Thursday, February 15, 2018

Opt-ing out of PCMH+ isn’t easy, and that’s not evidence that PCMH+ works

Preparing for a new project, I’ve been exploring how Medicaid members who are concerned about the state’s shift to PCMH+, a risky, experimental payment model, can exercise their right to opt-out of the program. Advocates have been very concerned about the new program’s potential to incentivize denying people the care they need, shift less lucrative or difficult members out of care, and cost taxpayers more, as has happened in other states. The federally-required notice to consumers placed in the program a year ago was corrupted at the last minute to accommodate pressure from the health systems that could profit from the program. DSS’s own survey found that consumers are confused by the useless notice that now requires a college education to understand.

My odyssey began last week, February 8th, when I called the toll-free number in DSS’s consumer notice and pressed phone tree option #5 as directed. The recorded announcement says nothing about PCMH, PCMH+ or opt-ing out of the program. I dutifully worked my way through the other options, calling back in several times, finding nothing about PCMH+ or opt-ing out. I finally just finally pressed zero and was connected to a human being who said they don’t handle PCMH+ opt-outs anymore (don’t know when that changed, no notice was sent to consumers of the change) but she would check with her manager. After a few minutes, she came back to tell me that I needed to call the spend down unit. I said that makes no sense, they aren’t related programs but she insisted.

So I called that new toll-free number. Again, the recording said nothing (on February 8th) about PCMH+ or opt-ing out. I then methodically tried the options and found that a human answered #2. She asked a lot of questions about who I was, why I was calling, etc. but finally gave me the info for consumers to now opt-out of PCMH+. Just to add to the confusion, she only referred to the program as PCMH (no plus) which consumers do not want to (and would have no reason to) opt-out of. In fact, PCMH (no plus) is an exceptional person-centered program that provides coordinated care and saves money for the state without any risk of denying necessary care.

Interestingly I called both numbers again today, just a week later, as I planned to write this blog. The first number is unchanged but the second one does reference PCMH+ in the recording, alongside the spend down program. Unfortunately, no consumer would have any idea to call that number.

Needless to say, DSS’s claim that everyone must be happy with the program because no one is opt-ing out is disingenuous. They can’t set up a system making it impossible to opt-out and then use that to claim that the program is working.

Wednesday, February 14, 2018

Healthcare Cabinet finalizes recommendations to control drug costs

At yesterday’s meeting, the state Healthcare Cabinet tweaked and finalized eight policy recommendations to lower prescription drug costs in Connecticut. Drugs are the largest driver of skyrocketing health costs. However, the Council acknowledged that, even if these recommendations are all adopted and implemented, a lot of work remains. The recommendations came from months of research and deliberation by four workgroups and the full Cabinet. Legislative recommendations include creating a Drug Review Board, with strong conflict of interest standards for membership, to investigate drug pricing and refer potentially unjustified cases to the Attorney General’s Office for action. Responding to reports of potential conflicts of interest in widespread industry backing of patient advocacy groups, the Cabinet is also recommending that drug companies, pharmacy benefits management companies (PBMs), and insurers publicly disclose funding to nonprofit advocacy groups. The Cabinet also recommends that PBMs cooperate with audits, and require that rebates and other reductions in drug prices be shared with consumers. Administrative recommendations include supporting meaningful discussions between consumers and providers about drug costs, priority setting, and adherence, including adding questions to consumer surveys and linking performance on those measures to funding. Other administrative recommendations include soliciting more information from insurers on the contribution of drug costs to premiums, and using comparative effectiveness research and value assessments to inform providers’ prescribing decisions.  Recommendations that aren’t ready for endorsement yet include public posting of provider compensation by drug companies, limiting coupons that may reduce costs for some consumers but raise them for the overall system, expanding access to the state employee pharmacy system to other payers, monitoring consumer and provider education efforts to ensure quality and balance with non-medication options, reimportation of drugs from Canada, and creating a public utility model for drug price oversight.

Tuesday, February 13, 2018

Webinar on new HIE for Connecticut

For years, Connecticut providers and payers have been begging for a functional Health Information Exchange (HIE). An HIE allows providers delivering care to each patient to share information, notes, careplans and lab results. A functional HIE should help coordinate care, lower costs, avoid duplication and overtreatment, and make everyone’s lives easier. Despite numerous attempts, many years, and millions of tax dollars, the state has never been able to make it happen. To fill the need, the CT State Medical Society has just taken the initiative and created one, CT Health Link, funding it themselves. This Friday, Feb. 16th at 10am the Complex Care Committee of MAPOC will hear about the project in a webinar. To join us, see the info below.

Join WebEx meeting Meeting number: 594 768 457 

Join by phone Call-in toll-free number: 1-(866) 578-5693 (US) Conference Code: 785 357 2699