New Brief: Patient-centered medical homes are working in CT, but standards are at risk

Patient-centered medical homes (PCMHs) are working well in CT. There is growing national and state evidence that certified PCMHs improve health care access and outcomes while controlling costs. PCMHs are a new way of delivering health care that uses a team of providers to coordinate care and help people keep themselves healthy. CT’s Medicaid program has significantly benefitted by adopting certified PCMHs attracting more providers to the program just as the program expands. Growing every month in CT, PCMHs are the foundation of thoughtful payment reform – paying for value rather than volume. But it is critical to maintain standards and accountability, ensuring that PCMHs are doing what they are paid to do. National PCMH certification standards like NCQA, the gold standard, work – ensuring we get value for our spending. Unfortunately nationally recognized PCMH standards are at risk in CT. The SIM process, and now DSS Medicaid regulation language, have proposed eroding those important standards, that are working so well for consumer and payers. A new brief by the CT Health Policy Project outlines the value of PCMHs and what is at risk for CT.

Data breach at Access Health CT, troubling for APCD future

Friday afternoon a backpack was found on a Hartford street with sensitive information on about 400 Access Health CT customers. The backpack included four notepads with handwritten names, social security numbers and dates of birth, as well as internal Access Health CT papers. People whose information was breached have been contacted and offered credit monitoring and resolution services. Access Health CT says they will find out how this happened and make changes to see that it isn’t repeated. Access Health CT testified against a bill this session requiring enhanced background checks for people handling sensitive information. The bill did not pass.

Unfortunately this is the same organization is being given responsibility for even more sensitive information in our medical records. Access Health Analytics, a unit of Access Health CT, will soon be collecting our medical records, across all insurers and government programs in an all-payer claims database (APCD). The plan is to use the information for health planning and, hopefully, to give consumers the information they need to make better health care choices. It could be a very effective tool to improve our health system. However, unlike Rhode Island’s APCD, Access Health Analytics has decided not to include an opt-out provision giving people control over their most sensitive information. Reportedly a very small number of people have chosen that option in Rhode Island, but just having it builds trust. Connecticut should re-visit this poor decision that undermines trust in a system that is not perfect.

June CT Health Policy Webquiz: CT hospital community benefits

Test your knowledge about community benefits at Connecticut hospitals. Take the June CT Health Policy Webquiz.

Advocates propose policy paper topics for SIM

In response to an offer from SIM staff, independent consumer advocates have proposed six topics for SIM policy papers. Topics that need detail and public discussion include protecting consumer choice, competition, and the safety net against contrary financial incentives, ensuring patient-centered care, integration with public health, behavioral health and oral health, conflicts of interest, and details on SIM’s plan to re-create patient-centered medical home standards.

Malloy signs bills allowing for-profit hospital conversions and not allowing e-cigarettes for minors

Among the 23 bills signed by Gov. Malloy yesterday was SB-35 which eases CT hospitals’ conversion to for-profit status, however with more restrictions and protections for patients and workers. The Governor also signed SB-24 making the sale of e-cigarettes to minors illegal.

Anthem & ConnectiCare premiums submitted are up sharply for 2015, HealthyCT rates down -- updated

Proposed premiums for the insurance exchange were due to the insurance dept. Friday and they are up significantly from this year’s premiums, according to CT Mirror. Anthem’s proposed premiums are up 12.5% on average; ConnectiCare’s base rate is up 11.8% for next year. CT’s premiums for this year are the 4^th highest in the nation and the highest among state-based exchanges. CID will now review those rates with the limited tools allowed them under law. Maximizing those tools last year CID was able to bring the rates down slightly. In contrast to Anthem and ConnectiCare the rate filing from Healthy CT, filed Monday, includes rates that are 8.9% lower than last year. United Healthcare, new to CT’s exchange, also filed proposed rates.

Unfortunately, as last year, AccessHealthCT will not be reviewing or negotiating to make premiums affordable. AccessHealthCT has refused to review rates and a bill directing them to negotiate with plans to make coverage affordable has died on the House calendar two years in a row. Consumers in states with exchanges that negotiate rates are enjoying more affordable premiums.

It is important to note that the high rates will only affect unsubsidized indivduals and all small business exchange customers who must pay the full premiums. Most AccessHealthCT individual members have incomes that qualify them for premium subsidies – their premiums are based on their incomes and not plan prices. Along with unsubsidized consumers and small businesses, the federal government (which funds the subsidies) will bear the cost of high premiums. AccessHealthCT’s funding is based on a percentage of premiums across the entire market, so their bottom line will benefit from rising premiums and their decision not to negotiate rates.

Health reform dashboard up again but APCD decision drags down progress

The CT Health Reform Dashboard is up a notch again this month to 29.7% on the progress meter, reversing last month’s slide. Areas of progress include new insurance market entrants and, as usual, Medicaid’s progress in many areas driven by transparent, open policymaking. CT Medicaid has made consistent progress toward turning around a deeply troubled  program by engaging all stakeholders, including consumers and advocates, in building success. Unfortunately the rest of CT health policymaking is not learning from Medicaid. The latest example – AccessHealth Analytic’s decision to overrule consumers’ privacy decisions – is responsible for holding back reform this month.