Thursday, August 28, 2008

PCCM concept paper out

The concept paper for the state’s planned PCCM pilot has finally been delivered to the legislature. The Appropriations and Human Services Committees now have 30 days to hold a public hearing and approve, deny or make changes to the plan. PCCM is a way of running HUSKY without HMOs and will serve as another option for consumers and the state to run the program. Under PCCM, consumers will choose a primary care provider (PCP) – a physician, APRN, nurse midwife, or Physician Assistant – who serves as their first contact for health care. Their PCP is responsible for providing routine checkups and health care, arranging for tests, specialists and other needed care and coordinating everything. Consumers will need referrals from their PCP for specialty and other care; PCPs will only need prior authorization from DSS for some hospital services. The state will provide access to an off-hours nurse advice line. PCPs will need to have or get an electronic medical record or electronic disease management data registry within a year. PCPs will be held accountable for the care and coordination they provide.

The goals of the program include improving outcomes, expanding access to primary and preventive care, improving doctor-patient relationships, lowering expenses, and empowering providers and consumers in guiding the HUSKY program. An advisory committee of providers will be convened and charged with developing a proposal for accountability and all other aspects of the program.

DSS plans to implement the program on Jan. 1st and to pay PCPs $7.50 per member per month for care management costs in addition to the usual fee-for-service payments for visits and procedures. Plans for outreach include regional forums for providers and consumers. We will let you know when those and the legislature’s public hearing have been scheduled.
Any providers who are interested in participating can call the CT Health Policy Project at (203) 562-1636.
Ellen Andrews

Wednesday, August 27, 2008

Sad news

From Gary Spinner, COO of the Hill Health Center:

“It is with great sadness that I let you know of the passing away of Cornell Scott, Hill Health Corporation's Chief Executive Officer. Scotty passed away at noon today in Yale New Haven Hospital. He had been ill for a great deal of time, and the past year has been one of frequent hospitalizations. Scotty has been the CEO of Hill Health Corporation since its founding in 1968. HHC was his love, his life, and his passion, and even until the end, he took great pleasure and joy in hearing about the work and mission of the Center.”

Scotty will be dearly missed here in New Haven, in Connecticut and across the US as one of the first and most prominent leaders in the movement to bring health care to those who need it the most.
Ellen Andrews

Tuesday, August 26, 2008

New Census numbers find uninsured largely unchanged in CT; many more buying insurance directly

In 2007, there were 326,000 uninsured CT residents, or one in eleven of us had no coverage – not significantly different from the 2006 numbers according to Census numbers released today. We had a good decrease in uninsured from 2005 to 2006 which has been stable. CT has the eighth best (lowest) uninsured rate in the US. HUSKY enrollment grew by 2% from 2006 to 2007. While this is all good news, there are still far too many CT residents living without coverage, risking both their physical and financial health. Click here for the CT Health Policy brief on the numbers.
Amongst all the stability is an interesting trend – the rising number of CT residents who directly purchase health insurance. That number rose significantly in 2007 to now equal the number of people without any insurance coverage. Anyone who has shopped lately for insurance, especially here in CT, knows how expensive it is. The state could do more for those direct purchasers to improve affordability and availability. Purchasers in CT’s small group market have several protections under state law including modified community rating (spreading costs over a larger group), guaranteed issue and renewability and the Insurance Dept. has to approve rate increases in the small group market. None of these protections apply in the individual market but they could. As part of their health care reforms, Massachusetts is merging their individual and small group markets, a reform that is expected to save individual purchasers 15 % (and only costing the small group market 1 to 1.5% more). MA also requires employers to allow workers to buy insurance with pre-tax dollars, saving direct purchasers even more. CT should look at these reforms at a minimum as more residents are relying on our largely unregulated individual insurance market.
Ellen Andrews

COHI seeking Executive Director

The CT Oral Health Initiative needs to hire a new Executive Director. For five years COHI has been advocating for better oral health for everyone. They have focused on access to dental care for CT’s underserved and education about the importance of oral health. COHI is seeking an experienced nonprofit leader who shares the organization’s mission and values. Speaking personally, I enjoyed my term working with COHI, learned a lot about the importance of oral health, and have rarely met a group of advocates as dedicated and nice to work with. For more info, go to
Ellen Andrews

Friday, August 22, 2008

eHealthCT designated as a Chartered Value Exchange

Connecticut is entering the e-health big leagues! Yesterday, our own eHealthCT was designated as a Chartered Value Exchange by the Agency for Healthcare Research and Quality. eHealthConnecticut is a not for profit entity incorporated in January 2006 and represents a collaborative approach to meeting the challenges of health information technology adoption and interoperability for the entire State. It is Connecticut’s single organization focused on statewide HIE, with the combined governance and resources of the public and private sectors and the flexibility of a private corporation. A Board of Directors representing physicians, providers, consumers (including the CT Health Policy Project), purchasers, payers, academia, and quality organizations governs eHealthConnecticut, with State agency officials providing direction on an ex-officio basis. Chartered Value Exchange status allows eHealthCT to bring critical resources back to our state, allowing CT health care consumers and payers to benefit from the benefits of health information technology sharing. Congratulations to eHealthCT for their hard work so far and good luck with the hard work yet to come.
Ellen Andrews

Thursday, August 21, 2008

Drama at the Medicaid Managed Care Council

Yesterday, the Council passed a resolution to recommend a delay in transitioning HUSKY families into the new HMOs and to freeze enrollment in Charter Oak until July 1st, 2009. The council was concerned that only a handful of providers have signed up with the two new plans, AmeriChoice and Aetna Better Health, and that patients won’t be able to access care. The motion was offered by Rep. Peter Villano and passed unanimously.
Unfortunately, DSS wasn’t there to hear Council members’ concerns. The Commissioner was not able to attend due to a family illness, but other staff were prepared to present and were in the room distributing handouts when they were abruptly called back to 25 Sigourney Street just before the meeting started.
The Council and visitors, including seven legislators, had a lively discussion with the three HMOs, the CT State Medical Society and the CT Hospital Association. Concerns beyond the inadequate provider networks about the program included provider rates and whether they will be made public under Freedom of Information law, inclusion of retail clinics, higher rates paid to some providers, whether the plans were contracting with providers for all three programs (HUSKY Parts A and B with Charter Oak), linkage of HUSKY with Charter Oak and the impact on families, the state’s liability for behavioral health and prescription costs, and why providers are being offered lower rates when the MCOs received a 24% increase in their rates from the state? (We were promised an answer to that question at the next meeting – Sept. 19th at 9:30am).
According to news reports, the Governor has dismissed the Council’s concerns suggesting that the legislators favor universal health care. There was no discussion of universal health care at the meeting. She says the HUSKY transition and launch of Charter Oak will go ahead unchanged.
It’s August; aren’t we supposed to be taking it easy?
Ellen Andrews

Tuesday, August 12, 2008

Retail Medical Clinics and Primary Care panels

Today’s panels at the CSG/ERC annual meeting explored retail clinics – opportunities and concerns – and primary care shortages. The clinic panel included Kim Rhodes from Take Care Clinics (owned by Walgreens) and Ken Ferrucci from the CT medical society. There are about 1000 retail clinics in the US, providing affordable access, including evenings and weekends, to basic services for conditions such as immunizations, colds, and ear infections. Ninety percent of patients who have used clinics are satisfied with the quality of care they received. Take Care Clinics have strong quality standards and work to connect patients to appropriate community services. Demand for clinic services is strong and growing, especially for people who cannot reach their doctor’s office during business hours and don’t need an emergency room. Ken emphasized that the medical society is not advocating to prohibit the clinics, but to ensure that they are regulated to protect patient safety. Other concerns include providing health care in stores that sell tobacco, offering lower copays to patients for visiting a clinic over a physician’s office, and the effect of clinics on the rest of the health care market.
The second panel focused on the shortage of primary care services and included Sen. Lisa Marrache (ME), Dr. Mario Motta, President-Elect of the MA Medical Society, and Dr David Stevens, of the National Association of Community Health Centers. Sen. Marrache, who is also a practicing primary care physician, created a legislative Commission to Study Primary Care Medical Practice. The Commission found that primary care physicians are leaving practice in record numbers primarily due to low reimbursement rates. The Commission recommended increasing and equalizing Medicaid rates, streamlining prescribing processes, investments in health information technology, and creating a medical home pilot project. Dr. Motta described the medical society’s recent study that found serious and growing physician workforce shortages, particularly in primary care fields. Half of MA physicians reported that they would not choose to practice medicine again as their profession. Waiting times for primary care appointments are increasing in MA which has serious implications for the success of MA’s health care reforms to cover all state residents. Insurance coverage is only part of the answer, being able to find a provider is just as important. Dr. Stevens focused on the critical role of community health centers in filling primary care gaps for underserved patients. He also highlighted the “medical home” model of care as a potential solution. In a medical home, patients have one place to access and coordinate comprehensive care in a culturally competent, compassionate setting. The medical home uses a team of providers including physicians, nurse practitioners, nurses and others to deliver appropriate, patient-centered care.
CT’s Governor Rell and Senator Harp attended both panels and actively participated in the discussions.
Ellen Andrews

Monday, August 11, 2008

State reform updates

I’ve been staffing the annual meeting of the Council of State Governments/Eastern Regional Conference health policy track meetings in Atlantic City, NJ. Today we heard updates from states at varying stages of reforming their health care systems – Maine, Massachusetts, Vermont and New Jersey.
Sen. Joseph Vitale described New Jersey’s comprehensive plan to cover all 1.2 million uninsured residents. Phase I was just signed into law expanding SCHIP for parents. They are starting an insurance mandate for children, but there are no penalties attached to it yet. Policymakers decided against any employer contribution. They allow families with higher income children to buy into the program at full cost – similar to HUSKY Band 3 – at a cost of about $137 per child per month (twice that for two children and three times that for three or more children in a family). The law increased the minimum allowed medical loss ratio for managed care companies from 75% to 80% -- CT has no standards for medical loss ratios. Phase II will include coverage for everyone not eligible for existing programs, will be self-funded, provide a benefit package similar to the most popular small group market product, and will reimburse providers at commercial rates.
Sen. Richard Moore updated the conference on Massachusetts’ reforms. The rate of uninsurance has dropped from 13% two years ago when Chapter 58 passed to at least 7% and possibly as low as 4% now – over 355,000 people have found health insurance. Not only has Massachusetts found no evidence of crowd out (employers dropping coverage assuming workers can join the new public programs), in fact employer sponsored insurance rates have increased since Chapter 58 passed two years ago. Uncompensated care spending is down 34%. Fewer state residents report not being able to access care due to cost, and medical debt is down. Public support for the reforms is strong and growing. Reforms of the non-group market have made insurance far more affordable and enrollment is up 50%. Despite this rosy picture, challenges remain. Residents who have chosen to remain uninsured may be difficult to convince, covering the underinsured, workforce shortages, and containing health care costs. To contain costs, a new law just signed by the Governor addresses price transparency, health information technology adoption, regulation of drug company gifts to providers, prohibits billing for “never events”, CON reforms, and a medical home demonstration project.
Jim Hester, Director of Vermont’s legislative Health Care Reform Commission, described Catamount Health which also passed in 2006. The Commission is a legislative oversight body that follows the implementation of reforms closely and is critical to the state’s success. 5,800 Vermonters have joined Catamount Health and 4,300 have newly enrolled in state programs. Vermont is having difficulty getting the federal government to honor its commitment to their global Medicaid waiver at promised funding levels. This year Vermont enhanced their reforms by expanding coverage for children on their parents’ policies to age 23 and a large increased investment in health information technology paid for with a 0.2% fee on paid claims across all payers. Vermont is also expanding their successful Blueprint for Health plan to reduce the prevalence and provide chronic care management for diabetes. ER use is down by 40% for patients in the self-management program.
Phil Saucier, from Maine’s Governor’s Office of Health Policy & Finance, talked about progress covering the uninsured. Their Dirigo health plan passed in 2003 and now covers about 18,000 Mainers. The state has taken the federal government to court arguing that they are owed financial support for the program. The state repealed the contentious savings offset payment mechanism to fund the program in favor of a flat fee on all payers, including self-funded plans, of 1.8% of claims as well as taxes on alcohol, tobacco and soda. The soft drink industry has mounted a referendum on the November ballot to repeal the tax on soda – a “people’s veto”. The state also increased the age children can stay on their parents’ policies to 25, prohibited billing for “never events”, created medical home pilots, and are addressing overtreatment inefficiencies.
Ellen Andrews

Tuesday, August 5, 2008

Charter Oak/HUSKY troubles in the news

The current problems getting providers to participate in the new Charter Oak/HUSKY plans have been hot news lately. A sampling:
The Day
Hartford Courant
Journal Inquirer
New Haven Register
Waterbury Republican American
Kaiser Daily Health Reports
Medical News Today
CT Post
WTIC News Talk 1080
Fox News 61
News Channel 3
Norwich Bulletin

According to DSS, as of Friday there were only 314 total primary care providers enrolled statewide in Aetna’s plan (only 2 in Windham county) and 225 in Americhoice’s panel (5 in Middlesex County). On Friday, there was still only one hospital signed up with Aetna and none had signed on with Americhoice.
Ellen Andrews