CMS approves forcing HUSKY families into HMOs

In a reversal of their position in a Dec. 5th letter, CMS is now allowing DSS to force 138,000 HUSKY members, 40% of the total HUSKY membership, to join capitated HMOs that advocates maintain do not have enough providers to provide care. The decision also disregards a letter from CT’s Congressional delegation urging CMS to wait until the networks are adequate. HUSKY families in the Anthem network will lose access to thousands of participating providers on February 1st. DSS is forcing the issue because they want to end their contract with Anthem and they believe the HMO networks are adequate.
Ellen Andrews

HUSKY (waiting for news) and PCCM (more bad news) update

DSS has now changed the date of PCCM’s start from next Thursday to February 1st even in the two small areas they approved, Waterbury and Willimantic. DSS’ plan, approved without revision by the Appropriations and Human Services Committees this summer, called for statewide implementation January 1st. In another sudden change of policy, further limiting the program’s reach, PCCM will only be open to current patients of participating providers in those two areas. In a meeting with providers and legislators last week, DSS stated that they expect to begin offering PCCM in other communities within three or four months. Consumer advocates were dis-invited by DSS from the meeting.

The state still intends to end HUSKY families’ access to Anthem’s more generous list of providers February 1st. Over 130,000 HUSKY members will be forced to find a provider participating in one of the three participating capitated HMOs -- Community Health Network, AmeriChoice (United Health Group) or Aetna Better Health. The state is awaiting word from the Centers for Medicare and Medicaid Services (CMS, the federal agency that oversees HUSKY) about whether the HMOs’ provider panels are sufficient to accept members. A December 5th letter from CMS required DSS to halt enrollment into the two new HMOs – AmeriChoice and Aetna – until they have sufficient network capacity. DSS now believes they have that capacity. But a survey of HUSKY HMO providers in New Haven and Hartford by New Haven Legal Assistance found that only one third are accepting new patients. This could make it very difficult for current Anthem members to find a new provider if forced into the HMOs.
Ellen Andrews

HealthFirst Authority draft report

The Authority’s much anticipated draft report was unveiled earlier this month. Thankfully, it does not include a recommendation for an individual mandate that all consumers must purchase health insurance. The report does recommend auto-enrollment in public programs of anyone who is uninsured with an income under 300% of the federal poverty level. A report on the inadvisability of an individual mandate in CT will be coming soon from the CT Health Policy Project.

Otherwise, the draft contains some good ideas that have been widely discussed – value based purchasing, evidence based medicine, raising Medicaid provider rates, maximizing federal funding, chronic disease care coordination, accelerate adoption of health information technology, better data collection and analysis, cost containment, and health care workforce planning. The authors intend to expand coverage options for CT residents by building on employer-sponsored health care, creating a pool based on the state employee health plan to offer coverage to those with an employer offer, with affordability standards and premium subsidies, and expansions of public programs including Charter Oak. The reforms could be coordinated by current agencies or a new entity. The authors recommend implementation and evaluation of Primary Care Case Management. Cost estimates for the recommendations will be available next month when the Authority will take a final vote on the report.
Ellen Andrews

Health First Authority update

The Authority is winding down, but there is still no draft of the plan. At Monday’s meeting, members got a list of bullet points that caused serious contention. There were many complaints about disorganization and not having a draft to review. Part of the problem is that they are not on the same page about the meaning of some of the bullets. But there are also substantive differences. Creation of a new agency, the CT Health Trust, to coordinate all state health care purchasing, implement national health reforms, monitor progress, ensure transparency, advance change, work to eliminate disparities and ensure everyone has access to quality affordable health care by 2012 caused the most disagreement. Members worried that creating a new “mega-agency” will not solve anything and asked why current agencies are not performing these functions. Plans to build on last year’s state-employee purchasing pool bill also created conflict. They decided to table discussion of the really difficult recommendations – whether to have an individual and/or employer mandate. Overall, the meeting was very contentious with interested stakeholders raising predictable objections and concerns. The facilitator kept trying to take the conversation to a higher level, without much success. There will be another Authority meeting on the 17th; a draft for review has been promised by Friday. I am so sorry I will miss it.
Ellen Andrews

Helpful DSS staff

It’s important to recognize people when they are helpful and good at their jobs, especially at DSS. Over the last couple of weeks four people at DSS have been exceptional and we wanted to thank them. One analyst I called for information ran an independent data analysis for me, and when he learned more about what we needed, he realized that I should have included another category and he re-ran the report. He asked questions, listened to my answers, and offered more help than I asked for. Jen got help from three DSS staffers – two with questions about DSS programs and one to help with a case. All four had to do some investigation to answer our questions and got back to us quickly. Most of them were people we contacted randomly from a website or a report, not personal contacts, but were friendly and helpful.
We want to thank these four and all the wonderful staff at DSS who share our mission to improve health care for everyone in CT. (Names are kept private to protect the innocent.)
Ellen Andrews

CT hospitals more profitable in 2007

The financial status of CT’s acute care hospitals continued to improve last year, according to OHCA’s latest report. Average margins (profits) were 3.62% of revenues in 2007, up from 2.51% in 2006. The biggest winner was Saint Vincent’s with a margin of 14.49%; Johnson lost 18.73% last year. The number of hospitals that lost money dropped from six in 2006 to five last year. Hospitals payments to cost ratios dropped from 2005 to 2007 for private pay, Medicare and Medicaid by 2, 6 and 7%, respectively. The average case mix (measure of patients’ medical complexity) continued to rise, but average length of stay is stable. The percent of discharges for patients in government programs (Medicare and Medicaid) held relatively steady at 58% in 2007. Uninsured discharges were up 14% from 2005 to 2007 while total discharges grew by only 2%. Uncompensated care rose to 3.1% of total expenses in 2007 from 2.8% in 2005, however CT’s average is still well below the national hospital average of 5.7% (2006).
Ellen Andrews

Good news for CT doctors, United to offer “insurance” that you can buy insurance in the future

CT physicians are getting some relief in their medical malpractice rates, according to today’s Hartford Courant. Most will see no increase next year and some will save money. Unfortunately, those savings are not expected to pass onto consumers. Employers and workers face six to seven percent increases in premiums next year.

Other news about doctors -- the most viewed article from yesterday’s NY Times is “Arrogant, Abusive and Disruptive – and a Doctor.” While the majority of physicians are well-mannered and respectful, a small minority who intimidate staff and refuse to do their jobs are reported to be responsible for low morale, workplace stress, and medical errors. Thankfully, the problem appears to be improving.

Today’s NY Times includes a report that United Health Care plans to offer people the option to pay now for the right to purchase individual insurance in the future, even if you become sick. You have to be well now and pass a medical review. The new product, called UnitedHealth Continuity, is not insurance but just the right to buy insurance in the future and will cost 20% of the current cost of individual coverage. There is no price guarantee for the eventual coverage. United expects UnitedHealth Continuity to appeal to people who have insurance now but are worried they may lose it in the future. The author points out that it may not be a good value for consumers and that national health reform may make the product obsolete. United is applying to sell this product in CT.
Ellen Andrews