Friday, October 17, 2014
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
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
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
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 précis, 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
Monday, October 6, 2014
Friday, October 3, 2014
CT was behind only NJ last year in the percent of hospitals receiving Medicare readmission penalties and the average penalty for CT hospitals more than doubled from 2012. Medicare fines hospitals for patients who return unplanned to the hospital for treatment within 30 days of discharge compared to an expected readmission rate, adjusted for severity of illness, age, and other conditions. According to experts, more than half of readmission spending could have been avoided. The highest penalty for a CT hospital went to St. Vincent’s which has been above average since the quality improvement program began three years ago. New Milford Hospital has received no penalty in any of the last three years. No CT hospital received the maximum penalty in 2013. Hospitals have responded to the program by replacing cursory paper discharge plans with meaningful connections to care in the community. This year the program expanded the maximum penalty and the number of conditions they evaluate. Twelve CT hospitals experienced significant increases in penalties this year.