Connecticut scores well in health care quality, but near the middle in disparities

The latest National Healthcare Quality and Disparities Report from HHS finds significant improvement in access to health care across groups in 2014, likely due to the Affordable Care Act. Released earlier this month, the annual report tracks over 250 measures of quality and disparities in health care. Along with other northeastern states, Connecticut performed well in the quality of care. However there is room for improvement in addressing disparities. For example, just over 20% of both Hispanics and Blacks in Connecticut reported not seeing a doctor when needed due to cost in the last year, compared with 7.5% of whites. Overall Americans’ quality of care has improved across most metrics. Improvement in patient safety was remarkable with 17% fewer hospital-acquired conditions saving an estimated $12 billion. However few disparities were eliminated; poor Americans continue to experience less access to care and poorer quality. Two bright spots were the elimination of disparities in some childhood immunization rates and rates of adverse events. However some disparities in hospice care and chronic disease management got worse. Challenges remain.

Click here for the report chartbooks, here for the State Snapshot Tool and here to spend some time Mapping Medicare Disparities by state or county and by condition, year, sex, age, and race. Warning – it is very easy to spend an entire afternoon in the data without realizing it.

DSS publishes a consumer-friendly PCMH description

For last week’s MAPOC Consumer Access Committee meeting, DSS developed a clear and simple description of Person Centered Medical Homes (PCMHs). The presentation focuses on what person-centered means – both provider and member responsibilities. Members learn what they can expect from providers, and what is expected of them. “Care is organized around you” balanced with “Support you in caring for yourself.” Medicaid’s PCMHs have been credited with significant improvements in health status, access to care, member satisfaction and cost control.”

CEPAC meeting next Thursday in CT – come watch smart people debate and vote on the effectiveness of palliative care interventions

The March meeting of CEPAC, New England’s comparative effectiveness council, will be in Hartford next Thursday, the 31^st at the Bushnell. CEPAC is an independent council of clinicians, academics and consumer advocates who take a deep dive into research around treatments for specific conditions, sorting out and voting on clinical effectiveness, but also which are worth the money specifically for New England. Previous meetings have addressed opiod addiction, breast cancer screening and depression treatments. CT is well represented on CEPAC by Rob Aseltine and Stacey Brown of UConn, practicing physician Claudia Gruss, Claudio Gualtieri from AARP-CT, Julie Rothstein Rosenbaum from Yale, and Rob Zavsoki, DSS’s Medical Director. Next week’s meeting will address Palliative Care: Barriers, Opportunities and Considerations for Quality Improvement. Very smart, independent people discussing how to do the best thing for patients and pocketbooks on the issues vexing the health system. We are lucky to have them coming to our state. Click here to register for the free meeting.

Happy 6th Birthday to the Affordable Care Act

Regardless of whether the ACA is meeting expectations or not, it bears some reflection six years after passage -- what’s been accomplished and what remains to be done.  If you have forgotten what’s in the 906 pages, re-read the Act here.

Wall Street Journal article celebrates CT Medicaid success after move away from private insurers

On page 3 this weekend, the Wall Street Journal highlighted CT Medicaid’s success  controlling costs and improving care by bucking the usual trend. Four years ago CT moved away from private insurers to run the program ourselves – and that has made all the difference. “’Been there, done that and it didn’t work,” says Robert Zavoski, a pediatrician and medical director for the Husky system.” The WSJ article by Melinda Beck notes that the total cost of care per member per month dropped from $718 to $670 from 2012 to last year, participating providers are up 7% and fewer members are forced to get care in an ER. CT’s administrative costs are down to 5%, far better than the 12% typical of private Medicaid managed care plans. The keys to success are clear, actionable data (which we could never get from the health plans) and person-centered medical homes (that actually manage and coordinate care centered on the member). The article features Dr. Barbara Ziogas, a pediatrician, and Marlene Donahue, a foster mother to children with complex medical needs. Both say the system now works far better for both members and providers on the ground.

Good news on CCIP – SIM’s plan for Medicaid

As recommended by independent advocates and others at from the Care Management Committee, DSS and SIM have agreed to make SIM’s Community and Clinical Integration Program (CCIP) optional for Medicaid provider networks, at least for the first year. Advocates and others on the committee were concerned that the plan was too prescriptive, very expensive, and could conflict with and duplicate other efforts already in place and successful. Networks are free to choose to participate in the first year; there maybe grants available to help defray some of the costs. The new option allows time to improve CCIP, develop a funding source, and engage other payers.

Unfortunately, DSS has affirmed their rejection of advocates’ concerns about undermining successful person-centered medical homes in Medicaid.

Advocates’ concerns to preserve PCMHs in Medicaid reform rejected

Last week independent advocates sent a letter to DSS urging them to preserve and support person-centered medical homes (PCMHs) in Medicaid redesign, but unfortunately our concerns were dismissed by the administration. PMCHs are the only reform that has extensive support in the literature as improving both access to quality care and success in controlling costs. By all accounts, PCMHs are the foundation of CT Medicaid’s nationally recognized success. We are deeply concerned that DSS’s plans will give very generous incentives to move less lucrative members with difficult problems out of PCMHs (the people who need it the most) and move more lucrative members with resources into PCMHs. We are also concerned that the policy will result in risk segmentation that will give a false finding that “shared savings” is working and escalate Medicaid costs to the state without anything actually changing. All participants in Medicaid redesign planning, including leadership, have affirmed the principle of supporting PCMHs as a priority. The advocates asked that all networks that wish to receive the extra bonuses be certified as PCMHs within the time frame DSS chose or forfeit some part of those savings. We also offered good faith waivers for practices that are making a real effort. The four advocates on the letter are members of the Medicaid Council committee that has been hashing out the program’s redesign with DSS over many months. Based on encouraging conversations and a lot of work and compromise to accommodate the department’s and networks’ objections over the last many months, the advocates were very surprised by the department’s recent decision to reject meaningful PCMH standards. In any event, there will no change to existing providers taking Medicaid – the new consumer protections would only apply to those who want to receive shared savings bonuses in addition to multiple other current revenue streams.