Thursday, February 11, 2016

Fascinating Health Care Cabinet meeting on hospital markets, concentration, costs and the magic of VT

This week’s Health Care Cabinet meeting was fascinating. We first heard about the impact of hospital consolidations in CT. We heard a moving story about a Spanish-speaking woman suffering a mild stroke who had to be airlifted from Windham to Hartford because since Hartford Hospital’s acquisition of Windham Hospital, there is no longer a neurologist available. This is despite hospital assurances during OHCA’s merger approval process that there would be no change in service availability. There was no interpreter for the patient, no one to talk to, on the 30-minute helicopter ride, as she was experiencing the effects of the stroke. We also heard from the authors of a critical report outlining the likely cost impact of Yale-New Haven’s proposed acquisition of L&M Hospital, and from a nurse from L&M concerned that what happened in Windham will happen in New London if the merger goes through.

We then heard a fascinating presentation by Zack Cooper from Yale’s School of Public Health and the Health Care Pricing Project on the first of several articles he is working on about health care prices. There were many themes including that hospital prices average 15.3% higher in monopoly markets where there is no competing hospital within 15 miles, that Medicare price and utilization dynamics are not correlated with private coverage, and that private plan prices are not linked to better quality of care – a big problem as we try to move CT’s health system toward paying for value over volume. My favorite finding is that there is no evidence of a cost shift from Medicare to private coverage prices. While it is true that Medicare pays providers less than private prices (Medicare rates cover the costs of care plus a small profit), there is no support for the widely-held assumption/complaint/excuse that this drives up private hospital rates.

Not surprisingly, all of CT is among the highest Medicare per person spending areas in the US. And while the Bridgeport and New Haven areas are also among the highest spending for private coverage, Hartford is a little below the US average. He also showed substantial price variation within markets. Patients searching for a lower limb MRI in CT can save $1,000 by shopping around. This is increasingly important with the growth of high-deductible health plans.

We also heard from the consultants working on the Cabinet’s cost-containment study. This month they focused on the magical state of VT which is miles ahead of CT in cost control. There was a lot of information on VT’s cost control success with Patient-Centered Medical Homes and the Blueprint for Health that supports those PCMHs, and their plans for a single, multi-payer ACO. The consultants’ attribute VT’s success to committed leadership, regulatory power and a culture that expects trust and collaboration. VT stakeholders put aside their narrow interests and work together in good faith toward a system that works for everyone. Cabinet members generally agreed that CT especially needs to work on the trust part.


It was a fascinating morning. I can’t wait for next month’s meeting.

Monday, February 8, 2016

New to the Book Club: Fighting for Life, by S. Josephine Baker, 1939

In the 1890s New York’s Lower East Side was the most densely populated square mile on the planet, with largely immigrant residents. A third of children born there died before their fifth birthday often due to epidemics of diarrhea, smallpox, typhus, child labor, poor sanitation, and other preventable conditions. But by 1911 the child death rate had fallen sharply and the community was among the most healthy in the country. By her retirement in 1923, Dr. Josephine Baker, director of the city’s Bureau of Child Hygiene, was credited with saving the lives of 90,000 children. In her very entertaining autobiography Dr. Baker describes how she did it. Read more on this book and others in the CT Health Policy Book Club

Wednesday, February 3, 2016

Governor’s budget proposal – it could be way worse

Today the Governor announced his proposed budget for the coming fiscal year that starts July 1st. The very, very good news is that Medicaid is largely untouched – no new cuts to providers, no more people losing coverage, and minimal service limits (orthodontia). This is smart because current reforms in the program are working to control costs significantly, while improving access and quality of care. The Governor proposes continuing hospital cuts from December and a 5% cut to the CT Children’s Medicaid Center’s subsidy. A lot of programs would shuffle between agencies to maximize federal reimbursements and fringe benefits would move into agency budgets. Like most other agencies, DSS would have to cut 5.75% from their operating budget ($18.6 million, not from Medicaid) if the Governor’s budget is adopted. It is hard to imagine how DSS staff will manage their difficult and increasingly complex job with fewer resources.

Unfortunately other services were not as fortunate as Medicaid. At DPH, the Governor has proposed reducing funding to local health departments, eliminating grants to community health centers, reducing grants to school-based health centers (because there are fewer uninsured due to the ACA), and $700,000 earmarked for asthma programs will be diverted from the Tobacco and Health Trust Fund to the General Fund. Fall prevention and respite care funding at the Dept. on Aging would be cut and mental health and substance abuse grants would be cut at the Department of Mental Health and Addiction Services. All those agencies will also have to cut 5.75% of operating costs if the Governor’s cuts are passed. Many observers are not only concerned about the cuts but also the lack of specificity; agency leadership will decide where to make cuts without legislative approval.


While the list of proposed cuts is long, it could be far worse. And please remember that because of cuts passed last year, about 18,000 working parents will lose HUSKY coverage this summer if nothing is done.

Tuesday, February 2, 2016

Two in three CT physicians had an electronic health record in 2014; well below US average

In 2014, only 67.5% of CT office-based physicians had a certified electronic health record (EHR) system according to a new CDC brief. Nationally 74.1% of office-based physicians had certified EHRs in 2014, up from 67.5% the year before. Only five other states had lower EHR participation levels. On the bright side, CT physicians who did have an HER were slightly more likely to share patient information with external providers or unaffiliated hospitals (33.7% CT vs. 32.5% US). Nationally only about one in ten physicians with an EHR shared patient information with home health, long term care or behavioral health providers. Electronic health records are key to improving patient care decisions and safety, consumer engagement and participation, care coordination, evaluation, research and better health planning.

Monday, February 1, 2016

February web quiz: costs on CT’s health insurance exchange

Test your knowledge about costs of plans and MLRs on CT’s health insurance exchange. Take the February CT Health Policy Webquiz.

Friday, January 29, 2016

CT Health Reform Dashboard redesign

Two years after the main Affordable Care Act expansions were implemented and almost six years after it became law, we’ve re-designed our CT Health Reform Dashboard to reflect the changing challenges and opportunities. Most of the 125 tasks and decision points in the original progress meter have been set in place. New opportunities to reform our health system are now occupying policymakers. The new dashboard includes a quick look at the status of CT reforms, a list of action items to ensure the reforms are effective and a more detailed breakout by issue area/silo with links to more information. We will still update the dashboard every month. We welcome feedback on items and content.


The archives are still available, as a reminder of what CT did, and didn’t, accomplish in the last four years.

Wednesday, January 27, 2016

Benefits of sponsoring out-of-state trips for policymakers

A new Health Affairs blog highlights the benefits of learning trips for state health policymakers working on systemic change. The author, President of New Jersey’s Nicholson Foundation, notes that out-of-state trips are very effective in fostering new perspectives on problems and finding innovative solutions.

“The Nicholson Foundation is dedicated to addressing the complex needs of vulnerable populations in New Jersey’s urban and other underserved communities. Over the years, we have sponsored many trips that have sent hundreds of New Jersey health leaders beyond the Garden State to study approaches used and innovations practiced elsewhere. The knowledge these leaders have brought back has helped transform how care is delivered at home.”


We couldn’t agree more. A delegation from CSG/ERC’s health committee visited New Jersey in October for a conference sponsored by the Nicholson Foundation, to hear more about New Jersey’s success with high-cost, high-need Medicaid members. We learned a lot and bought their experience and best practices back to Connecticut. It’s great to hear others who appreciate the value of travel and policymakers learning from each other; CSG/ERC has been doing this since 1933.