. The CT health reform progress meter is part of the CT Health Reform Dashboard.

Thursday, April 30, 2015

CT exchange plans violating ACA women’s coverage protections

Researchers found eight violations in 2014 and thirteen violations this year of Affordable Care Act women’s coverage provisions by plans offered in CT’s insurance exchange. The new report by the National Women’s Law Center analyzed benefits and offerings of ACA-required services women need among marketplace plans in fifteen states. Violations in CT included breastfeeding supports and supplies, essential health benefits, and coverage for birth control. Other state violations also included genetic testing, prescription coverage, pre-existing condition coverage, maternity and preventative services. The Center working with local CT advocates were able to encourage state regulators to issue a bulletin to all insurers outlining legal requirements for coverage of birth control services.

Wednesday, April 29, 2015

SIM responds to advocates’ Medicaid concerns

Monday the Lieutenant Governor responded to a letter sent earlier this month signed by twenty independent consumer advocates and providers raising concerns about SIM’s plans for Medicaid. In her letter, the Lieutenant Governor agreed that CT’s Medicaid program has become a national model of success, improving access to care, raising quality and controlling costs. Those achievements resulted from our transition three years ago from financial risk models to care coordination – through person-centered medical homes and intensive care management. Advocates are concerned that SIM’s rushed return to financial risk models will unravel those achievements. Data systems and policies are not ready to carefully monitor financial incentives in de facto downside risk arrangements, or to identify and correct under-service driven by the new incentives. The advocates’ letter urges the administration to learn the lessons of the spectacular HUSKY MCO failure and consider well-tested, better options that have greater potential to improve quality, coordinate care and further control costs.


In her letter, the Lieutenant Governor understands our concerns and has agreed to delay implementation of the new Medicaid plan by six months. That is a good start; hopefully it will be sufficient to protect people and hard-won progress. In any event, the advocates remain committed to work constructively with the administration toward the common goal of developing a value-based program.

Monday, April 27, 2015

Appropriations Committee restores most of the Governor’s proposed health care cuts

Today the Appropriations Committee released their budget, restoring most of the deep Medicaid cuts the Governor proposed in February. The committee rejected the Governor’s proposal to cut 34,000 working parents and pregnant women from HUSKY coverage. The committee also restored funding, accounting for inevitable delays, for the innovative health neighborhoods pilots to coordinate care for fragile state residents eligible for both Medicare and Medicaid. The committee also restored much of the Governor’s proposed cuts to Medicaid provider rates. The committee also cut in half spending to implement SIM’s controversial plan for Medicaid.