Medical Society pilot guides practices to PCMH recognition

A pilot training and support program has helped 13 small CT primary care practices, with 105 physicians plus clinical and administrative staff, achieve NCQA patient-centered medical home (PCMH) recognition. Six other practices have applications pending. Those practices join the growing list of 600 recognized PCMH providers in CT as first adopters of this important delivery system innovation. The state medical society and the CSMS-IPA sponsored the pilot program; they intend to expand the program to more providers in CT. The PCMH model relies on team-based care and care coordination to help consumers keep themselves well. The model has been associated with improved health outcomes while holding down costs.
Ellen Andrews

Bill adding consumer and small business voices to Exchange Board passes Insurance Committee unanimously

Earlier today the legislature’s Insurance Committee unanimously passed HB-5013 with substitute language. The new bill language adds one consumer and one small business representative to the CT Health Insurance Exchange Board and makes the State Health Care Advocate a voting member. The bill will be effective upon passage. The bipartisan bill partially addresses concerns raised by advocates, small businesses, editorial boards and others about the lack of consumer and small business voices on the Exchange. The bill now goes to the House floor.

Pooling bill moves forward

Friday OPM approved the first step in allowing municipalities to join the state employee health care pool. The option was created in law last year but has been held up by concerns about cost. Changes to the proposed rules allowed the program to move ahead. Proponents argue that the law will provide higher value, lower cost health coverage options for municipalities and their workers. Enrollment is scheduled to begin next Jan. 1st.

Advocates disrupt insurance exchange meeting

Yesterday, advocates spoke out during the CT Health Insurance Exchange Board meeting to protest the lack of consumer voices on the Board. The Board has been widely criticized for lacking any voting consumer members, despite federal regulations that call for consumers to comprise a majority of voting members. Several members of the Board called for more transparency, better communication and regular opportunities for public comment. Jeanette DeJesus, Special Advisor to the Governor on Health Reform, expressed support for the protestors. The Board is quickly staffing up and expects to have most of the important operational pieces in place by the next meeting scheduled for March 15th. Advocates have called for legislation, effective immediately, to add consumer and small business votes to the Board before the next meeting to ensure stakeholder input into those critical decisions. CT is among a small minority of states moving this quickly to establish exchanges; most states have not yet decided whether to run their exchange themselves or let the federal government do it. The Board has hired a public relations firm to collect input from stakeholder groups including consumers, brokers, small businesses, insurers and providers. The consultants will be holding meetings across the state in the next week. Those meetings were to be invitation-only but Board members at the meeting insisted in opening them to the public.
Ellen Andrews

Insurance public hearing to add consumers to insurance exchange board

Today, the Insurance and Real Estate Committee held a public hearing on HB-5013 – a very weak bill that would have added only one, narrowly defined consumer advocate and one small business person to the exchange but not before July 1st. It also would have given the State Health Care Advocate a vote But again not until July 1st – safely after all the important decisions have been made. The Board has been criticized for having three members representing insurance interests and no voting consumer representatives. The Board is now choosing a CEO and a team of other senior management (at eye-popping salaries) and considering whether to cede the small business exchange toCBIA. Many people, including consumers, advocates, brokers, small businesses, providers and labor representatives, spoke to the need for at least two consumer reps and two more small business people on the Board. Speakers also emphasized that the CEO being hired should be independent of the insurance industry, to help build some credibility for the exchange among the people who will rely on it for affordable coverage in 2014 when the individual mandate becomes effective. Speakers also strongly opposed allowing CBIA to run any part of the exchange. CBIA has lobbied against state and national reform in the past; handing the exchange to opponents of reform invites failure. Speakers also asked for the legislature to clarify that the Ethics Commission enforces conflict of interest provisions in the original law, specifically excluding Board members affiliated with insurance companies.
Ellen Andrews

Medicaid Council update

Friday’s Medicaid Council meeting featured DSS Commissioner Bremby’s comprehensive, long overdue client services system overhaul. To say the current systems are outdated is a massive understatement – fragmented, ancient, paper-based, and under-resourced. DSS’ plans for the future are as good as the current system is bad. Phone and online systems will be integrated, information for clients will be consistent and easily available, processes will respect how people use systems (not the other way around), clients will be able to pre-screen for eligibility saving everyone a lot of time. Staff are getting training on courtesy, responsiveness and keeping promises. We still need to hear about privacy protections, but this is a wonderful thing.

DSS then described their evolving model to redesign how they pay for the care of possibly 50,000 people eligible for both Medicare and Medicaid. They are proposing to build on the ASO model’s care management services available now to every Medicaid member with data integration and advanced analytics, intensive care management to coordinate between the two programs, and other consultative services such as pharmacy, disease educators and nutritionists, if CMS allows. They are also planning to foster the development of three to five medical neighborhoods, loose affiliations/networks of local providers each serving about 5,000 people offering team-based care individually matched to the patient’s needs. DSS has proposed to split any savings with the feds 50/50. DSS intends to develop strong quality monitoring systems to ensure that needed care is not inappropriately denied. The really big question, how the savings will be shared with providers -- primary care and their neighbors, remains to be decided. This could be a quantum shift improving the lives of fragile patients, or a complete disaster. It is unlikely that the first iteration will work perfectly – there will be winners and losers, financially and in quality. It will be up to policymakers to actively monitor those imperfections, and have the will to make unpopular changes that may not benefit large, powerful institutional providers. We’ll see.
Ellen Andrews

Governor’s proposed budget adjustments – one major health change

The Governor’s proposals to adjust the current biennial budget include changes to LIA (the former SAGA program). When SAGA was merged into Medicaid in 2010, creating LIA, the asset limit of $1,000 was removed. Since that time enrollment has grown significantly due in part to removing the asset limit (the economy doubtless had something to do with it as well). Because program costs are now matched by the federal government, significant new revenues came into the General Fund. While enrollment growth has moderated, the Governor is proposing re-imposing a more generous $25,000 asset limit, and counting family income for applicants under age 26 living with a parent or claimed as a dependent for taxes. He has also proposed unspecified limits on medical services. The changes would save $22.5 million in the next fiscal year. In 2014, those applicants will become eligible for Medicaid anyway under national reform.

Other proposals include changes to who can administer medications, expanding childhood vaccinations, cost of living increases for private providers, expanding Money Follows the Person, among others.
Ellen Andrews

Yalies oppose federal needle exchange program cutback

Yesterday, a group of Yale students, the Student Global Health and AIDS campaign, protested the recent Congressional reversal of a 2009 Obama administration decision to fund needle exchange programs. The programs are an important, very effective public health measure preventing the spread of disease including HIV/AIDS.

CT Health Reform Dashboard -- 10.4% progress to date

How is CT doing reforming our broken health system? Are we making smart choices? Are we taking advantage of opportunities? Having trouble keeping up with the many moving parts? Visit our CT Health Reform Dashboard at www.cthealthreform.org

February web quiz – Insurance exchange planning report

Test your knowledge of CT’s health insurance exchange planning. Take the February CT Health Policy Webquiz.

Hospital errors rising, state investigations dropping

An analysis by the CT Health I-Team of DPH hospital adverse event reports finds that the number of errors has risen steadily over the last five years. The same investigation finds that DPH investigations of serious medical errors in hospitals have been rare and the numbers are dropping. Of 17 patients who reportedly died or were seriously injured during surgery in 2010, DPH investigated only six. For the first time, hospitals are named individually in DPH’s report. Hospitals with the highest rates of reported errors were New Milford, St. Raphael’s, Sharon, Johnson Memorial and Backus, in that order. It is important to note that the data is based on self-reporting; DPH does not audit hospitals’ error reports (or lack of reports). A national study found that voluntary reporting systems miss 90% of errors.
Ellen Andrews