Thursday, June 23, 2016

CSG-ERC offers Medicaid reform resources for state policymakers, including underservice protections

Medicaid is now the largest coverage program in the nation, consuming over a quarter of state budgets, and that share is rising at an unsustainable rate. State Medicaid programs are working on reforms to shift from a system that rewards volume with no regard to quality to a better system that builds value. Next week in Boston the Council of State Governments-Eastern Region is hosting State Medicaid Reforms: Different Models, Common Goals, a meeting of Northeastern state Medicaid policymakers, including several from CT, to learn about best practices across the US, available support and to share resources. CSG-ERC has posted three backgrounders to support the meeting. The first describes state reform models and the second outlines the status of Medicaid reforms in ERC states including CT.


Focusing on work done in CT, the third brief gives states options to prevent inappropriate underservice. As an income-based, entitlement program run by states with federal support that serves members at risk for poor health due to social determinants, Medicaid carries both unique strengths and challenges. Unnecessary over-treatment has received a great deal of attention as a driver of rising health costs in the wider health care system, but inappropriate under-service is also a problem across payer sources. As health care payment moves away from volume-based systems such as fee-for-service to quality and risk based systems such as shared savings, the potential for underservice grows. Federal regulations acknowledge, “Programs that include incentives to reduce costs for care may result in unintended consequences such as avoidance of at-risk patients, [and] “stinting” on care”. The meeting will be at the Massachusetts State House June 29th from 10am to 4pm. Click here for more info and registration.

Thursday, June 16, 2016

Medicaid reform application released – good interest at bidder’s conference

CT Medicaid’s plan for payment reform marked a milestone last week with release of the RFP for provider networks and community health centers to participate. Most of the independent consumer advocates’ Medicaid Study Group recommendations are included, but not all. Pros include protective attribution, no downside risk, smart quality incentives to reward improvement, re-investing savings in quality, makes the questionable CCIP plan voluntary for networks, PCMH support, requires formal consumer advisory oversight in the governance structure, and strong language prohibiting payment of savings generated by inappropriate underservice. The RFP reflects the Care Management Committee’s concerns about shared savings’s potential to encourage underservice by including policies to prevent the problem and a yet-to-be-developed robust monitoring system. The bidder’s conference this week was well-attended by community health centers and private ACOs with lots of specific questions. Proposals are due July 26th for a contract start date of Jan. 1st of next year. There is still a great deal of work to do.

Wednesday, June 15, 2016

Healthcare Cabinet sets state agency context for recommendations

At yesterday’s meeting, the Healthcare Cabinet heard from ten state agencies that all touch on health. They were asked to report on how they were saving money, improving the quality of care, and innovating to improve the health of state residents. DSS got twice as much time as everyone else, with good reason. Among the impressive initiatives there were a few trends – individualizing interventions, especially for high-cost, high-need patients, working with communities and consumers collaboratively, making care affordable, protecting and supporting families, targeting homelessness and ED use, using data and evidence, and making better use of limited resources. After hearing for months about innovations from other states, it was very helpful to hear about promising initiatives we can build on here. This could be the beginning of breaking down silos that have stymied progress in the past. At next month’s meeting on July 12th we will begin working on recommendations for reform in Connecticut.

Tuesday, June 14, 2016

Medicaid Council hears about promising homelessness partnership

Friday’s Medicaid Council meeting highlighted a new federal Medicaid-Housing Partnership opportunity for CT. The collaborative application by CT Medicaid and six other agencies and non-profits was one of eight states awarded. Under new federal guidance, Medicaid can cover tenancy sustaining and transition services, such as help with identifying a home, application assistance, help with moving, and early identification and intervention for behaviors that may jeopardize housing. The program will help the state link those Medicaid-funded services to other resources to pay for non-Medicaid supports. Because of CT’s access to comprehensive Medicaid data, since moving away from multiple MCOs, data matching with homeless data sources will allow earlier identification and intervention to avoid costly poor health outcomes.

Sunday, June 12, 2016

FDA committee split on benefits of C. difficile treatment


Last week, the FDA’s Antimicrobial Advisory Committee drilled deep into evidence on the safety and effectiveness of Bezlotoxumab, a drug intended to reduce recurrence of C. difficle infections. The evidence was extensive – slides with data tables and charts numbered at least 1,855. Half a million Americans suffered from serious C. diff infections and 29,000 of them died in 2011. Many patients, even after cured of a C. diff infection have a recurrence (20 to 35%) and those patients are at 33% higher risk of dying. Preventing C. diff recurrence is a top public health priority. Bezlo is a new biologic drug intended to reduce the chance of recurrence when given with antibiotics to cure the initial infection. However the FDA and committee members voiced serious concerns over whether Bezlo could interfere with the initial “cure”, which was unexpected, conflicting evidence between studies of whether there was any improvement in recurrence rates with Bezlo, and troubling rates of serious adverse events. It is important to note that C. diff infections are more common in elderly, already fragile patients. We heard about different definitions of the initial “cure” between the FDA and Merck, debated why there weren’t fewer deaths in the Bezlo-treated group over controls, and whether Bezlo could be administered after the initial antibiotic has already worked to avoid any inference with the cure. While members generally agreed on the concerns, we split on whether there was “substantial” evidence of Bezlo’s safety and effectiveness. This was the first time I’ve voted against a drug’s approval. C. diff recurrence is a serious and deadly problem, this approach offers great potential, and there was a great deal of support for the company working on a solution, however many members felt the evidence wasn’t there yet. The FDA makes the final decision.

Wednesday, June 8, 2016

27 minutes average ER wait time for Connecticut

Governing magazine reports that in 2014 the average Emergency Room patient in Connecticut waited 27 minutes for care. That wait is similar to neighboring states but well below Maryland with the longest wait at 46 minutes, and well above Colorado and Utah where patients waited only 16 minutes. The article cites CMS Hospital Compare Data.


Average ER wait (2014)
CT
27 minutes
MA
37
RI
27
NH
28
VT
25
NY
24
NJ
30


Tuesday, June 7, 2016

CT Insurers want enormous rate hikes in 2017

Insurers in CT have asked the Dept. of Insurance for permission to raise premiums significantly next year, both on the exchange, AccessHealthCT, and off. Insurers want to raise individual AccessHealthCT premiums on average by 26.8% (Anthem with 56,700 covered lives), 14.3% (ConnectiCare Benefits covering 47,597 lives) and 12.21% (HealthyCT with 16,274 covered lives). Those averages cover a range of a 39.8% to 13.0% for individual plans. Insurers blame rising health care costs and expiring federal transitional reinsurance provisions. Several important points – in the past, the Insurance Dept. has lowered insurers’ rate increases, many people are eligible for federal income-based subsidies to help with the cost of exchange premiums, and the exchange has indicated an interest in negotiating with insurers to bring premiums down. Individuals in off-exchange plans cannot access federal subsides; insurers have requested average increases between 6.6% and 27.9% for those plans. Small groups are facing similar increases, both on and off the exchange. The Insurance Dept. will hold hearings on the increases August 3 and 4 and is accepting public comment now.