New faces at the CT Health Policy Project

We are pleased to announce two additions to the CT Health Policy Project community. Jen Ramirez, MSW has joined us as Director of Programs. Jen will be in charge of the Consumer Health Action Network, including newsletters, surveys and advocacy, as well as several policy areas. Jen has worked at the Latino Policy Institute of the Hispanic Health Council, the Partnership for Strong Communities, CCAG and as an eligibility worker at DSS. We are excited to have her policy experience and sensitivity to consumers’ needs here at the Project. (And to students and former staff, we've already taken Jen's picture for the wall.)
Hillary Waldman has also joined our Board of Directors. Now at the Hispanic Health Council, until recently Hillary was the health care reporter at the Hartford Courant for twenty years.
Please join us in welcoming Jen and Hillary.

PCCM could save HUSKY more than $100 million over HMOs

An analysis by the CT Health Policy Project estimates that it will cost the state $113 million more annually to moving HUSKY families to HMOs than to Primary Care Case Management (PCCM). PCCM is a way of running HUSKY without HMOs, by creating “medical homes” to coordinate care. PCCM has been successful in thirty other states providing better health outcomes, and higher consumer and provider satisfaction and saving money. The estimates are based on total HUSKY program costs reported by DSS for November 2007 (before the capitated HMOs left the program) and May 2008 (during the fee-for-service transition) adjusted for HMO and PCCM administrative fees and the 24% rate increase granted to HMOs this year. Policymakers facing difficult program decisions due to this year’s significant budget deficit are taking note.
Ellen Andrews

Second PCCM provider forum also successful

Last night, DSS held their second forum for providers on PCCM at DSS’ offices in Hartford. Again the event was very well attended and most providers were enthusiastic about the program. As in Tuesday’s forum, concerns about adequate adult medicine resources were raised, but in at least one case community adult and pediatric providers linked up at the meeting to collaborate in providing care in their area. Concerns were also raised about marketing guidelines and how families will be informed about this new option.
Ellen Andrews

Governor agrees to delay HUSKY defaults until February

Yesterday legislators and the Attorney General held a press conference urging Governor Rell to delay forcing 250,000 HUSKY families into HMOs with inadequate provider networks. Families were scheduled to be defaulted into three HUSKY HMOs December 1st including two new health plans, Aetna Better Health and AmeriChoice, which have had difficulty enrolling providers. Just after the press conference, the Governor announced she would delay the default until February 1st. It has been reported that CMS also urged the state to delay defaulting families. Advocates have urged the state to focus on the PCCM pilot project scheduled to begin January 1st as a less costly alternative, more attractive option to the HMOs for HUSKY families.
Ellen Andrews

Possible legal action to stop HUSKY families default into HMOs

Kevin Lembo, CT’s Health Care Advocate, plans to sue the state to stop the planned December 1st mandatory transition of over 200,000 HUSKY consumers into managed care plans that do not have adequate provider networks. Lembo and a growing group of advocates and officials have been concerned that the planned transition will lead to many consumers unable to access necessary services and worries about the impact on HUSKY families’ health. DSS has been under pressure at Medicaid Managed Care Council meetings for months to delay the transition and reportedly CMS has also urged DSS to reconsider. DSS has asked CMS for an additional four months for the transition if needed.
Ellen Andrews

Successful PCCM provider forum last night

Over 30 providers attended the PCCM forum held with DSS at our offices in New Haven last night. We had to get more chairs and make extra copies of the materials. There was a great deal of enthusiasm for the program and most providers suggested that they will be filling out an application. Most providers attending were pediatric; there are concerns about getting enough adult providers to participate in HUSKY – either PCCM or the HMOs. However DSS noted that they have received inquiries from adult providers about PCCM and community health centers are enthusiastic about participating. Aetna’s medical director attended and was offered an opportunity to speak by DSS.
Ellen Andrews

Photography exhibit highlighting racial and ethnic disparities

Friday afternoon 2pm at New Haven City Hall there will be a reception to feature an exhibit of photographs taken by ten African American women highlighting issues that make it difficult to live healthy lifestyles to eliminate racial and ethnic disparities. Senator Toni Harp, our Board President, joined the project as a photographer-for-a-day. The exhibit includes 48 photographs, commentary and statistics. The project was led by Yale-Griffin Prevention Research Center with funding from the CT Health Foundation.

Governor’s deficit mitigation plan includes cuts to medical interpreters

Today the Governor announced her plan to address CT’s looming $268 million state budget deficit. Her plan cuts $1.175 million in previously approved funding for medical interpretation services in the Medicaid program. The CT Health Foundation reports that 22,000 people with limited English proficiency were enrolled in CT’s Medicaid program in 2003 and that communication is critical to effective health care service delivery. Her plan also diverts $14.5 million in anticipated savings from the state employee health plan from addressing the state’s unfunded liability to her deficit reduction plan. Her plan includes an expectation of $2 million in increased Medicaid Disproportionate Share (DSH) federal funding for hospitals and $157 million from a settlement with the federal government of rates paid to Dept. of Developmental Services intermediate care facilities and group homes. The Governor does not recommend new taxes, layoffs, or accessing the Rainy Day Fund but does include a Tax Amnesty to increase revenues. These cuts follow cutbacks directed by the Governor earlier this year including a hiring freeze. The Governor plans to call the General Assembly into session on November 24th to consider her plan to address the deficit.
Ellen Andrews

Windham PCCM forum cancelled

The provider forum on PCCM planned for October 22nd at Windham Hospital has been cancelled.
To learn more about the program, come to either the October 21st forum in New Haven (at our offices at 703 Whitney Avenue in New Haven) or the October 23rd forum in Hartford (at DSS' offices, 25 Sigourney Street in Hartford). Both are at 6:30pm.

HUSKY/Charter Oak update

At today’s Medicaid Managed Care Council, the HUSKY HMOs’ provider panel reports showed that progress continues to be very slow. Sen. Harris pointed out that at this pace, the two new HMOs will take over a year to reach capacity similar to CHN’s panels. In the counties already transitioning to the HMOs, 94% of HUSKY members have not been able to choose an HMO. DSS still plans to default everyone in the state into an HMO as of December 1st. Letters to that effect will be going out to families in two weeks giving them 30 days to choose a plan or be assigned to one.
Plans for PCCM continue with an anticipated start date of Jan. 1st. Legislators strongly urged DSS to wait to default members into plans until PCCM is operational giving consumers the best array of options and giving PCCM a fair chance to succeed. DSS announced three PCCM provider forums.
DSS also released numbers suggesting that the state saved money under the old HMO-based system compared to the interim fee-for-service based system we have now. They stated that total HUSKY costs in Oct. 2007 (before the HMOs left the program) were $61.4 million and in April 2008 (during the fee-for-service period) costs were $73.3 million. However those numbers do not account for the increase in enrollment of 11,483 people between those dates or the (very high) $18.18 per member per month fee paid to the HMOs in April for administrative processing. However, even if we allow DSS those numbers, adding the 24% increase in rates to the former HMO spending (Oct. 2007 numbers) brings the monthly spending $3 million higher per month than fee-for-service (April 2008 number). The bottom line is that, even using DSS’ numbers, we will likely be spending significantly more under the new HMOs than we did under fee-for-service.
Thankfully, there is good news on the dental carve out. The number of participating dental providers has almost doubled; there are now 342 “Doors Open for Access” or sites to access dental care for HUSKY families across CT with 674 participating providers. We lost a very small number due to lower payments but picked up far more in the new system independent of HMOs. This is very encouraging news for PCCM which is also independent of HMOs.
Ellen Andrews

PCCM provider forums scheduled

DSS has scheduled three forums for providers to learn more about PCCM. They are all at 6:30 pm.
October 21 CT Health Policy Project offices in the Red Cross Building, 703 Whitney Avenue, New Haven
*CANCELLED* October 22 Windham Hospital, 112 Mansfield Avenue, Willimantic
October 23 DSS offices, 25 Sigourney Street, Hartford

Applications and the PCCM concept paper are available on-line.
To RSVP contact Marcea Wolf at Marcea.Wolf@ct.gov or (860) 424-5354.

Report: CT family premiums rising 8.2X faster than earnings

A new report by Families USA finds that from 2000 to 2007, family health insurance premiums in CT rose from $7,292 to $13,173 (80.7%) while CT family median earnings rose only 9.9%. Employees’ share of premiums rose even more – 10.5 times faster than earnings. Individual coverage grew by 52.8% during those years, and employees’ share grew by 73.1%. CT had the third worst disparity between health insurance premiums and earnings. The report doesn’t address the increasing burden on families of rising co-payments, coinsurance and the costs of benefits no longer covered by employer sponsored insurance. Wall Street’s problems will fall hard on CT, and with unemployment already at 6.5 % (above the US average of 6.1%) it is likely that the gap between premiums and earnings will only grow this year.
Ellen Andrews