Thursday, August 25, 2016

Reform is hard and Econ 101 doesn’t work

An article published today in the New England Journal of Medicine highlights the challenges in health reform and why the usual, simple fixes aren’t working.  The article by Richard Bohmer, The Hard Work of Health Care Transformation, explains why changing financial incentives or governance structures aren’t sufficient to effect change. The status quo is very strong. It’s great to see of the fact that the usual payment reform tactics miss the point. Shifts in incentives or structures are not the goal, they can support reform but alone they are usually irrelevant distractions and, at worst, counter-productive. Change is about consistent, small changes made over time, institutionalized within organizations that build internal capacity. Payment and governance shifts should follow and support reforms -- not the other way around. There is plenty of evidence that simply changing who is at financial risk or organizational/governmental structures and counting on an invisible hand doesn’t work for health care reform. 
“The short­ term investments that are required can be surprisingly small, because most organizations already have many of the requisite human as­ssets. The most substantial hurdle, it seems, is the change in mindset.” 

Monday, August 15, 2016

CSG-ERC annual meeting in Quebec: States seek relief from rising prescription drug costs

The rising cost of health care is hitting hard across North America, both in houses of government and at home, around the kitchen table, where the cost of vital prescription drugs can too often make or break a household budget.

From 2001 to 2011, health care spending by states jumped a staggering $5.1 billion across America, an increase of 59 percent. Just as families might be forced to sacrifice a summer vacation as medical bills mount, states have cut $4 billion in spending in other vital areas like education, housing, public safety and mental health, in order to compensate for the spike in health care costs.

It’s not a sustainable model, and states are increasingly taking bold steps to attempt to normalize cost drivers, specifically prescription drug costs.

Earlier this year, Vermont became the first state in the U.S. to pass legislation requiring drug manufacturers to provide pricing justification for the biggest selling drugs in the state. And in Massachusetts, the Commonwealth’s Health Policy Commission is playing a hands-on role in improving the transparency and accountability of the health care system.

One of the major issues with prescription drug costs in America is that there’s no agency that tries to value drugs before they’re available to be marketed, according to Dan Ollendorf, chief scientific officer for the Boston-based Institute for Clinical and Economic Review.

ICER is trying to change that by advocating for value-basedanalysis of new drugs as they’re brought to the market. ICER uses an impartial benchmarking system that seeks to establish a value for each new drug based on a number of factors.

“In our reports, we try to set a level on what we think is a reasonable price,” Ollendorf said. “We try to time our reports around launch of drugs to United States so the benchmarks we present will affect negotiations over pricing.”

Ollendorf believes a third-party valuation of prescription drugs adds transparency to a process that is often shrouded in secrecy, while protecting pharmaceutical companies from being forced to share proprietary information or hindering innovation.

Sara Sadownik, Deputy Director of the Massachusetts Health Policy Commission, said controlling prescription drug costs have come into focus as it implements a new law that requires new health care costs do not outpace the state’s budget growth.

“Rising costs are not an anomaly, they’re a trend,” she said, adding projections show they’ll continue to jump in the high single digits annually over the next few years before stabilizing at a 4-6 percent annual jump.

-Jesse Chadderdon


Friday, August 5, 2016

Lots of hospital quality news, CT not excelling


In the last few days several sources have released hospital quality rankings and measures. The bottom line -- CT’s hospitals have a lot of work to do.

CMS released their long-awaited five star system for hospital ratings, but no CT hospitals received five stars. In fact, only one earned four stars (Backus), 17 received three stars, 9 got two stars and one (Danbury) only received one star.

According to CMS and Kaiser Health News, Medicare has penalized 19 of CT’s 28 hospitals every year for high readmission rates since the program began five years ago. Interestingly, the highest penalty for readmissions in this round goes to Yale-New Haven, who has applied to acquire Lawrence and Memorial, with the lowest penalty.


US News also came out with their 2016 hospital ratings and no CT hospitals made the Honor Roll.

Updated CT Health System Primer online

Our Basics of CT’s Health System has been updated for 2016. It addresses private insurance, Medicare, Medicaid, the uninsured, health care financing, reform and where CT stands. The primer is part of our resource collection available at cthealthbook.org.

Thursday, August 4, 2016

CT Health Reform Dashboard – SIM ethics problems growing, hospital mergers threaten

August’s CT Health Reform Dashboard update is again very active – and not in a good way. Thousands of working HUSKY parents lost coverage this week. SIM ethics problems continue to plague reform efforts. Efforts to bypass DSS’s prudent evaluation of the new, untested, very ambitious Medicaid reform plan are disturbing. Consultants for the Health Care Cabinet have recommended a troubling plan for reform that misses what is working in CT. Yale-New Haven’s health system wants to get even bigger, risking monopoly power and price increases we can’t afford.

Wednesday, August 3, 2016

August CT Health Policy Webquiz: Top salaries at CT hospitals and health systems

Test your knowledge of top salaries at CT’s hospitals and health systems. Take the August CT Health Policy Web Quiz.

Monday, August 1, 2016

CTHPP website down, apologies

Our CT Health Policy Project website has been down for an unacceptable length of time. (I know some of you feel our pain.) Be assured we are working furiously on a solution – both short and long-term. We apologize for any inconvenience. If there is something you are looking for, please let us know at information@cthealthpolicy.org. (That’s still working).