Complex Care Committee hears about serious problems with new technology for home health visits

Friday’s meeting of MAPOC’s Complex Care Committee focused on problems with DSS’s new Electronic Verification System to ensure accountability in provision of home care to Medicaid members. Implementation of the troubled, costly, mandated system began January 1^st and is scheduled to be completed February 1^st. All stakeholders, including consumer advocates and home health agencies, repeated their strong commitment to program integrity. However because of significant problems with the new system, agencies have not been able to submit visits and claims to the system and have not been paid, and have had to hire more administrative staff, with no compensation for the increased burden. Concerns were raised that, contrary to federal regulations and laws, the system was not developed in collaboration with stakeholders, providers cannot bill for care provided in the community, and that flaws in the system violate patient privacy rights. Agencies, advocates and legislators have called on DSS to halt implementation of the new system until problems can be corrected. The Complex Care Committee asked DSS to provide a response to concerns raised in the meeting, ongoing reports tracking access to care, utilization, and payments to providers, as well as a corrective action plan. Legislators and DSS are meeting today to discuss the issue.

Help Connecticut health policymaking with our trust issues – take a quick survey

For decades Connecticut has struggled with reforming our broken health care system. In several health policy circles, a lack of trust has been suggested as the main barrier to progress. We are seeking thoughts and ideas to build trust across Connecticut’s health care system. Please take a very short confidential survey to contribute your ideas and thoughts. You may have the perfect answer – please share.

Maryland explores state options to control pharmacy costs

Like many states, Maryland is considering state policy options to control rising prescription costs. Tuesday, the state’s Senate Finance Committee heard from 13 invited experts about possibilities. Committee Chair, Sen. Thomas “Mac” Middleton, opened the briefing stating that controlling prescription drug costs is “one of the biggest issues that we’ll deal with this year.” Ellen Andrews, CSG-ERC’s health policy staff was invited to describe possible federal action, what states are currently doing to control costs, options other states are considering, and especially Vermont’s first-in-the nation transparency law that passed last year.  Others on the initial panel included Steve Pearson from ICER talking about their work developing value-based prices for medications and other treatments, and Caleb Alexander from Johns Hopkins’s Center for Drug Safety and Effectiveness and the Johns Hopkins-FDA Center of Excellence in Regulatory Science and Innovation. Senators asked great questions, drilling deep into how transparency could help control costs, the difference between retail and final, net prices for medications, research & development spending both by companies and government, and reimportation. There was a great deal of interest in moving to a value-based pricing model to ensure fair prices that encourage innovation that can lower costs in other parts of the health system. Two relevant bills have been proposed in Maryland regarding price transparency and state authority to sue drugmakers for price gouging. Last month Maryland joined 19 other states suing generic drugmakers for price fixing.

Unlike most of US, non-medical vaccine opt-outs for children rising in CT

New analysis by the CDC finds that while the percentage of families opting out of school-required vaccines for kindergartners for non-medical reasons is dropping nationally, Connecticut’s rate continues to rise. The percent of Connecticut kindergarteners without vaccines rose from 0.8% in 2009/2010 to 1.7% in 2015/2016. Connecticut is one of only eleven states with rising rates of non-medical exemptions. As in most states, Connecticut parents can opt-out of required vaccines for their children by asserting a religious objection. In 2015, the state changed the law to require annual certifications witnessed by a public official.  Last September, the American Academy of Pediatrics issued a position statement urging all states to eliminate non-medical childhood vaccine exemptions stating, “The AAP views nonmedical exemptions to school-required immunizations as inappropriate for individual, public health, and ethical reasons and advocates for their elimination.”

How Republican plans to replace the ACA could affect you

The Washington Post has published an online tool to predict how four Republican plans to replace Obamacare would affect you and your coverage. Input your age, income, pre-existing conditions, and coverage status here and the tool uses expert analyses to predict the impact of the leading Republican proposals. While details on the new administration’s plans to replace the law are not available, the tool provides the impact based on each of the most prominent replacement plans offered to date – the House GOP Leadership’s Better Way for Health Care, Sen. Orrin Hatch’s Patient Care Act, Rep. Tom Price’s Empowering Patient First Act, and Sen. Ted Cruz’s Health Care Choice Act.

Help Connecticut health policymaking with our trust issues – take a quick survey

For decades Connecticut has struggled with reforming our broken health care system. In several health policy circles, a lack of trust has been suggested as the main barrier to progress. We are seeking thoughts and ideas to build trust across Connecticut’s health care system. Please take a very short confidential survey to contribute your ideas and thoughts. You may have the perfect answer – please share.

PCMH + evaluation plans – weak review and too late to matter

Wednesday DSS unveiled their initial plans to evaluate PCMH +, the new experimental HUSKY shared savings program that just started January 1^st with 160,000 members. HUSKY’s previous experience with financial risk was a universally acknowledged failure. Contrary to promises for a meaningful evaluation of the program before moving another 200,000 members into the program next January, DSS does not plan to complete the evaluation until two months after the finalized RFP is released for the second wave of the experiment. In accord with the department’s principle to Do No Harm and only act in the best interests of members as required in federal law, advocates urged the state to ensure quality, access and cost control were not eroded in the first stage that just began. The advocates are concerned about the potential for the experimental payment model to reverse hard-won progress over the last four years that significantly improved access to care, raised the quality of care, engaged new providers to participate and saved at least $471 million. In a July letter advocates wrote, “That requirement of federal law cannot be met if the agency rushes another 200,000 enrollees into this experiment without first assessing the results of placing the initial 200,000+ there, and using what it learns to protect all of them.” Beyond that serious concern, the department’s plans for the evaluation are wholly inadequate. The plan relies heavily on desk and ACO office reviews of “operational policies and procedures”, very similar to the inexplicably glowing evaluations of HUSKY MCOs for years while the program was dramatically failing. It includes no description of any analysis of underservice, access to care, quality, movement toward PCMH certification for all primary care practices, adverse selection/cherry picking, or overspending. For example, evaluators intend to interview only two members/families of the program, and then to choose from the handpicked consumers appointed by ACOs to their advisory committees. Advocates in other states with Medicaid ACOs report deeply conflicted family members of ACO owners appointed to advisory boards as “consumers”. CT has a long history of concerns about the independence of “consumer advocates” appointed to policymaking boards.

In good news, HUSKY’s PCMH (no +) program continues its remarkable progress celebrating five years of improving access to care, quality, consumer satisfaction, provider engagement, and controlling costs.

Cabinet begins to tackle prescription costs

CT’s Health Care Cabinet began drilling down into rising prescription drug costs and state options to stem the rise. We heard from Ameet Sarpatwari, consultant to NASHP on their report for states, and Tom Brownlie of Pfizer and Jenny Bryant of PhRMA. Dr. Sarpatwari outlined high US spending on drugs and the consequences for consumers’ health and finances. He acknowledged that drug companies face high, expensive hurdles in bringing a drug to market. But he also rebutted claims that high prices drive innovation (no evidence for that) and it’s the FDA’s fault (not true either). The real driver of rising costs, according to Dr. Sarpatwari, is the lack of competition and barriers to timely generic market entry. He outlined eleven state policy options including transparency laws, bulk purchasing, legal accountability, protecting consumers from misleading marketing, active shareholder advocacy, and creating a public utility for in-state drug prices.

Pfizer and PhRMA put drug spending in context of rising health costs across sectors, that retail prices are heavily discounted for most payers, and the important health improvements and cures that innovative new drugs provide. The speakers suggested better benefit design, medication synchronization, improving adherence and medication management. They also highlighted the recent sharp rise in cost shifting to consumers, which can reduce utilization of both high and low value medications. Cabinet members also offered successful counter detailing programs and public health prevention programs to manage conditions without medications as options. Our next meeting will be February 14^th at 9am.

Busting Medicaid spending myths

Despite best efforts by legislators, advocates, and state officials, persistent myths remain about the success of Connecticut’s Medicaid program. It’s understandable – before the shift five years ago away from private insurers to care coordination, costs were out of control, but things are very different now. We’ve looked under the hood, drilled down into details, and whacked the weeds to explore the myths and lay them to rest. Medicaid is saving the state money – both in total state spending and in per person total-cost-of-care. Compared to national per person cost growth, Connecticut has saved $471 million in the last four years. And the savings are not an artifact of bringing in a lot of relatively healthy childless adults under the ACA expansion. We know what is driving the savings – lots and lots of innovative programs. Pretty much any good idea is being tried and evaluated. The really remarkable thing about this success is that it didn’t come at the expense of improved quality, access and consumer satisfaction. In fact, they are integral to controlling costs. Connecticut Medicaid is building real value – both improving quality and controlling costs. Let’s support and continue that success.

Help Connecticut health policymaking with our trust issues – take a quick survey

For decades Connecticut has struggled with reforming our broken health care system. In several health policy circles, a lack of trust has been suggested as the main barrier to progress. We are seeking thoughts and ideas to build trust across Connecticut’s health care system. Please take a very short confidential survey to contribute your ideas and thoughts. You may have the perfect answer – please share.

CT ranks third among states in health this year, up from sixth from last year

This year’s America’s Health Rankings finds that overall Connecticut residents are healthier than all but two other states. We benefit from low smoking and infectious disease rates and high rates of childhood immunization. However we need to work on air pollution, excessive drinking, rising obesity rates, and our disparities based on educational level are embarrassing. Drug overdose deaths rose 44% in the past three years; physical inactivity is up as well. Lots to be proud of, but lots of room for improvement as well.

CT hospital Medicare hospital-acquired condition penalties much higher than US average for third year in a row

Next year fourteen of Connecticut’s 31 hospitals will be penalized by Medicare for poor rates of potentially avoidable complications, according to an analysis by Kaiser Health News. While this is down from eighteen this year, it is almost three times higher than the US average. Seven Connecticut hospitals have been penalized under this program every year since the program began in 2014, a much higher rate than other states. The penalties are based on the rate of patients with conditions such as blood clots, falls or bed sores, and for the first time since beginning the quality program three years ago, Medicare included antibiotic-resistant infections in the calculations. The CDC estimates that 23,000 Americans die each year of antibiotic resistant bacterial infections they got in a hospital. Penalized hospitals will lose 1% of all Medicare payments for the year that began in October. A recent study found that a similar Medicare quality improvement program – the Hospital Readmission Reduction Program – improved performance in all but one state, especially among the lowest performing hospitals. Under the program, Medicare readmissions dropped 7.7% in CT from 2010 to 2015.