Wednesday, April 28, 2010

$50 million health coverage opportunity for CT from national health reform

CT can access $50 million in federal funds to cover state residents with pre-existing conditions until 2014 when insurers will no longer be able to exclude adults from coverage because they have health problems. Under the law, insurers are prohibited from excluding children with pre-existing conditions from coverage this year. Since 1975, CT has had a high risk pool to cover state residents who cannot get coverage in the private market, but premiums are very high and it has provided relief to only a small number of consumers. The new federal funding comes with several options for delivering the temporary coverage including starting a new program, building on the current program, or if we do nothing, defaulting to the national pool which is being developed in Washington. Governor Rell has until the end of this week to signal CT’s intentions.
Ellen Andrews

Monday, April 26, 2010

SustiNet medical home committee making progress

At last week’s SustiNet Patient-Centered Medical Home committee meeting we heard about medical home initiatives in the two programs that will form the basis of SustiNet, the state employee plan and Medicaid/HUSKY. Tom Woodruff of the Comptroller’s Office presented on the state employee plan’s medical home initiative. The state will be moving to a self-insured ASO model as of July 1st and will include a very large pilot medical home program to start early next year; the state has chosen Anthem and United as administrators for the plan. They will partner with ProHealth Physicians to provide NCQA Level II or higher medical homes to their all 350,000 patients, including at least 40,000 state employee plan members, early next year. ProHealth Physicians is a large primary care practice with over 250 providers at 74 sites across the state. The Committee then heard about PCCM, the HUSKY medical home initiative, and the barriers placed by DSS on consumers and providers struggling to access care in the program. The committee then began considering questions and potential recommendations. The consensus of the group was to be as inclusive as possible in defining medical homes, but that payment must be tied to concrete standards. NCQA certification was identified as the goal and payment standard, with recognition for practices reaching milestones on the road to certification. The committee recognized the need for significant support to help practices reach that goal. Recognizing the lack of Medicaid providers, lower payment levels, and approximately 150,000 new CT Medicaid members in 2014 under federal health reform, that the committee does not want to jeopardize or undermine those providers in transitioning to a new system of care in which every state resident has access to a medical home. The committee will continue the discussion, focusing on national health reform, at our next meeting this Wednesday April 28th 10am to noon. The committee will be meeting at the Dept. of Transportation, Conference Room B, 2800 Berlin Turnpike in Newington.
Ellen Andrews

Sunday, April 25, 2010

Predictably Irrational author comes to CT

Dan Ariely, author of Predictably Irrational: The Hidden Forces That Shape our Decisions, spoke at Wednesday’s Donaghue Foundation annual meeting in Farmington. How choices are framed has a lot to do with how we respond. For example, a group of people were asked to name either 3 or 10 reasons they love their significant other. They were then asked to rate how much they love that person. You’d think the people who came up with 10 reasons would be more in love, but you’d be wrong. Apparently, it is hard to come up with 10 reasons you love someone, according to Ariely. People reason that if they have so much trouble coming up with 10 reasons, how much could they love them. Today’s Predictably Irrational blog relates the link between people in powerful positions and hypocrisy – judging subordinates more harshly than themselves in moral situations. However that hypocrisy evaporates, even reverses, when the powerful regard their position as illegitimate or undeserved – in that case, they hold themselves to higher standards than others. He related the research back to lessons for policymakers who want to improve people’s health – don’t overwhelm with information, provide aid, consider how you present alternatives, and understand the role of emotion. Fascinating stuff.
Ellen Andrews

Wednesday, April 21, 2010

The Treatment Trap author visits CT

I had already ordered her book online after reading a review in Health Affairs when I got an invitation to hear Rosemary Gibson, author of the Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health and What You Can Do to Prevent It. Her visit yesterday was hosted by AARP-CT and the CT Center for Patient Safety. Ms. Gibson highlighted the problem of medical overtreatment and how it harms our health. 32% of Americans report getting treatment they didn’t need. She related at least a dozen stories of patients whose health was compromised by getting too much care. An accountant received joint replacement surgery in his toe for arthritis, but his pain got worse until he was eventually restricted to a wheelchair. He had the joint replacement removed saying he could live with arthritis, but not with the replacement. A healthy woman was told she needed heart surgery and overheard the doctor say to a nurse, “We’re under pressure to get more patients. We’re only at 9 a day now and we need to get to 14 to make this place pay for itself.” She got a second opinion and avoided surgery. A RAND study found that 1 in 3 angiograms were unnecessary. Ms. Gibson asserts that avoiding overtreatment and its costs would more than fund all the care needed by America’s uninsured.
Ellen Andrews

Tuesday, April 20, 2010

Smoking bans slowly move to private clubs

The 2003 state law prohibiting smoking in restaurants and bars exempted private clubs. In 2007 the Supreme Court upheld the law in a challenge filed by a few bar owners. When the law passed, many believed that private clubs would become more popular as sanctuaries for smokers. However, according to yesterday’s Hartford Courant, a growing number of clubs, in CT and nationally, have voluntarily implemented smoking bans. The clubs are responding to members’ preferences.
Ellen Andrews

Monday, April 19, 2010

Myths and truths in national health reform

There has been a lot of misinformation about the new national health reform bill and what it will mean for Connecticut. Rumors include 16,500 new armed IRS agents to enforce the individual mandate, Medicare cuts, skyrocketing premiums and budget deficits. We’ve collected twenty of them, some true and some false, from calls to CT’s Congressional delegation and to us. We’ve checked the facts in our latest policymaker issue brief.

Friday, April 16, 2010

BHP initiative reduces hospital delay days by 22% in two years

At Wednesday’s Behavioral Health Partnership Oversight Council meeting, Value Options, DCF, DSS and eight hospitals announced remarkable progress in reducing the number of HUSKY children in discharge delay at hospitals, ready to leave but waiting for appropriate outpatient behavioral health care. The initiative aligned performance incentives across providers and administrators. During 2007, before the initiative, there were 43,493 child-days in delay. By 2009 delay days were down 22% to 33,744. During those same years, enrollment in the program grew by 8% and total admissions rose by 19%. Over the two years the percent of discharges that were delayed dropped by 32% and the average length of delay dropped by 58%. Delay status is not the only indicator that improved, acute length of stay was down 14%. Value Options credited staff at all the agencies and hospitals with focusing attention and hard work on ensuring that every child has an appropriate place to get care. The reductions in delay status were not accompanied by any change in readmission rates suggesting that the movement to outpatient care was effective and permanent for most cases. Congratulations to all involved for their dedication to make the system work for kids.
Ellen Andrews

Wednesday, April 14, 2010

House passes budget mitigation plan

Yesterday the House approved a plan to address the $371 million deficit in this year’s state budget. The Senate will vote on the plan today and the Governor is expected to sign it. The bill includes freezing subsidized enrollments in the Charter Oak program at the end of this month; consumers paying full cost will still be enrolled and people enrolled before May 1st will continue to receive premium subsidies. The bill also increases copays on children in the HUSKY Part B program, cuts over the counter drugs, and limits eyeglasses to one per year for all programs. The bill also makes changes to the definition of medical necessity for services in all programs.
Ellen Andrews

Tuesday, April 13, 2010

Foundation working to get health reform truth out

The Universal Health Care Foundation of CT announced yesterday a public awareness campaign to help people in CT understand the benefits of national and state health care reforms and to counter substantial misinformation efforts by opponents of reform. Speakers pointed out that 150 volunteers have been working for months researching and designing CT’s health system redesign as part of the state’s SustiNet program planning. Speakers at the announcement included Stan Dorn of the Urban Institute, Kathy Lewis, Executive Director of the CT Public Health Policy Institute, John Olson, AFL-CIO President, Brenda Kelley, state AARP Director, John McNally a consumer with a pre-existing condition, Fred McKinney President of the Greater New England Minority Supplier Development Council, and Frances Padilla, Acting Director of the Foundation. For coverage of the event, click here and here.
Ellen Andrews

Sunday, April 11, 2010

eHealthCT wins federal grant for health IT training

This week eHealthConnecticut announced their application for $5.7 million in federal stimulus money was approved. The funding is to create a training center for CT health care providers implementing electronic health records. eHealthCT joins a network of sixty similar training centers across the nation. Electronic health records are a long overdue innovation in medicine that will improve patient safety and the quality of care while reducing costs and paperwork. But it is critical that systems are used effectively and that requires training. Most practices in CT are small and don’t have the resources to implement electronic health records. eHealthCT’s initial training will focus on CT primary care providers starting later this spring, but eventually will expand to other specialties.
Ellen Andrews

Medicaid Managed Care Council update

Friday’s Council meeting was relatively uneventful. We started with a wonderful outreach video by CT’s Healthy Start programs describing the important work they do supporting at-risk pregnant women and connecting them to the care they need to ensure healthy births. (Advocates think it would be a good idea to start every Council meeting with babies – it makes it hard to be grumpy.) We then heard about the challenges of keeping families enrolled in HUSKY. A study by CT Voices for Children found that 141,000 people came into HUSKY in 2006 and 2007, but total enrollment grew by only 11,000. However they were unable to determine if people left because they found other coverage or if they became uninsured. DSS noted that they have implemented several improvements to the eligibility system since 2007. PCCM/HSUKY Primary Care enrollment is up to 359 clients and 237 providers. DSS has also agreed with advocates’ concerns and will ask CMS for permission to delay the PCCM evaluation until 2011 when it is hoped enrollment will be high enough to make the study meaningful. DSS described their plans to move all SAGA recipients into Medicaid (as of April 1st) under a new option passed in the recent national health reform act. It is expected that the option will save CT $53 million over the next 15 months. CT is the first in the nation to apply under this provision. However we are eligible because the state never acted on multiple directives from the General Assembly to apply for a waiver to cover SAGA – most other New England states have been covering childless adults under a Medicaid waiver for years. New enrollment numbers from ACS show that about half of all Charter Oak members are over age 50 and that older members have higher incomes than younger members – over half of members paying the full, unsubsidized Charter Oak premium are over age 50.
Ellen Andrews

Wednesday, April 7, 2010

Federal health reform and CT small businesses seminar

The Universal Health Care Foundation of CT is hosting a free seminar for small businesses on national health care reform Monday, April 12th 7:45 to 9:30am in Meriden. A panel of experts will describe the new federal law and CT’s SustiNet plan and how they will impact small businesses in CT including how to get tax credits, employer contributions, health insurance exchanges and benefits for self-employed business owners. Space is limited so reservations are required. Click here to sign up.

Tuesday, April 6, 2010

High risk pools in federal health reform

Questions are surfacing about the federal reform bill’s provision to create a high risk pool will be implemented. The pool is meant to provide temporary coverage for people locked out of the insurance market until the bill’s pre-existing condition ban for adults becomes effective in 2014. People who need high risk pools include those timing out of COBRA, those turned down for individual coverage, people who don’t have access to COBRA because their former employer went out of business, among others. CT has had a high risk pool since 1975 but it is very small (2,336 as of 12/31/08). We have explored the pool as an option for many clients who call our helpline, but it has never been an affordable option. CT state law sets the rates charged in the pool to between 150 and 200% of standard market rates, which are already too high for many. Thirty five states have high risk pools, most of which also don’t meet the growing need. But MN’s high risk pool has much higher enrollment for a variety of reasons. One of the most important is that MN’s pool rates are between 101 and 125% of standard market rates by law. A recent blog from Health Affairs outlines other important provisions that need to be included in the federal pool if it will be useful to more than a handful of people. Building the high risk pool is only one of many devils in the details of health reform. Advocates from ME, MA and VT have been through this and emphasize that passing reform is only step 1A; the hard work starts now.
Ellen Andrews

Friday, April 2, 2010

New OLR report finds PCCM succeeds, saves money in other states

A new report by the legislative Office of Legislative Research outlines enrollment, savings and impact on hospital visits in states that have implemented Primary Care Case Management (PCCM). PCCM is a different way of running Medicaid managed care plans (HUSKY in CT) used in thirty states. PCCM does not involve HMOs, but rather rests on the medical home model. Consumers choose a primary care provider to deliver and coordinate their care. Researchers found that PCCM enrollment is growing in all but one state. They also found that, if implemented thoughtfully, PCCM can generate significant savings for states. A study found that the cost of PA’s PCCM program was almost half the cost of the HMO program operating in the same counties. Impact on hospital care has been mixed. Researchers offer that successful states target assistance to people with health risks such as asthma, diabetes and congestive heart failure. Implementation of CT’s PCCM program has struggled; DSS in the current administration has not been supportive of the program.
Ellen Andrews

Thursday, April 1, 2010

April Webquiz – CT preventable hospitalizations

Test your knowledge of CT hospitalizations that could have been prevented with access to primary care. Take the April CT Health Policy Webquiz.