Wednesday, March 26, 2014
DPH has been working for over a year to develop CT’s State Health Assessment and Health Improvement Plan -- a comprehensive plan to identify health challenges in CT, set priorities and create an action plan to address them. The process has been collaborative, inclusive, transparent and through. The plan focused on promoting health equity, ensuring action steps are feasible, effective and designed to engage and inspire communities. The plan is evidence-based with a focus on systems change. The plan set seven final priority issues with dozens of measurable benchmarks under each. Now comes the hard part – implementing the plan.
Yesterday’s first meeting of the MAPOC Complex Care Committee underservice workgroup was very productive. (We need a shorter name). The committee is charged with designing a framework for monitoring under service in CT’s plan for health neighborhoods to cover people eligible for both Medicare and Medicaid. Advocates have raised concerns that a shared savings payment model may lead, even unintentionally, to people missing out on necessary care. The workgroup includes over half consumers and advocates, in addition to providers, academics and state agency representatives. The committee reviewed a survey to collect input for the monitoring system. The committee also plans to hear from NCQA accredited Accountable Care Organizations (ACOs), CT ACOs, search the literature, check with other states, and survey national groups.
Not much happened at Monday’s SIM steering committee meeting. The lists of recommended workgroup members from both the SIM personnel committee and the Consumer Advisory Board were distributed but not voted on. There was dispute over the number of physicians on workgroups centered on a recommendation from physician groups to add significantly to their numbers. Arguments were made that a wide variety of physician specialties must be represented on each workgroup as they have unique interests. Concerns were raised that this would violate the balance between interested stakeholders. Observers found this an ironic contrast with earlier discussions about types of “real” consumers vs. advocates. There were also objections raised to language in the Equity and Access group charter that they would only monitor for “intentional” underservice. In legal settings “intentional” requires an extremely high standard of proof. Advocates are concerned that requiring proof of intention may make any monitoring system ineffective. The group responded to the independent consumer advocates’ latest letter with concerns about workgroup composition denying that our solicited input was not given consideration, advocates are not excluded from membership, references to expectations that members must agree to support final workgroup recommendations were deleted, and workgroups will not meet during usual business hours but they will circulate meeting times and locations. There was no commitment to post materials for reasonable public review before meetings, to take public comment at workgroup meetings, or to explicitly state that workgroup members are free to follow their best judgment about recommendations.
Monday, March 17, 2014
We’re very excited to launch the updated CT Health Policy Project’s website. The site has been cleaned up, optimized and reorganized. Links to social media, our blog and listserv sign up are easy to find at the top of the page. It should be easier to find what you are looking for now. If you don’t find it or a link is broken, let us know at firstname.lastname@example.org.
Friday, March 14, 2014
Today’s Medicaid Council meeting focused on continuing problems with enrollment and recommendations to reduce Medicaid ED use. In response to a letter from Council members, we learned that 63% of calls to the DSS Benefits Center from August through December 2013 were dropped – people waited 17.5 minutes on average before hanging up. Things are getting better however – the backlog of applications is coming down and the average wait time to get a call answered has dropped from 90 to 25 minutes. DSS shared operational improvements they expect will continue to improve customer service and they plan to implement a “call back” option. They also promised to include these measures in the monthly dashboard on program performance starting next month.
The Council also heard from the legislative Program Review & Investigations Committee on their study of ED use by Medicaid consumers and shared their recommendations. ED use consumes only 4% of the entire Medicaid budget, but Medicaid members are twice as likely as other state residents to visit an ED. While Medicaid ED visits dropped between 2008 and 2012, costs per visit rose. There are a small number of Medicaid consumers who are frequent ED visitors, often seeking prescriptions. The researchers made several recommendations and DSS responded that they are implementing some of them. DSS also stated that they will include ED metrics in the monthly dashboard.
Wednesday, March 12, 2014
Monday a group of 16 independent consumer advocates delivered a letter to the SIM steering committee voicing deep concerns about the implementation development process. Advocates have voiced concerns about the SIM process from the beginning, offering constructive options that support the goals of improving quality and access to care while controlling costs. Concerns voiced in the latest letter include SIM staff soliciting input from consumers and advocates that was not communicated to or considered by the steering committee, a continuing lack of transparency, and a preference to exclude independent consumer advocates with policy expertise from implementation workgroups. Those workgroups will consider complex questions and develop the critically important details of the plan – effective, independent consumer input is essential to success. Advocates are concerned that conveneing the committees has been delayed, including the critical Equity and Access Committee that is tasked with developing a monitoring system to ensure consumers are not inappropriately denied necessary services under SIM’s new payment model incentives. In yesterday’s Health Care Cabinet meeting we learned that SIM will be going forward with their current plans; the consumer letter was not discussed.
In the Cabinet meeting we also confirmed that critical public health priorities were added to the SIM plan at the last minute to improve CT’s chances of getting a federal grant. Consumer advocates have repeatedly objected to re-making CT health reform priorities for the purpose of securing a grant for hiring state agency staff and consultants. CT priorities should be set here in CT by CT stakeholders in thoughtful consensus processes which are ongoing across our state. We should only pursue funding opportunities that already fit with CT’s priorities, not the other way around. We also learned that they intend to develop a common set of standards across all CT payment sources for medical homes to be eligible for shared savings payments. They are moving ahead with plans to develop a survey of CT providers to inform development of those standards. Mirroring advocates’ questions, concerns were also raised about how traditionally public health functions and consumer choice will be protected in the integration into a medical model of care.
In yesterday’s Health Care Cabinet meeting’s insurance exchange report we learned that staff there welcome complaints as windows into their system’s flaws. They understand that if they hear one complaint, it usually means there are 50 other consumers with the same problem who didn’t call. They see these as opportunities to fix problems and learn. Refreshing. The call center abandoned call rate is down and the Spanish language site has received about 1,000 applications since it opened a few weeks ago. However, because of technical issues in the exchange, they still can’t answer important questions about how many of the 60,000 people who have enrolled in insurance coverage were previously uninsured. It was suggested that the exchange commission a survey by an outside, credible group that will vigorously protect privacy to answer that question and more. In a future meeting, the Cabinet will get more information on plans to sell an “exchange in a box” to other states.
In contrast, the SIM update was disappointing.
Monday, March 10, 2014
Join us this Wednesday March 12th, 5pm at Harkness Auditorium, 333 Cedar Street, in New Haven for a panel on the changing health care landscape. Panelists include Ben Barnes, OPM Secretary, Lisa D’Abrosca, AFT Local 5049 at L&M Hospital, Paul Taheri, Yale Medical Group, Joseph Neff, Raleigh News & Observer, and George Jepsen, CT Attorney General. Rev. Tracy Johnson Russell, Vicar at St. Andrew’s Episcopal Church in New Haven, will moderate. The forum is co-sponsored by Local 34 and 35 Unite Here, Universal Health Care Fndn of CT, CT AFL-CIO, and the CT Health Policy Project.
Friday, March 7, 2014
Final results from a study confirm that, contrary to predictions, CT’s 2011 paid sick leave law did not cause an undue burden on businesses or the state’s economy. Confirming preliminary results, the study found that the law has brought important relief to tens of thousands of workers, predominantly in health/education/social services, hospitality and retail establishments, and especially part-time and nonunion workers. Few affected businesses reported abuses of the law – on average workers used less than half the sick days available to them, and one in three workers didn’t use any sick days in the last year. Many employers reported improved morale and reductions in the spread of illness. 77% of affected employers surveyed now support the law. One employer who had actively opposed the legislation commented that the new law “doesn’t even hit the radar screen.”
Thursday, March 6, 2014
I don’t believe CEPAC has addressed as sensitive an issue as supplemental screening for dense breast tissue. We heard very moving public testimony from survivors and advocates at the December meeting. About half of women have dense breast tissue and face the questions of determining their risks, whether to have supplemental screening, and if so, what screening to get. An important product of these meetings is the final action guide for patients, clinicians, payers and policymakers – now available for this issue. The action guide ensures that the science doesn’t just sit on a shelf but is translated into real tools to make better decisions. The consumer guide with 5 Questions for Women with Dense Breast Tissue to Ask their Doctor is available in English and Spanish.
Wednesday, March 5, 2014
In the first survey since the Affordable Care Act’s coverage expansions became effective, state health thoughtleaders’ perception of our state’s progress hasn’t changed much. CT again earned a C+ on health reform, and interestingly a somewhat lower C grade for effort in the latest survey. Among issue areas, CT continues to earn better marks for Medicaid, patient-centered medical homes and the health insurance exchange. The lowest marks are for health information technology, engaging consumers in policymaking, and payment reform/quality improvement. Thoughtleaders’ suggestions to improve progress are to engage consumers, smarter policymaking and leadership, and to improve communication and public education. The survey is part of the CT Health Reform Dashboard.
Tuesday, March 4, 2014
Monday, March 3, 2014
In the latest Gallup Well-Being Index CT dropped to 31st among states in 2013; we were in pretty good shape at 16th the year before. The Index includes typical measures such as rates of obesity, smoking, depression and eating produce, but also includes questions about other, less well measured but critical well-being indicators such as having safe places to exercise and learning new and interesting things daily. CT scores behind VT, MA, NH and ME in New England, but ahead of RI. By domain, CT’s best performance is in Healthy Behaviors (9th); our worst domain is Work Environment (49th). CT’s drop of 15 ranks from 2012 to 2013 was the second worst among states.