Budget implementer makes significant changes

Early this morning the House passed HB-1502 – the 686-page bill that describes how the state FY 2016-2018 budget passed four weeks ago is to be implemented. But the bill also makes numerous substantive changes to the original budget. In addition to tax reductions for large businesses, the bill includes the implementer language to cut coverage for 23,700 HUSKY parents, preserves funding to community health centers for future Medicaid shared savings changes, more funding for nursing home employees heavily weighted toward unionized workers, allows DSS to pay nursing homes based on patient acuity, delays some mental health coverage changes, removes property tax exemptions for new off-campus properties bought by Yale-New Haven and Hartford Hospital health systems, allows limited provider lists and cost-based hospital rates for workers compensation care, concussion notices for athletes, an ambulatory surgery center tax, expands coverage for autism treatment, changes how hospital Medicaid rates are structured, changes to Medicaid case management services, reforms Medicaid provider auditing, allows UConn grad students to join the Partnership Plan for health coverage, insurance coverage for certain off-label use of prescription drugs, expands reporting of impaired health care professionals, makes changes to the medical marijuana program, and creates new Men’s Health license plates.

The bill also includes a study by DSS and DPH due next June of community-based health care service capacity and high-utilizers of emergency dept.s.

Early numbers show CT uninsured rate dropped only 2.1% last year

A new CDC survey of early uninsured numbers by state, finds that CT’s uninsured rate fell from 9.1% in 2013 to 7.0% last year, the first year of coverage expansions under the Affordable Care Act. The US rate dropped to 11.5% from 14.4% in 2013. For some reason, CT’s drop was more consistent with states that did not expand Medicaid (2.1% average drop) rather than the 5.1% average drop in uninsured rate among expansion states like CT. The rate of public coverage in CT grew modestly from 33.3% to 35.9%, while private insurance coverage was essentially unchanged (64.0 % in 2013, 64.1% last year).  The uninsured rates measure the percent of people who report being uninsured at the time of the interview; the survey is conducted continuously over the year. The numbers were released prior to final data editing and weighting.

Webinar online – Caring for high-need patients – Lessons for CT

Evidence is growing that we cannot fix our health care system without addressing the needs of the small number of patients with very complex and costly health problems. Connecticut can learn from other programs across the US as we build reforms for our state and our Medicaid program.  On this week’s webinar we heard from Clemons Hong, MD, MPH; in addition to coordinating complex care management programs on the ground, Dr. Hong has written extensively about lessons learned across the country. Dr. Hong outlined how to identify and engage high-need patients, find opportunities for improvement and how to intervene effectively. The webinar includes policy and implementation best practices from similar programs across the US. Click here for slides, video and links to articles from the webinar.

Where We Live – Hospital CEO pay: How much is too much?

Last year, CT’s hospital CEOs averaged over $1million in compensation. Yesterday’s Where We Live focused on those salaries and the disconnect with quality of care. The lowest paid CEO in CT – at New Milford Hospital – runs the only CT hospital not penalized this year by Medicare for having too many patients return within 30 days. CT hospitals ranked second worst in the US on readmissions, and are falling behind across quality metrics. But CEO pay rose 17% on average last year. The rest of us averaged 3.1% increases. Hear the conversation online.

Webinar: Caring for High-Need, High-Cost Patients – Lessons for Connecticut

Join us Monday, June 22^nd at 2pm for a webinar on best practices in complex care management for the most fragile and costly patients. Evidence is growing that we cannot fix our health care system without addressing the needs of the small number of patients with very complex and costly health problems. Luckily CT can learn from other programs across the US as we build reforms for our state and our Medicaid program.  On the webinar we’ll hear from Clemons Hong, MD, MPH, of Massachusetts General Hospital and Harvard Medical School. In addition to coordinating complex care management programs on the ground, Dr. Hong has written extensively about lessons learned across the country. Click here to register for the webinar.

CT News Junkie reports on SIM ethics debate

Today’s CTNJ is reporting on the SIM ethics debate. The article points out that the weak conflict of interest policy proposed by SIM staff and adopted by the steering committee admits “Members of the advisory bodies may participate in program design and development decisions, even if they or their organizations may potentially reap a benefit.” At their next meeting, the committee plans to reconsider adopting the state Code of Ethics that governs all similar councils that are not appointed by the Lieutenant Governor.

A letter was sent yesterday to SIM committee members clarifying misstatements about Connecticut’s Code of Ethics.

SIM punts on ethics

In response to the recent state Ethics Board Declaratory Ruling the SIM steering committee took up ethics at their meeting last week. The Ethics Board found that because SIM committee members are appointed by the Lieutenant Governor, SIM was not covered by the state Code of Ethics for Public Officials that applies to similar policymaking committees in state government.

Unfortunately, rather than adopt the state Code of Ethics, staff proposed an extremely weak policy that would do little or nothing to prevent conflicted interests from driving health reform and SIM’s $45 million in grants. Problems have already arisen about the application for a grant from a SIM steering committee member’s employer. This issue was first raised with SIM’s Consumer Advisory Board in November, with no action taken, and in a February sign on letter from advocates to the Lieutenant Governor, with no response. At their meeting, the SIM steering committee heard from four public commenters on the importance of integrity, building trust, offering alternatives to engage key stakeholders without compromising ethics, and urging adoption of the state Code of Ethics. Commenters noted that municipal boards, not covered by state law, have nevertheless adopted the state Code of Ethics to build public trust.

Unfortunately the Committee was misinformed about several areas of policy. It was reported that the Code of Ethics includes revolving door and employment barriers to members. However those provisions only apply to state employees. For example, former state employees are prohibited from disclosing confidential information they gained during their state employment for financial gain. The Code imposes no barriers to employment on non-state employees. Thankfully a SIM committee member dispelled the misinformation that if SIM adopts the Code, members would necessarily have to file financial disclosure forms. Only 3.9% of CT’s 65,000 public officials are required to file financial disclosure forms. Members also seemed to believe that the financial forms are extensive. Disclosure includes only naming sources of income, large assets and investments, not amounts; members do not have to release their tax forms. Contrary to assertions from the Lieutenant Governor’s staff, SIM committees are not purely advisory – as confirmed by the Ethics Board Ruling.

Unfortunately, the committee decided to adopt the weak policy but plans to study the Code further. To ensure the committee has accurate information, they should ask for a presentation by the Office of State Ethics. Some members did emphasize the importance of following up on the issue in a timely way to ensure the public’s trust.

Sign the petition for access to your own health data

Secure access to your personal health information is important  -- for accuracy, to save filling out forms with the same information over and over, because things get lost, to be sure the people treating you all have the same information, and so you know as much as they do about your care. A group of consumers, caregivers, advocates, health professionals and concerned citizens has created an online petition, getmyhealthdata.org, urging policymakers to ensure you have access to your own information and to keep it safe, secure, private and complete.  Sign today.

Best practices guide on integrating behavioral health into primary care

Up to 70% of physician visits involve a mental health issue and health care costs for people with mental health issues are often up to three times higher than other patients with similar conditions. CEPAC, New England’s comparative effectiveness council, has published their latest guide featuring best practices for integrating behavioral health services into primary care practice. Based on the strongest evidence base, CEPAC’s membership of providers and consumer representatives from across the region, voted to endorse the Collaborative Care Model of integration. But the group noted that practices pursuing integration “should use available resources and seek guidance from organizations that have experience with the CCM and other models while accounting for differences in population, resources, treatment priorities, and funding.” In addition to the full report, CEPAC has published a guide for policymakers and other decision makers, and a New England-specific action guide that includes resources and implementation support for our region.

June web quiz on CT Medicaid/CHIP enrollment

Test your knowledge of Medicaid and CHIP enrollment in Connecticut. Take the June CT Health Policy Webquiz.

Webinar: Caring for High-Need, High-Cost Patients – Lessons for Connecticut

Join us Monday, June 22^nd at 2pm for a webinar on best practices in complex care management for the most fragile and costly patients. Evidence is growing that we cannot fix our health care system without addressing the needs of the small number of patients with very complex and costly health problems. Luckily CT can learn from other programs across the US as we build reforms for our state and our Medicaid program.  On the webinar we’ll hear from Clemons Hong, MD, MPH, of Massachusetts General Hospital and Harvard Medical School. In addition to coordinating complex care management programs on the ground, Dr. Hong has written extensively about lessons learned across the country. Click here to register for the webinar.