Monday, December 24, 2012
Effective January 1st, the Affordable Care Act includes a payment increase for Medicaid primary care providers bringing rates up to Medicare levels. The federal government is reimbursing states 100% of the cost of the rate increase for two years. While nationally that averages a 73% rate increase, CT providers will see only 41% increases in primary care rates, according to estimates. A survey by the Kaiser Family Foundation found that CT physician Medicaid rates are already close to Medicare levels. This confirms previous studies which also found that CT Medicaid rates are among the highest in the US. Despite these higher rates, CT is forth lowest among states in physician Medicaid participation. A study by the CT Health Policy Project found that a 2008 significant rate increase had no impact on CT physicians’ likelihood to participate in Medicaid. Barriers included billing issues, delayed reimbursement, administrative hassles, poor communications and poor provider relations. Fortunately, since that study was published last year, DSS has systematically worked to address all the recommendations.
Friday, December 21, 2012
At yesterday’s CT Health Insurance Exchange meeting we learned about an attempt by Exchange staff and the Insurance Dept. to reduce the Essential Health Benefit Package that had been agreed to earlier this year in a contentious but inclusive and public process. Like the last process that rejected active purchasing, this process happened in evening conference calls not open to the public in a very short time frame. This time, however, providers and advocates on the committees voted down the benefit package erosion (active purchasing was not part of the reconsideration) and the staff finally agreed to pull the proposal from the Board committee agenda yesterday. However at the meeting, staff stated that they plan to lobby the fed.s to let them re-consider, and lower, the agreed-upon essential benefit package. The issue is CT mandates for coverage in state law – whether they cost or save money in premiums and how much. A public commenter noted that affordability is very important, but eroding mandates may not work to keep costs down. Active purchasing is proven to reduce costs, but the Board and staff have rejected that proven tool and have indicated no interest in re-visiting that decision. Other news included a strong theme of affordability in the Healthy Chat public events. Staff noted that many people were new faces to health care, not traditional activists. They also noted that people had “done their homework” and were very sophisticated in their understanding of active purchasing and its potential for affordability. The staff is still working on the details of the health plan benefit standards and benefit design, how plans will be rated for innovation and plans for quality monitoring. Advocates will be watching this process carefully for further standards that erode consumer protections, if there is any transparency or opportunities for meaningful public input.
Thursday, December 20, 2012
The state budget is facing a billion deficit next fiscal year. We have 31 ways to both save money and improve quality and access to care. The options focus on payment reform, re-engineering care delivery, engaging consumers, quality reforms and prevention, learning from experience, removing waste and excessive administration. In 2010 we only had fifteen ways to save. One of those, shifting HUSKY from capitated managed care to self-insured, coordinated care. We recently learned that the shift is saving the state millions.
Wednesday, December 19, 2012
A story in today’s NY Times describes mounting evidence of compassion and dedication to caring for the ill among human communities living thousands of years ago. Multiple burials provide evidence of years of care, in some cases it would have likely been around the clock care, for people with disabilities and illnesses. The provision of that care would likely have cost the community dearly in scarce resources. One woman buried on the Arabian Peninsula probably suffering from polio and unable to walk, showed evidence of severe dental disease, unusual for someone of her age. Experts believe she may have been fed many sweet dates to make her happy. It’s nice to know we are hard wired to care for those who need it.
Monday, December 17, 2012
The CT Health Insurance Exchange staff’s presentation to the Medicaid Council Friday described the “opportunity” under the Affordable Care Act for significant state savings by shifting HUSKY parents into the exchange. They described subsidized premiums ($45 to $243/month), some caps on out of pocket costs, and a list of covered services. However, with questioning from legislators, providers and advocates, the rest of the story emerged. Now those low-income, working HUSKY families (this year $31,809 to $42,643 for a family of four) pay no premiums and benefit from a comprehensive benefit package covering important services that the exchange does not cover or charges more for. A legislator confirmed that the ACA does not require the state to cut HUSKY parents off the program and that the state always had that “opportunity”. It was also noted by a questioner that, many low-income working families are just getting by on what they make and paying even subsidized premiums is not realistic; their alternative, if HUSKY is cut, is to pay a $95 tax penalty the next April that will be very difficult to implement in any case. So for policymakers the “opportunity” is to cut people off HUSKY, save the state some funds, but force tens of thousands of CT working parents into paying much higher costs or into uninsurance.
Luckily there is another ACA option – the Basic Health Plan -- that saves the state millions and gives those families, and thousands more, comprehensive coverage with little or no cost. Several economists have crunched the numbers and found that available federal subsidies would more than cover the costs of care for the population with funds left over to raise provider rates. When asked about the BHP option they had not included in their presentation, exchange staff answered that the feds have not yet released regulations on the option and that they have heard that some other states are not planning to use the option.In other news, we learned that some primary care Medicaid providers who do not work under the direct supervision of a physician may not qualify for the ACA increase in rates to Medicare levels, to become effective Jan. 1, 2013. We were also given information on January 1st increases in Charter Oak and unsubsidized HUSKY B premiums. Charter Oak rates are increasing 32% for all -- to $589/month for people who enrolled after June 2010. HUSKY B rates are increasing 16% from $270.36 to $314/month for families who do not receive subsidies (over 300% FPL). We will receive new enrollment numbers next month to know how many people these rates affect.
We also heard from Commissioner Bremby about strong measures his office has taken about problems in processing applications and voter registrations at the Hartford DSS office. He described plans to upgrade enrollment and other systems as well as enhanced monitoring that will help ensure this never happens again.
Friday, December 14, 2012
As advocates predicted, it appears the shift from capitated managed care to self-insurance saved the HUSKY Part B program $4 million in lower medical costs in the first six months. (The numbers are still tentative, as there may be some outstanding claims from the first half of the year, but they are not expected to be large). January 1st of this year the state moved the entire HUSKY program out of capitated HMOs and into a self-funded model with care coordination. At this week’s PCMH committee of the Medicaid Council, DSS reported that spending in the HUSKY B program was down significantly after the switch. The switch was only effective for six months of the latest fiscal year (FY12) but even so, medical service spending was down by $4 million over the previous year. HUSKY B spending in FY 11 was $35 million. If the $4 million savings continues for the rest of 2012, savings would be 23%. Enrollment varied by only 2% between the years. HUSKY Part A savings from the switch were not available as that spending is included in the much larger Medicaid line item.
Tuesday, December 11, 2012
Along with six other states, CT’s health insurance exchange received approval yesterday from the federal agency providing funding. CT was among the first six states to apply to HHS for approval – 14 states have applied to date. No state’s application has been denied. CT’s exchange has been criticized for their plan to accept any willing plan and refusing to negotiate with insurers to control costs and reduce consumer premiums. CT’s exchange also voted not to conduct a secret shopper survey to monitor whether people who purchase their insurance plans can find a provider. The exchange has also been criticized for having no independent consumer Board members, having Board members with close ties to the insurance industry and for members with insurance company investments.
Monday, December 10, 2012
Frank Morocco, a Buffalo area ex-convict, intentionally got himself arrested for shoplifting two weeks ago. He stole $23 worth of miscellaneous items, making sure he was seen by store employees and other customers. He stated that he was desperate and saw no other way to get treatment for his cancer. He suffers from a rare form of leukemia for which he received great care while in prison. But since his release last December he has been unable to afford private insurance and his employer does not offer benefits. With assistance from his probation officer he applied for Medicaid and disability coverage, but was denied. He has incurred $5,000 in medical debt in the last year. The Buffalo Times article notes other cases of ex-convicts getting arrested for health care.
Friday, December 7, 2012
Yesterday’s New England Comparative Effectiveness Public Advisory Council (CEPAC) meeting centered on sleep apnea. Too many new (and expensive) treatments and technologies are adopted and gain wide use without a careful analysis of their effectiveness in treating the condition and/or cost effectiveness compared to other options. CEPAC’s mission is to produce actionable information to aid regional policymakers in the medical policy decision-making process. CEPAC includes researchers, clinicians and patient advocates from across the New England states who, twice a year, drill down into the research around treatment options for a condition, evaluate effectiveness and costs, and vote on whether there is sufficient evidence to recommend each treatment’s use. About 10 to 20% of middle-age and older adults suffer from sleep apnea, with regular bouts of difficulty breathing through the night. And rates of the condition are rising, driven in part by rising obesity rates. Studies have found that sleep apnea patients have higher rates of health care use, including more and longer hospital stays, and higher health care costs before diagnosis than after. Sleep apnea has been linked to lower productivity among workers, higher motor vehicle crash rates, and cardiovascular disease. After long discussion of the research and impact in the real world, the group voted on effective treatments (home sleep studies) and treatments (urging more research on weight loss support). Studies like these are critical to the double goal of both improving the quality of care and controlling costs. We have to find more opportunities like this if we are going to fix our broken health care system.
Tuesday, December 4, 2012
Test your knowledge of DSS spending on medical assistance programs, most notably Medicaid. Take the December CT Health Policy Project webquiz.
Monday, December 3, 2012
Small grants, engaging an army of trusted community messengers, ubiquitous marketing, and robust monitoring will be critical to enrolling the estimated 130,000 newly eligible CT Medicaid members in January 2014, according to a report by the CT Health Policy Project. Best opportunities for outreach include providers, current HUSKY members, faith-based communities, connecting with employers and other state programs, targeting life transitions, improving application and enrollment processes, and thanking outreach partners. It will require strong, concerted efforts to overcome the program’s stigma and other barriers to enrollment. The report draws on the experience of community organizers, consumer advocates who worked on HUSKY outreach, providers that care for CT’s uninsured patients, and lessons from other states. While aimed at Medicaid, many of the report’s findings also apply to the new CT Health Insurance Exchange.