Thursday, December 28, 2017

CT spends more on healthcare per capita than other Americans, but less as a percent of total spending

While average per capita healthcare service spending by Connecticut residents at $7,509 was the 13th highest among states last year, at 15.4% of total consumption, we were below the US average, according to the Bureau of Economic Analysis. Connecticut residents’ average healthcare service spending was the lowest in New England. Total per capita personal consumption in Connecticut averaged $48,497, fourth highest among states. As for most Americans, last year Connecticut residents spent more on healthcare services than gasoline and other energy goods or off-premises food and beverages, but less than on housing and utilities.

Tuesday, December 26, 2017

CTNJ op-ed: Policy Failures – Why Healthcare Innovations Don’t Travel Well

Too often policymakers, advocates and others return from conferences or read reports highlighting great ideas that are working in other states. But when we try to implement them here in Connecticut, they too often fail. . . Each failure erodes our enthusiasm for reform and builds cynicism. This problem isn’t limited to Connecticut, but it happens a lot here. While each failure is unique, there are a few Connecticut-specific themes  Read more

Friday, December 22, 2017

New to the Book Club: Distracted: How Regulations are Destroying the Practice of Medicine and Preventing True Health-Care Reform

I knew that doctors face increasing administrative burdens, but I had no idea how bad it was. Distracted is 201 pages of examples of bureaucratic burdens and Catch 22’s that make no sense placed on practices trying to provide the best healthcare they can. The author concedes that costs are out of control, the healthcare system isn’t working, errors happen, and that quality needs improvement. But his examples make very clear that new regulations, new technologies, quality measures, and payment hurdles forced on practices by well-meaning bureaucrats and insurers meant to fix real problems are only making things worse. His examples may seem hard to believe at points, but the problems are familiar – no one thought about how the “solutions” would have to work in his real world. He often has to note “I’m not making this up”. I don’t agree with everything in the book, especially his chapter on Patient-Centered Medical Homes, but his point is clear and painful to hear for anyone involved in healthcare policymaking. Anyone involved in healthcare at any level should read this book. Read more from the CT Health Notes Book Club

Thursday, December 21, 2017

New federal Medicaid data finds CT’s Medicaid administration higher than most states

According to new data from MACPAC, Connecticut spent 5.73% of Medicaid spending on administration last year, higher than 37 other states. If CT had administrative spending like the US average (4.56%), the program would have saved taxpayers $91 million last year.

Wednesday, December 20, 2017

MAPOC: Harnessing the power of data analytics to improve health

Last week, MAPOC’s Complex Care Committee heard an exciting presentation by Alan Fontes of UConn Analytics and Information Management Solutions.  Alan came to UConn from DeLoitte where he led their project providing healthcare advanced analytics and information management for states across the US. He described the power of analytics to help guide smart planning for health systems like Medicaid, which is especially important for members with complex, chronic conditions. It’s important to first understand the questions that need answers. My favorites are “What are the most common preventable events?”, “How do we get consumers involved with managing their own care?”, and “How do I develop and monitor performance based incentive programs?”. He described how a well-designed analytics and information system can track disease progression, gaps in care, care coordination, and outcomes among other options. The other critical piece is to make the data, and the analysis, available to all involved users, including policymakers and advisors, through dashboards that allow drilling down into the data – not carefully selected bullet points on a Powerpoint slide. The Committee kept Alan almost an hour over his time with questions and a very lively discussion about the potential for Connecticut’s Medicaid program. As we now have access to all claims data in the program this could be a vast improvement in running the program, improving health, and carefully targeting scarce resources. Several members have followed up with Alan for more discussions.

Monday, December 11, 2017

Heated debate – healthcare vs. health care

Have you ever wondered if health care should be one word or two? Apparently it is currently two words, according to the Associated Press, but the debate is heating up. Each side has strong support and even stronger feelings about the subject. I always thought that the CT Health Policy Project used two words, but a site search finds that we aren’t always consistent. Rest assured, that will be rectified going forward.

Tuesday, December 5, 2017

Medicaid update: PCMH+ limping along, bad news for HUSKY parents, and Medicare cuts loom

PCMH+, CT Medicaid’s experimental move back into financial risk that now impacts just over 100,000 people, survived the budget cuts – sort of. The PCMH+ budget was cut from $500,000 (state costs) last year to $300,000 this year, but the SIM federal grant has been devoting a lot of resources to the initiative. We have no idea what CT’s SIM program is spending on this, or on anything actually. Contracts for the current nine ACOs have been extended to March. It is still expected there will be an RFP for a new round to add another 250,000 people to the program. No meaningful evaluation of the impact on the first 100,000 will not be available until well after March. In a webinar last month, Mercer reported on their administrative evaluation of the program, which only looked at policies and procedures, not outcomes, health impact or costs in the program. They did interview two consumers from each ACO, but the consumers were chosen by the ACO, not randomly chosen. Mercer’s evaluation addressed only a couple of independent advocates’ concerns, and found only a few, minor problems with the program. We don’t know how much this evaluation cost the state.

At last month’s Medicaid Council meeting, as required by law, DSS reported on the fate of the last group of 18,903 HUSKY parents who lost coverage in the budget cuts of 2015. The federally-required reassessment of the members found that 7,694 (40.7%) remained eligible under a different category. But as of October 25th, only 2,387 (12.6%) were covered by Access Health CT, CT’s health insurance exchange, leaving 8,822 working parents (46.7%) without coverage and likely uninsured. This doesn’t bode well for the 9,200 more HUSKY parents cut off the program in the latest budget.

Friday’s MAPOC meeting at 9:30 am in Room 1D of the LOB will focus on the over 100,000 low income seniors and people with disabilities that are losing Medicaid subsidies to pay their Medicare costs.