Medicaid creating a committee to assess access to care

Prompted by new federal regulations, at today’s Medicaid Council meeting DSS announced the creation of a Medicaid Medical Care Advisory Committee that will track quality and access to care in the program. The committee will advise on an Access Monitoring Plan, due out July 1^st, to ensure that Medicaid members’ access to care is similar to the general population’s. The plan will consider provider rates but also enrollee needs, availability of providers, and utilization trends. The state must compare Medicaid rates to Medicare and private payers, and must solicit public, member and provider input to the plan. DSS intends the committee membership to focus on direct consumers and providers participating in the program. All meetings, data, and analyses will be public. They will soon be accepting applications for the committee.

In response to requests at last month’s meeting, DSS and AccessHealthCT shared their plans to help 17,688 parents transition off HUSKY this summer. While they plan extensive outreach to ensure people who are eligible stay on HUSKY and help those who can afford AccessHealthCT coverage to buy it – there are no plans to help the large number who will likely become uninsured to protect their health. If parents cut off last year are any indication, over 7,000 working parents will lose coverage. The last time HUSKY parents were cut off, it fell to advocates and community groups to inform consumers.

Advocates’ letter urges delay of SIM plans for Medicaid

Fifteen independent consumer advocates sent a letter to the administration yesterday expressing deep concerns with SIM’s Community and Clinical Integration Plan (CCIP) for Medicaid. Advocates are concerned that CCIP will undermine hard-won progress in our state’s Medicaid program that has improved access to high quality care while controlling costs. In contrast to successful programs in other states, SIM is proposing that CCIP be required of Medicaid provider networks in CT. Deep concerns about CCIP have been shared recently and in September regarding the costs and burdens placed on providers, over-prescriptive standards that are not evidence based, and the need to engage other payers beyond Medicaid. In the letter, advocates urge the administration to delay a mandate that developing Medicaid provider networks adopt and fund CCIP’s extensive standards to allow time for study to integrate with ongoing Medicaid and community efforts, avoid duplications, resolve conflicts, and engage other payers.

Health Care Cabinet – RI, MA reforms reviewed, hospitals’ response to price presentation

Today’s Health Care Cabinet meeting was as fascinating as last month’s. We heard again from the consultants working with the Cabinet to develop a plan to reform CT’s health care system. This time they focused on reforms in Rhode Island and Massachusetts. Rhode Island is also facing hospital consolidation, but with more geographic overlap than CT, so they may not face the anti-competitive concerns we do. Rhode Island focused their reforms on increasing primary care spending (not just rates), PCMH expansion (as has been very successful for CT’s Medicaid program), support for HIT, alternative payment models, and hospital reform, most specifically a cap on cost increases. Unfortunately the reforms haven’t yet resulted in controlling costs. RI is also behind in building consumer protections for their reforms; something CT cannot afford to put off given our history and culture. The key to Rhode Island’s success is a visionary leader who was very transparent, inclusive policymaking, aggressive and respectful stakeholder engagement, and a commitment to evidence-based standards. Massachusetts also has a long history of diverse reforms; some worked and some didn’t. Massachusetts is wisely focusing price transparency on markets rather than consumers. While getting price information to consumers is important, to expect that alone to reduce costs is not realistic. Their latest iteration is movement toward global payments (similar to capitation), which are gaining momentum. It seems global payments have saved money, increasing primary care use, but overall annual health cost increases exceeded the benchmark in2013 o 2014 (the latest year). One of Massachusetts’s most effective tools is the ability to regulate the market, especially blocking provider market consolidation that could drive up prices. Next month we will hear about Maryland and Oregon.

We also heard from a panel of CT hospital representatives responding to last month’s presentation on hospital spending  -- the impact of consolidation on prices and the lack of correlation between government and commercial plan prices. The hospitals mainly complained about the state’s Medicaid cuts, suggesting that they are driving up prices for commercial plans. However research does not support the cost shifting theory. It was pointed out that Medicaid is working better now than anytime in recent memory, and that in times when the state was very generous with hospitals’ Medicaid payments, there is no evidence that commercial prices were reduced.

Survey of CT ACOs – early yet, good intentions but uncertain future

Together with the Hartford Business Journal, the CT Health Policy Project conducted the first survey of CT ACOs finding some unexpected findings. ACOs are networks of providers across the continuum that coordinate high-quality care for people and receive a share of the savings they generate. ACOs are a foundation for efforts to reform health care systems and control costs, but they are very new. Nationally results are mixed and there is very little known about how CT’s ACOs are developing. The survey, designed to fill that information gap, found that ACO leaders in our state are motivated by important goals such as care coordination, population health and quality improvement. Increasing revenue is a lower priority. But ACO leaders are fairly tentative about their future. They need assistance from policymakers to ensure they succeed, including timely data and funding for the substantial investments required. In a troubling but understandable finding, several are considering affiliating or creating an associated insurance function. Consolidating these undermines an important balance of interests for consumers. CT does not currently regulate ACOs.

FDA flu vaccine meeting – lots of smart people doing important work, tons of wonk fun

Today’s FDA meeting to vote on what subtypes next year’s flu vaccine will include was fascinating. As more than one participant said, our heads hurt by 10am. There is a lot of work by people all over the globe that goes into figuring out what nature has planned nine months from now. (An important example of international cooperation that benefits us all.) Really smart scientists make very educated guesses based on what is circulating in the Southern Hemisphere right now, evidence about how the virus will “drift” over the next year, and which subtypes are the most deadly. In the end, we followed the WHO guidelines from last month. Luckily for people, this year’s flu season has been unusually light, in contrast to the year before. Despite substantial variation in viral strains between countries, we agreed with the best guess of really smart people at WHO. Like a lot of health policy, they have to plan next year before this year’s data is complete – build a plan while flying it. Thankfully we have pilots who’ve been doing this for many years. Hopefully next winter’s season will be like this winter, and not the year before.

March web quiz: Medicaid costs in CT

Test your knowledge of Medicaid costs in CT. Take the March CT Health Policy Webquiz.

CT Health Reform update – hospital consolidation delay allows breathing room but weak SIM proposal for Medicaid is troubling

The Governor’s Executive Order to delay approvals of large hospital consolidations leads the CT Health Reform Dashboard updates this month. $185 million savings in the state’s share of Medicaid spending last year also leads the news. Medicaid redesign planning is still on track, working collaboratively with all voices at the table. However that good news was balanced by troubling news that SIM is pushing a costly and burdensome proposal for community oversight on Medicaid without evidence to support the prescriptive standards. Advocates and others are concerned that SIM’s proposal will jeopardize hard-earned quality, access and cost control progress in the program.