First HIT privacy committee meeting

The HITE-CT privacy committee held its first meeting last week. While mainly organizational, the consensus of the group was that developing a patient consent model – opt-in vs. opt-out – was foundational to our work. Most other policies flow from that decision. Efforts to limit discussion to just tracking federal privacy issues were considered but the membership agreed that it was critical to develop a consent model that respects consumer rights and provider time constraints. Concerns were raised about providers’ ability and time to accurately flag legally protected sensitive health information as required in an opt-out system, especially in small practices, and to accept liability for that process. Concerns were raised about the quality of information and consent management across practices – the pool of information is only as strong the weakest contributor. The need for extensive patient education was raised, particularly in light of HITE-CT’s plans to devote only $35,000 of the total $7 million budget to patient education. Concerns were raised about plans to upload everyone’s private information to the system, with or without permission, and plans to allow providers to over-ride even an affirmative opt-out decision by a patient to access that information against the patient’s wishes. Concerns were raised about HITE-CT’s proposed narrow definitions of security breaches, lax reporting parameters and leaving the decision about what is a breach to the providers who would have to pay the penalty. Advocates noted that the committee’s first meeting is being held seven months after the bill passed, despite numerous requests to DPH over those months. This raises concerns that consideration of the patient consent model could be further delayed until after the legislative session and that the delay could be used by opponents of consumer rights to kill any legislative remedies to protect patients. The committee decided to research other states’ policies, particularly our surrounding states and those that have recently switched from opt-out to opt-in policies, and other policies in CT. The next meeting of the committee will be Jan. 25th at 3:30 at the LOB.

Medicaid Council meeting

The news from Friday’s Medicaid Council meeting was that there was no news. Unlike previous HUSKY transitions, the shift from three capitated HMOs to only one entity, Community Health Network (CHN), running the program was uneventful. There had been concerns that many providers previously participating in the HMO networks were not enrolled in regular Medicaid, potentially compromising continuity of care. However, only a small fraction of providers were not already enrolled in Medicaid, and 82% of those chose to enroll in the new program. Less than 0.1% of all HUSKY patients had been seen in the past by a provider who is not now enrolled in Medicaid, and may have to find another provider. DSS and CHN have instituted an impressive array of reforms recommended by providers and practice managers in a recent study of barriers to provider participation including better communications, easing payment and credentialing hassles, and significantly improved provider recruitment.

Health Reform Cabinet meeting

The highlight of last week’s Health Reform Cabinet was a report by Frances Padilla of the Universal Health Care Foundation of CT, Co-Chair of the Business Plan Development Committee, outlining efforts to develop option(s) to offer quality, affordable health benefits to individuals and small businesses, possibly including a public option. The Committee is also Co-Chaired by OPM Secretary Ben Barnes and Nancy Yedlin of the Donaghue Foundation and is currently gathering and analyzing data on CT’s insurance market, competitiveness, consumer needs and other states’ models. The next meeting of the Business Plan Committee is Monday Jan. 23rd at 3pm.

Dual eligible care and payment model development committee update

Last week the Medicaid Council sub, sub-committee developing a payment and delivery model for a new Medicaid program serving dual eligible met. The committee is considering shared savings payment options in which savings from coordinating care, reducing duplication and emphasizing quality would be captured and shared with providers. The project grew from a CMS planning grant to DSS received last year. Discussions centered on options available under the Affordable Care Act, integration with other Medicaid and other payer initiatives, and getting reasonable numbers of potentially eligible people. The next meeting is Tuesday Jan. 24th at 1pm in Room 1D of the LOB.

Health Care Workforce forum

It is estimated that CT will need 9,000 more direct health care workers in the next five years. The CT Commission on Aging is sponsoring “The Direct Care Workforce: Meeting the Demand and Responding to the Needs of CT Residents” Friday Jan. 27th from 10 am to noon in Room 1D of the LOB. The forum will include a panel of experts on workforce development and long term services and supports for paid and unpaid direct care workers. The Commission will also release their Direct Care Workforce Strategic Plan at the forum. To RSVP contact coa@cga.ct.gov or call (860) 240-5200.

Legal aid suing over Medicaid delays

Yesterday New Haven Legal Assistance Association filed a federal class action lawsuit against DSS over extreme delays in processing Medicaid applications. The application for one plaintiff, a 27-year old man with a seizure disorder, has been in process for almost six months. He has provided all the information requested and was told by the Department that he is likely eligible. Delays in processing applications have been growing, from 38% overdue in September 2010 to 55% in November 2011. Due to the economic downturn, the number of Medicaid applications has also grown significantly. Delays are affecting not only initial applications, but also eligibility for people with high medical bills in the “spend down” category. Attorneys blame reductions in the number of eligibility workers at DSS. In the last ten years, the number of Medicaid enrollees has grown 52% but the total number of eligibility workers has dropped 30%. Attorneys largely blame neglect by previous Commissioners and are optimistic that the current administration will remedy the problem and avoid jeopardizing federal funds.

Upcoming health policy meetings

CT’s health policy community is making up for the holiday lull in meetings. Next week’s meetings include:

Patrick Hollander, former CFO of the MA Health Connector will speak at the Speaker’s Working Group on Small Business Health Care Monday Jan. 9th at 3pm in Room 1D of the LOB.

Also Monday, the Complex Care Model Design Group of the CT MMAPOC (formerly the Medicaid Managed Care Council) will meet to discuss payment reform models for state residents eligible for both Medicare and Medicaid at 1pm in Room 1E of the LOB.

Tuesday the SustiNet/Governor’s Health Reform Cabinet will meet from 9 to 11am also in Room 1D of the LOB. The agenda is here.

Wednesday the CT MMAPO Council’s Care Management (formerly PCCM) committee will meet from 10am to noon, thankfully in Room 2A of the LOB.

Later that day, at 12:30, the Privacy Committee of the HITE-CT Board will hold its first meeting to discuss protecting consumer privacy in electronic health record exchange and building a sustainable exchange for CT. Room TBD.

We get a day off Thursday, thankfully.

On Friday, the full CT MMAPO Council will meet from 9:30 to noon in Room 1E of the LOB.