Tuesday, August 18, 2015
Health Policy panel at CSG/ERC’s Annual Meeting in Wilmington DE focused on health care innovations that build value. States shared lessons learned and resources. We heard from Heidi Louise Behforouz, MD of AnansiHealth and Brigham and Women’s Hospital about the value of including community health workers into the health team. We also heard from Jeff Brown of NJ’s Quality Improvement Collaborative about that state’s plan to move Medicaid members into Accountable Care Organizations, by improving access to quality care and using the resulting savings to improve community health. We heard from Kerri McGowan Lowrey, J.D., M.P.H. of the Network for Public Health Law -- Eastern Region about the rich resources and technical assistance their project provides to Eastern Region policymakers seeking help with public health law and analysis. And finally we heard from Secretary Rita Landgraf of Delaware’s Department of Health and Social Services about innovations in their state. As with ten other ERC states, DE has been awarded a State Innovation Model grant from CMMI. But understanding that all stakeholders need to be engaged and involved for successful reform, DE has chosen to create a nonprofit to shepherd patient-centered reform in their state. For the effort, DE has devoted $100 million in state funds to supplement $30 million in federal funding.
Sunday, August 16, 2015
raised concerns about DPH’s planning to address health equity. Important planning meetings occur in closed meetings, without public notice or minutes. (Sound familiar?) Questions were also raised about how federal funds have been spent and the required conflict of interest policy is not available. (Also familiar). But in contrast to SIM, DPH’s representative had the right answer. He thanked SB for raising the issues, DPH is taking the concerns seriously, are looking into answers for his questions, and will work to make all meetings public. (That’s how advocacy is supposed to work.)
Consultants gave a presentation on the SIM Practice Transformation Task Force’s (PTTF) plans for a Community and Clinical Integration Program. CCIP is meant as a resource of services in the community, clinical and non-clinical, to supplement PCMHs. It was reported that it will focus on Medicaid’s reforms and will be a requirement in DSS’s RFP for networks to receive shared savings. The consultants reported that the PTTF has made important decisions about the target populations, core elements of the program, and program design. They are now finalizing standards for the program. Target populations that Medicaid networks can choose among for care management include complex patients, people experiencing equity gaps, and people with behavioral health needs. They plan to develop an algorithm to identify target patients. There was a great deal of discussion about consulting with other SIM committees and aligning with SIM’s goals. Connecting with Medicaid, or its existing, very successful Intensive Care Management program and existing risk profile data work was not mentioned. PTTF leadership sitting in at the table made it clear that decisions are still being made and nothing is set in stone.
There was a presentation on CAB’s communications plan to explain SIM to consumers and get feedback. There were several recommendations from steering committee members to include both the risks and benefits of shared savings, especially risks of underservice. One member felt it was too early to be talking with consumers about reforms, it would be too confusing for them and the minutes of SIM meetings are available online, but other members disagreed. CAB’s representative agreed to bring the comments back to the committee.
Evaluators for SIM proposed creation of a Rapid Response Team, with membership similar to the Steering Committee, to monitor progress toward SIM’s goals, such as moving half the state’s population into shared savings by 2017 and 88% by 2020. If the state doesn’t reach SIM’s goals, the team would enact policy changes to move faster. It was suggested that it would function like a SWAT team. There was no discussion of who would appoint members to this very powerful, new committee or if their work would be public. (See above) However, the Steering Committee didn’t see the need for a new committee that would replicate their functions.
Friday, August 14, 2015
Thursday, August 13, 2015
Last week the Freedom of Information Commission held a hearing on my request for SIM documents related to their Consumer Advisory Board’s (CAB’s) votes on appointments to SIM committees. Those committees are making very important decisions about CT’s $30 billion health care system and ethical questions have been raised about committee members receiving substantial SIM grants. I also asked for an opinion about CAB’s secret meetings to choose those representatives. SIM objected to submitting my prepared testimony so it was not allowed. Questions have been raised about the adequacy of SIM’s response to the FOI request. For example, their response included only one ballot from voting on the second round of candidates. If that had been the only vote cast, the outcome would have been different. There are seventeen CAB members and the FOI response included about a dozen ballots from voting on the first round of candidates.
Wednesday, August 12, 2015
Tuesday, August 11, 2015
Contrary to early CDC numbers, a new survey by Gallup finds that CT’s uninsured rate dropped from 12.3% in 2013 to 5.0% for the first half of this year. CT’s drop was similar to other states that chose to both expand Medicaid and create a state-based health insurance exchange. Rhode Island is tied with Oregon for the third biggest drop in uninsured rates among states, from 13.3% to 2.7%. An early CDC survey published in June found that CT’s uninsured rate had dropped very modestly from 9.1% in 2013 to 7.0% last year.
Friday, August 7, 2015
Connecticut’s State Innovation Model (SIM) is seeking to radically transform our state’s $30 billion health system by aligning incentives to build value. SIM has chosen a shared savings payment model for those reforms. Advocates are concerned about incentives to deny necessary care under the new payment model, as happened in the past. SIM’s Equity and Access Council was charged with developing protections to limit and prevent underservice. The Council has offered its 72-page report with 28 recommendations. One critical recommendation was strongly supported by consumers, advocates, providers and at least one state agency. It was opposed only by insurers and consequently did not reach consensus. A guide to the report includes background on shared savings, its features and how it can impact underservice. The guide also includes brief summaries of the Council’s recommendations, as well as the original report text. We expect the report to be opened for public comment soon.