My favorite end of the year list

Time’s Top Ten Scientific Discoveries of 2009 includes epigenetics, water on the moon, and gene therapy curing color blindness. Some days I miss my old job, but then I learned from the list that robots can do science now. Happy New Year.
Ellen Andrews

The health benefits of coffee

This is one less resolution we need to make for Friday – coffee is good for you, from the Wall Street Journal. Sort of, maybe, not for some people with some conditions. It’s all very complicated. No wonder consumers have no idea what to eat and drink.
Ellen Andrews

How do shared doctor visits work?

Shared medical appointments have been described as an important innovation to improve access to better quality care, especially for chronically ill patients. Proponents claim that shared appointments provide faster access to care, more time with the doctor, support from other patients facing the same illness, better patient and provider satisfaction, and improved efficiency. A video from the Wall Street Journal shows how a shared visit works at Harvard Vanguard Medical Associates in Boston.
Ellen Andrews

Judge reinstates health coverage for 4,800 legal immigrants in CT

Late Friday, Hartford judge Grant Miller overruled Governor Rell’s action to cut off HUSKY for CT legal immigrant adults. Governor Rell implemented the cut December 1st without legislative action. The judge’s reversal was in response to a suit brought by Greater Hartford Legal Aid. DSS intends to appeal the ruling. DSS also incorrectly terminated dozens of immigrants in the administrative move; those residents have been re-instated.
Ellen Andrews

Insurance Dept. approves insurer rate increases 85% of the time

A report by the CT’s Office of Legislative Research on rate increases approved for the five largest health insurance companies, found that the CT Insurance Dept. (CID) sided with insurers in 22 cases out of 26 since 2006. The average approved rate increase was 12%. This analysis covers a small number of health plan rate increases in the state; CID does not have statutory review authority over many plans. The five largest companies are Anthem, HealthNet, ConnectiCare, United and Aetna, in that order. None of United’s previous products are subject to CID review and are not included in OLR’s report. HealthNet will soon no longer offer coverage in CT; CID recently approved United's purchase of HealthNet’s subscriber information despite concerns by providers and consumer advocates.
Ellen Andrews

Patient-Centered Medical Homes in national reform

Very early this morning, the US Senate overcame the last barrier to passing historic health care reform. The bill they will vote on is similar to the one recently passed by the House in many ways, but differs significantly in provisions for patient-centered medical homes (PCMHs). Proponents have argued that PCMHs will both improve the quality and safety of health care while reducing costs. PCMHs are a different way of delivering care -- considering the whole patient, emphasizing prevention and primary care, and drawing on a team of providers all working at the top of their license. The House and Senate versions differ in which providers can serve as the primary clinician in a PCMH, which patients will have access to PCMHs, where the funding is allocated, and in how prescriptive they are about the function of PCMHs. For a description of the bills and the differences, see the CT Health Policy Project’s paper. For a letter on the subject signed by 133 members of the House including our Board member, Congressman Joe Courtney, click here. For more on the patient-centered medical home concept, see our PCMH resource page.

MA anti-smoking program helped 30,000 people quit; exceeds expectations

Three years ago when policymakers in Massachusetts voted to cover anti-smoking treatment under Medicaid, they expected to eventually see results. But the rate of smoking among poor state residents is down from 38% to 28% since 2006, and hospitalizations for heart attacks and ER visits for asthma are also down. The rates of smoking and hospitalizations did not change during the same time period, ruling out unrelated population effects. The results have not been peer reviewed but are so striking that Congress is considering adding smoking cessation coverage to national health reforms. Advocates in CT have been working to get Medicaid coverage of anti-smoking treatments for over a decade with no success. If we had passed the same provision when MA did, CT’s budget hole would be smaller and our state would be healthier. That is only one of thirteen ways to save money in CT’s health care budget that also improve health. Why are we always so far behind the curve? It’s not too late.
Ellen Andrews

Patient-centered medical home committee meeting

Yesterday’s meeting of the SustiNet patient-centered medical home (PCMH) committee was full of energy. The discussion highlighted the tension between all the stakeholder groups who want to make sure their issue area or profession is included with the need to keep PCMHs feasible. If there are too many bells and whistles, it will be impossible for any practice to become a medical home. There are others however who are resisting any standards, saying that NCQA, the nationally recognized accrediting organization, sets the bar too high for most small CT practices to meet. However, payers including the state are not going to reimburse practices for medical home functions just because they say they are doing it – there have to be standards and documentation to be meaningful. When it passes, federal health care reform will settle some of the debate as well as providing significant resources to support PCMHs. We are working on a list of groups to consult with and issues to address. There is a lot of excitement in the committee about making sure every CT resident has a patient-centered medical home and a genuine commitment to collaboration. I can’t wait for the next meeting.
Ellen Andrews

New report finds CT will gain 225,000 new insured if national health reform passes

A new report by Families USA finds that in ten years CT will have 225,000 more insured residents than we do now if the Senate Patient Protection and Affordable Care Act is passed. Without it, our uninsured numbers will grow by 58,000 to almost 400,000. The number of uninsured residents in our state is already larger than the combined total populations of New Haven plus Hartford plus Middletown plus New London plus Bloomfield. CT’s uninsured are ten times less likely to get care for an illness or injury and seven times less likely to get urgent care. Three CT residents die each week because they are uninsured. Nationally, 62% of all bankruptcies are due to medical bills.
Ellen Andrews

Medicaid Managed Care Council update

Friday’s meeting was depressing. The Community Health Centers reported on their large increases in patient volume made possible by investments in infrastructure. In 2008, CT’s clinics provided 263,043 patients with over 1.2 million encounters. Unfortunately, the Governor’s proposed cuts will undermine those gains just as demand for clinic services are up sharply.

DSS outlined the program cuts they will be making without the need for legislative approval. Those cuts include eliminating any transportation for SAGA patients, already cut to the bone. According to DSS, the types of transportation that will be cut are trips to dialysis and chemotherapy. (This means patients receiving chemotherapy will have to take a bus home after treatments.) DSS also intends to increase premiums in Charter Oak between $28 and $78 monthly per income band; those increases will be phased in to begin in February. Interestingly, Charter Oak applications have leveled off in recent months and HUSKY/Charter Oak applications are actually down – difficult to understand given unemployment numbers. Unfortunately more HUSKY/Charter Oak and Charter Oak applications are being denied.

In a bit of good news, DSS reported on significant progress in recruiting providers for the PCCM expansion effective Jan. 1st, particularly in the New Haven area. An army of independent work-study students, interns and volunteers with the CT Health Policy Project and New Haven Legal Assistance have been working hard in the area including mailings and phone calls to all practice managers in the region, provider forums, visiting provider offices, and a media campaign. We’ve also been reaching out to consumers through mailings, calls, other community organizations, newsletters, schools and churches. We have printed brochures, flyers, and other outreach materials.
Ellen Andrews

CT 28th in nation in tobacco prevention spending, and that’s the good news

CT is up to 28th among states in spending on tobacco prevention, according to a new report from the Campaign for Tobacco Free Kids. The bad news is that we will spend only $7.2 million this year on prevention, 16 % of what CDC recommends. However we bring in $494 million from the tobacco settlement and in tobacco taxes annually. Every year 4,000 new CT children become smokers and 4,700 CT adults die due to their own smoking.
Ellen Andrews

How reducing health care costs could work

Many pundits have criticized the national health reform bills because they don’t do enough to reduce costs – to “bend the cost curve” – and deride the pilot programs to test cost cutting innovations. But an article by Atul Gawande in the latest New Yorker magazine describes how government sponsored pilot programs reduced skyrocketing food costs and reformed agriculture a hundred years ago. Criticized for leading to a government takeover of agriculture, the pilot programs are responsible for the fact that the average American family now spends 8% of income on food, down from 40% in 1900. Efficiencies have also allowed most workers to expand to other sectors, like health care. The pilots included data collection and analysis, dissemination of best practices, and reducing fragmentation. Sound familiar?
Ellen Andrews

Obesity and tobacco forum

The CT Public Health Policy Institute will hold a breakfast forum on overweight and obesity in CT and tobacco use and smoking in CT Tuesday Jan. 19th from 8 am to noon in Room 2A of the Legislative Office Building. The forum will include presentations with background, cost analysis and consequences of the problems followed by a panel on future interventions and time for questions. The research was funded by the Universal Health Care Foundation of CT. Previous work by the CT Public Health Policy Institute includes an analysis of overweight and obesity in CT, and another on CT’s primary care capacity.

Insurance Dept. approves United-Health Net acquisition

Not surprisingly, the CT Insurance Dept. (CID) has approved United Health’s proposal to purchase information on all Health Net members, past and present. Advocates and providers have raised grave concerns about the merger including privacy of sensitive health information, consolidation in CT’s already anti-competitive insurance market, and large increases in premiums for consumers and small businesses. Health Net will no longer be offering health insurance in CT; United has proposed paying millions to buy Health Net’s list and information on members. In defending their decision, CID maintains that if Health Net members who are offered coverage by United aren’t happy, they can shift to another plan. The only problem is that every one of those consumers always had the option of choosing United for their health care and rejected them. It is not clear that United was everyone’s second choice. Defaulting them into United or dumping them into an even more hostile insurance environment with one less choice is no favor. Based on CID’s softball questions to the insurers and refusal to allow us a voice as interveners, it was clear to this observer that the outcome was decided before we entered the hearing. The Attorney General’s office is investigating the proposed merger for anti-trust violations.
Ellen Andrews

Way too much fun

The pink glove dance to raise breast cancer awareness from the Providence St. Vincent Medical Center in Portland, OR.

December web quiz – CT managed care plan performance

Test your knowledge about the performance of CT’s managed care plans. Take the December CT Health Policy web quiz.

The upside of rising unemployment and rising health costs

An article in yesterday’s Wall Street Journal found the silver lining in our current economic crisis. As incomes for many dropped this year and health care costs for virtually everyone went up, more Americans will be able to qualify for the end of year tax deduction for medical expenses. Because the rules do not allow deductions until health care costs rise over 7.5% of income, few filers have been able to take it in the past. But this year more people will be eligible. In more good news, the range of expenses that qualify as medical for IRS purposes is large but there are important strategies to claiming the deduction. Most important is documenting the expenses and managing the paperwork.
Ellen Andrews

Public hearing on impact of the recession

Speaker of the House Chris Donovan is holding the first of five hearings around the state on the impact of the recession on CT families this Saturday, December 5th at 10am at the Legislative Office Building, Room 2C. Policymakers especially want to hear from children and youth about how the recession is affecting them, their families and their communities. The first hour is reserved for youth testimony; grownups to follow. This hearing will focus on the First Congressional District, represented by Congressman John Larson. The hearing is sponsored by the Speaker’s Task Force on Children in the Recession and hosted by the First District Youth Cabinet. For more information, click here.

CT ranks 7th healthiest among states

America’s Health Rankings again finds CT’s overall health better than 43 other states. The good news is that we do well with a low rate of smoking (16%), obesity (21%), and uninsured (10%). The bad news is that we have high rates of infectious diseases and low rates of immunizing children. Authors of the rankings predict that obesity will soon become the prime health problem in the nation. They predict that by 2018, one in three CT residents will be obese. Obesity costs each CT resident, whether obese or not, $1,052 on average. However, if we were able to keep our rates as they are now, by 2018 we would save $582/adult state resident in health bills.
Ellen Andrews

Kaiser compares Congressional health reform bills

The Kaiser Family Foundation has posted a comprehensive comparison of the US House and Senate health reform plans.

Governor’s mitigation plan slashes health programs; 13 better alternatives offered

Yesterday the Governor released her plan to address the $470 million deficit for this fiscal year. This is on top of the cuts made in the budget that passed into law a few months ago. Her proposal includes cuts to the diaper bank, autism pilot, drugs in public coverage programs, new premiums and increases in HUSKY, higher copays in HUSKY and Medicaid, eliminate vision and transportation in SAGA, delay HIV/AIDS waiver, cut lead poisoning programs, genetic disease programs, school based health centers, eliminate adult dental care in Medicaid and SAGA, cut Healthy Start, cuts to community health centers, hospitals and nursing homes. Her proposal also empties all the money out of several funds including stem cell research and the Tobacco and Health Trust Fund.
Sadly, there are alternatives that could save the state money as well as improve health care. We have offered thirteen of them.
Ellen Andrews

Insurance Dept. hearing on United Healthcare buying HealthNet

Monday’s CT Insurance Dept. (CID) hearing on the acquisition of Health Net’s license by United Healthcare was fascinating. If you didn’t hear anything about it, you’re not alone. It was not well publicized, there was little time to respond, and the hearing was not held at the Legislative Office Building, but in a windowless room, down a maze of halls, in the back of the CID offices in Hartford. Just to set the tone of the hearing, the pens for visitors to sign in with at the CID offices carry the United Healthcare logo. The CT Health Policy Project, the CT State Medical Society, the American Medical Society and Patient Advocacy Institute had already been denied intervenor status in the proceeding; apparently CID does not believe that consumers and providers have a critical interest in the proposal.

In an unprecedented arrangement, United is not merging with Health Net (which is leaving CT), but simply buying all their information about us. They can then choose which of us, possibly based on our health status, they will offer to insure. They can also decide what they will charge us. United could more than triple their share of CT’s health insurance market; studies have found that less competitive markets lead to higher premiums for everyone. CT’s health insurance market is already too concentrated and we are at high risk for anti-trust concerns. Also, consumers who are lucky enough to be defaulted into a United policy may have to change doctors and medications. United’s provider panel is sparse in areas of the state and they have a different formulary than HealthNet. Also, as a matter of privacy, United will now have sensitive personal health information on about 200,000 state residents that we never consented to share with them. Health Net is now under investigation for losing a hard drive with Medical claims data. I also pointed out that all those 200,000 HealthNet members already had the choice of insuring with United and rejected it. To default them into a plan they already rejected is not doing them any favor.

For two hours, United’s own lawyers were able to ask their own executives and consultants softball questions extolling the virtues of the proposal. Then CID staff asked technical questions for another hour. Interestingly, United happened to have a large chart display just to respond to one of the CID staff questions. Then we had our turn at the podium. The CT State Medical Society, the Office of Health Care Advocate, the Center for Medicare Advocacy, the American Medical Society, the Patient Advocacy Institute, Middlesex Professional Services and the CT Health Policy Project all testified in opposition. We got very few questions. Then the United witnesses were asked softball questions by CID staff allowing them to rebut any of our concerns (I’m told lawyers call that rehabilitating the witness). One of those questions to the insurer asked whether actual workers in a small business have a role in choosing the insurance plans offered. United, as experts on small businesses like ours, answered that only owners have that choice. I guess that means that consumers really don’t have a voice in choosing health plans, only employers. (In our small group the opposite is the case, but I wasn’t given an opportunity to say that). We were only allowed to submit any written comments for a few hours, however United was given until 4pm the next day to submit anything they choose.
Democracy in action.
Ellen Andrews

Congressman Larson to hold forum on Women’s Health

Women’s Health Care: A Call to Action, sponsored by Congressman John Larson, will be this Tuesday from 8:00 to 9:30am at the Hartford Hilton, 315 Trumbull St. Speakers include Judith Stein of the Center for Medicare Advocacy, Teresa Younger of the Permanent Commission on the Status of Women and Ellen Andrews from the CT Health Policy Project. To register, contact Congressman Larson’s office at (860) 278-8888.

New in the Book Club: Super Freakomonics

Who knew that economics, microeconomics at that, could be entertaining? Super Freakonomics, our newest Book Club addtion, includes more examples of why everything, even things that don’t seem it, involves competing incentives and how to find simple, cheap solutions by thinking about things differently including information technology and ER overcrowding, measuring the skill of doctors, and getting doctors to wash their hands with a screen saver. Did you know that walking drunk is more dangerous than driving drunk (the authors don’t promote either)? How the automobile saved New York City from a horse manure crisis. Does a sex change affect your salary since men make more than women? Really funny stuff.
Ellen Andrews

Medical home and PCCM meetings

Yesterday’s organizational meeting of the SustiNet Patient-Centered Medical Home Advisory Committee was very encouraging. There is a lot of energy across stakeholder groups, especially among providers and payers. We are soliciting input on who/what groups to consult for input and what issues to consider. Suggestions include business coalitions, NCQA, medical homes from other states, consumer and provider groups. Issues raised include integrating primary care with behavioral health, the role of chiropractic care, primary care shortages, health IT, the costs of implementation, and savings to the health care system. It was also noted that while policymakers are learning about the medical home model, most providers still need to understand it.

Unfortunately, the meeting of the Medicaid Managed Care Council’s PCCM Subcommittee that followed did not go as well. DSS has refused to remove the irrelevant and intimidating Freedom of Information clause in PCCM provider contracts. As one provider in the room put it – the first time a provider gets a request or a subpoena, that will be the end of the program. It is important to note that providers participating in HMOs are not required to sign similar contract language. DSS also continues to refuse to devote any resources to marketing PCCM, despite the overwhelming marketing allowed by the HMOs, paid for out of tax dollars. DSS estimated that the HMOs were spending 1% of the cap rates on marketing, which is roughly $7 million/year. Marketing activities by HMOs, approved by DSS, and paid for out of tax dollars, include free ice cream and haircuts to sign up with an HMO, a banner behind an airplane at a community festival, gifts, radio and billboard advertising, and raffles for school uniforms and supplies. DSS noted that when they talk to providers about signing up for PCCM, they also encourage them to sign up for the HUSKY HMOs and Charter Oak. It is unclear whether providers understand that they can sign up for just PCCM or if they believe they have to also sign contracts with the HMOs. DSS also announced that they will hire Mercer to conduct an evaluation of PCCM to be done by July. However, they acknowledged that the very small enrollment in the program so far makes it nearly impossible to make valid statements about how well the program is doing in providing care, reducing costs, or improving quality. Mercer was the DSS contractor that approved the 24% HMO rate increases for the HUSKY HMOs, which were called into question by the Comptroller’s independent audit, and derives a great deal of their business from managed care plans, in CT and nationally.
In the meantime, advocates are working without any tax dollars to market PCCM to both providers and consumers in New Haven and Hartford in anticipation of the program’s roll out there January 1st. We have an army of volunteers and energetic students mailing and calling providers, practice managers, community organizations and consumers. We are holding two forums open to anyone interested, and eligible to join, the program. By far the largest obstacle we are encountering is skepticism about DSS’s commitment to the program and a strong distrust of the state. If you are considering PCCM, for more information click here.
Ellen Andrews

Governor’s health reform council meeting

In Governor Rell’s message when she vetoed HB-6600, the SustiNet bill, she created a CT Health Care Reform Advisory Board. Her board mirrors the SustiNet Board in many ways, but largely includes people appointed by or who work for her. While the legislature over-rode her veto and the SustiNet Board has been up and running for months, the Governor has decided to convene her group anyway. They met for the first time yesterday. Membership is very conservative including the insurance industry, an insurance broker representing a very conservative small business coalition, state agencies, and some providers. No consumer voices are at the table. Members urged payment reform, health system reform, and health information technology. Covering the uninsured rarely came up; ensuring that people get the value they pay for out of insurance, curbing insurance company abusive practices, limiting administrative overhead and profits, and protecting consumer rights were never mentioned. There was a great deal of criticism of current federal reform proposals. Aetna made a remarkable, and expensive, offer – they will provide free actuarial support to cost out the group’s recommendations. I guess they are confident that the group will only endorse options they agree with. Aetna also got the Chair to agree to move up the date for final recommendations from January 2011 (after Governor Rell’s term is over) to the middle of 2010.
Ellen Andrews

CT’s hospital safety system questioned

Media reports have raised concerns about patient safety in CT hospitals and the system that is meant to protect us. A Hartford Courant article on Sunday uncovered thousands of “adverse events” or dangerous mistakes at CT hospitals that were never reported to DPH. A 2002 law mandated public reporting of serious errors, but a 2004 law watered down the reporting requirement so that most of the errors do not need to be reported at all, and those that are, remain secret. Proponents of the 2004 law maintain that shielding error reports from the public encourages reporting and development of constructive plans to fix the problems. However there is no evidence that it is working that way and the number of investigations is down since 2004. The AG has called for a return to strong public reporting requirements. Indiana, Minnesota and Massachusetts all provide consumers with detailed, specific information on medical errors, and in at least one state that reporting has served as a “catalyst for change” leading to adoption of best practices and better quality care. Sunshine heals.
Ellen Andrews

Medicaid Managed Care Council meeting

Friday’s Medicaid Managed Care Council meeting was very frustrating. Upon questioning, DSS made clear that they will not be recovering the $50 million in overpayments to the HUSKY HMOs that were identified by independent auditors commissioned by the Comptroller, proposed by the Governor to cut for the current state budget and agreed to by the General Assembly. To be exact, they stated that they are “in negotiations” but in response to questions they stated that they are concerned that the HMOs might choose to leave the program and echoed the perennial, tired complaint that the HMOs aren’t making enough money. They claimed that the Milliman audit was based on earlier financial information. (Leaving aside the issue that DSS refused to share more recent financial information with the auditors.) They had no answer when reminded that the HMOs have always whined that they don’t make enough money on this program, including the years that Milliman used in their analysis. They also raised the threat that any cut to the HMOs will result in reduced services to consumers. Why the HMOs can’t manage on rates comparable to what other states are paying, and why DSS wouldn’t enforce their contracts was not addressed. Apparently, re-bidding the program is too hard, which led to the point that if DSS is not willing to lose any of the HMOs, it can’t be much of a negotiation. They also conveniently forgot that the advocates and the General Assembly have given them an alternative, a bargaining chip (not to mention a better option for consumers based on patient-centered medical homes) in PCCM which DSS has been unable and/or unwilling to implement.
Although it was on the agenda, PCCM wasn’t discussed at the meeting, again.
Ellen Andrews

SustiNet Board and Workforce Task Force meetings

Yesterday the SustiNet Board heard from eHealthConnecticut , a CT nonprofit created four years ago to develop a secure statewide health information exchange. The Board includes broad representation across the health care spectrum including physicians, hospitals, clinics, pharmacists, employers, insurers, academics, quality organizations, state agencies, policymakers and consumer advocates including the CT Health Policy Project. Scott Cleary described eHealthCT’s three main projects to date. The CT Health Quality Cooperative allows physicians to compare their performance on a variety of quality measures to their colleagues across the state and nation. CHQC is one of only a handful of similar quality comparison projects in the US. eHealthCT is also working on a pilot health information exchange set to go live next February for Medicaid clients. (Editorial comment: How great is it that we are starting health information exchange in CT with the Medicaid population – usually the last to benefit from innovation.) eHealthCT has also submitted CT’s application for federal stimulus funds to create a health information technology regional training center to assist providers adopting electronic medical records. The SustiNet Board also began approving members of the advisory committees, but is continuing to accept names. The next meeting of the Board will be with committees on Nov. 23rd. As much of the work is now happening in the committees and task forces, the full Board will not meet again until January. You can sign up for alerts on SustiNet meetings and publications online.

At the Health Care Workforce Task Force meeting yesterday afternoon, the group finalized a list of groups we will reach out to for input and recommendations. The next meetings of the task force will be early next year with these groups. There was interest in mapping providers across the state geographically, tracking not only numbers of providers but patient access to care, particularly for Medicaid and HUSKY, including the public health workforce in our deliberations, how technology can help improve training, and measures to address skyrocketing prescription drug costs. The task force agreed to ask for a joint meeting with the Allied Health Workforce Policy Board which has been working for several years to identify and address areas of need. Chancellor Mark Herzog provided the task force with a compilation of the allied health and nursing programs at each of CT’s community colleges. Decisions about what programs to offer is driven by community demand, market forces, and constraints on state funding. Nursing is the most expensive program to offer.
Ellen Andrews

Hartford area PCCM/HUSKY Primary Care forum

A forum for providers and consumers eligible for and considering the new HUSKY Primary Care/PCCM option is being held in Hartford on Tuesday November 24th from 5 to 7pm. The forum will be at the offices of Greater Hartford Legal Assistance, 999 Asylum Avenue, 3rd floor, Hartford. HUSKY Primary Care, a form of Primary Care Case Management (PCCM), will be available to HUSKY families by January 1st. A forum will also be held for the New Haven area, at our offices, 703 Whitney Avenue in New Haven on Thursday, November 19th from 6 to 8pm. For more information on either or to RSVP, call (203) 772-2817 or email information@cthealthpolicy.org. The forums are hosted by the CT Health Policy Project and the New Haven Legal Assistance Association.

Governor’s Health Care Reform Advisory Board to meet

The Governor’s Health Care Reform Advisory Board will hold its first meeting November 17th from 9 to 11am; the site has not been determined. The committee was created by the Governor’s Executive Order No. 30 accompanying her veto of HB-6600, the SustiNet bill. The General Assembly subsequently overturned her veto. The SustiNet Board has been meeting for two months and is constituting its advisory committees. Various members of the administration have attended and participated in SustiNet Board meetings. The Governor’s committee is Chaired by Cristine Vogel, Deputy Commissioner of Public Health, and also includes Thomas Sullivan, Commissioner of Insurance, Mike Starkowski, Commissioner of Social Services, Robert Galvin, Commissioner of Public Health, Robert Dakers, OPM, Nancy Wyman, State Comptroller (who Co-Chairs the SustiNet Board), Mark Bertolini, Aetna, Jim Cox-Chapman, ProHealth Physicians, Christopher Dadlez, St. Francis Medical Center, Rick Willard, National Federation of Independent Businesses, Lenny Winkler, former legislator, Cathy Bartell, and Carole Noujaim.
Ellen Andrews

New in the Book Club

Silence Kills: Speaking Out and Saving Lives (Edited by Lee Gutkind, 2007) is a collection of essays describing real life stories from providers and victims about their experiences with medical errors. Providers’ descriptions of pain, guilt, shame, and fear for their future are compelling. Victims’ stories include indifferent and careless providers and a stupid system that leaves them with few options to get the care they need. The heroes in these stories are eager to confront their errors, system design failures, and to embrace shared problem solving with other providers, with patients and with families.
Ellen Andrews

House passes historic health reform bill

Late Saturday evening, the US House of Representatives passed HR-3962, the Affordable Health Care for Americans Act, by a margin of 220 to 215. If passed into law, the bill would provide affordable, comprehensive health coverage for nearly all CT residents. The measure requires both consumers and employers to purchase coverage, includes subsidies for low income consumers and small businesses, a decent public optional plan for consumers to choose (or not), closes the Medicare prescription drug coverage doughnut hole, a large increase in Medicaid eligibility regardless of family circumstances, important insurance market reforms including prohibition of coverage denials for pre-existing conditions, creation of a health insurance exchange to help consumers choose coverage that works for them, and initiatives to moderate rising health costs, manage chronic disease, create patient-centered medical homes, and support prevention and wellness. The bill is the most important health legislation to pass since Medicare and Medicaid were created in 1965. All of CT’s five House members voted in favor of HR-3962. The reform battle now moves to the Senate with far weaker proposals pending.
Ellen Andrews

PCCM/HUSKY Primary Care Forum

To answer questions as PCCM, now known as HUSKY Primary Care, is rolling out in New Haven and Hartford by January 1st, advocates are holding a forum Thursday November 19th at 6pm. It will be at our offices in the Red Cross Building – 703 Whitney Avenue in New Haven. The forum is sponsored by the CT Health Policy Project and New Haven Legal Assistance. For more information call (203) 772-2817 or email information@cthealthpolicy.org.

CT Health Care Advocate’s Office has saved consumers $2.7 million so far this year

The Office of Health Care Advocate's latest update reports saving state consumers $2.7 million in denied health care claims and services through September of this year, including $700,000 in the third quarter alone. Last year the office saved consumers over $5.2 million and are predicting an increase of over 50% in the number of cases for this year. Consumers having trouble accessing health care can call the office for assistance toll-free at 1-866-466-4446.
Ellen Andrews

November CT health policy quiz

Test your knowledge of the CT health system's performance. Take the November CT Health Policy Project web quiz.

Another reason to be an advocate – you’ll be happier

A researcher has found that people who are politically active are happier than disengaged citizens who can’t name the Vice-President. Protesters are more optimistic and socially connected. And there is some evidence that it isn’t just an association; that getting people to think like activists makes score higher on “vitality.” Aristotle apparently stated the same thing, although it’s not likely he did a controlled experiment. Personally, I think at a certain point there are diminishing returns.

Ellen Andrews

Behavioral Health Partnership forums

The CT Behavioral Health Partnership, family advocacy organizations and the Community Collaborative are sponsoring three forums about Enhanced Care Clinics (ECCs). The Partnership is CT’s non-risk program providing coordinated mental health and substance abuse services to HUSKY members. ECCs are behavioral health providers that offer timely urgent and routine care as well as coordination of services and are culturally competent. The forums will be:

Nov. 4 from 9 to 11:30am in Enfield at the St. Francis Care Building, 7 Elm Street
Nov. 4 from 11:30am to 1pm in Danbury at the Tarrywile Park & Mansion, 70 Southern Blvd.
Nov. 16 from 11am to 1pm in Hartford at the Village for Families & Children

For more information call (860) 263-2172 or (877) 552-8247 or email ctbhp@valueoptions.com

Capitol Hill visit

It was an exciting time to be in DC yesterday. Our health policy class was able to attend the House press conference on the West Steps of the Capitol releasing their health reform bill that is expected to go to the floor next week. We heard from a panel of very tired health policy staffers from across the spectrum including Sarah Dash from Congresswoman Rosa DeLauro’s office, who I spoke with at length later about the bill. In the afternoon I visited all the offices of CT’s delegation. CTHPP Board member Congressman Joe Courtney and his health staffer, Maija Welton, were very gracious. Joe had just left the House Caucus and full of details about the bill. Senate staff in Sen. Dodd’s HELP committee were less sanguine about the chances of getting 60 votes for many of the House bill’s best provisions but very helpful in explaining where they are. Asked what we can do to help them, Joe asked that advocates work to clear up the myths being sold to seniors that health reform will harm Medicare. In fact, the House bill reduces and eventually eliminates the donut hole in prescription coverage, adds coverage for more preventive services, includes demonstrations for important initiatives that could vastly improve access to care, care coordination, and would help stabilize the program’s financial stability (which without reform is tenuous). My visit was energizing and exciting – I haven’t said that about a visit to DC in a very long time. It is very possible that something historic is about to happen.
Ellen Andrews

Last day of policy training classes

Yesterday was our last day of classroom federal health policy training. Our “classroom” has been the Kaiser Family Foundation’s Barbara Jordan conference center in downtown DC – a fantastic facility. We had an intriguing breakfast discussion with a registered lobbyist who has worked for Academy Health, the health research think tank that is running the training, and GAO. We had backgrounders on Medicare and state health policy and a session on how to communicate with policy leaders. Not surprisingly, advocacy at the federal level is a lot like the states – same motivations, same dynamics – but slower and more deliberative. This training is primarily for health services researchers; my classmates are very frustrated that research isn’t the only factor that drives health policymaking. It’s far worse at the state level. Today we go to the Hill for our last day of training.
Ellen Andrews

More health policy training in DC

Yesterday we heard about polling, federal budgeting, the role of the judiciary in health policy and a capstone panel with an overview of policymaking from beginning to end using regulation and rule making for electronic health information breach notification in the federal stimulus bill as a case study. The panel on the role of the judiciary was fascinating. We heard the differences (courts don’t care about data or statistics, it is all driven by individual cases or anecdotes) and similarities (politics decides alot) with policymaking in other branches. The bioethics underlying the law came up repeatedly – medical marijuana and assisted suicide cases. But the one that fascinated me most was a hospital in rural Maine that sued recently claiming that the requirement that hospitals treat everyone who enters their doors (at least to stabilize them) regardless of ability to pay was an unreimbursed “taking.” Something like when government takes your home to build a highway, they have to pay you a fair price. The hospital claimed that the government was requiring them to provide uncompensated care and not reimbursing them. This hospital provided only a very small amount of uncompensated care – 0.5% of revenue -- the national average is ten times that. The Courts found against them, but the reasoning was that the hospital’s trustees didn’t have to run a hospital. They could have chosen to convert it to another purpose (a hotel maybe?) and then nothing would be “taken”. I can’t wait to see what we’ll learn today.
Ellen Andrews

DC health policy training

This week I am learning about how health policy gets made at the federal level, thanks to funding from the Council of State Governments/Eastern Region. Yesterday we heard the basics – White House offices and staff dynamics, how Congress works, then how it really works, agencies and their roles in developing policy, and how it all interacts. My head still hurts from the complexity, but the parallels to state policymaking help. Everything is framed in the context of the current health reform debate. It is an extremely exciting time to be here.
Ellen Andrews

CT Voices re-opens search for budget analyst position

CT Voices for Children is seeking a budget analyst to research family economic security issues and state fiscal analysis. CT Voices is a New Haven-based nonprofit advocacy organization working on behalf of children and families.

Another PCCM/HUSKY Primary Care outreach tool

A brochure for consumers about the PCCM/HUSKY Primary Care option is available on the CT Health Policy Project website.

From the Consumer Helpline

On Wednesday, the New Haven Adult Education Center held their Community Resource Day. This was my first consumer outreach event, and it was a great introduction. The fair was extremely well-attended, and the organization of the event and how smoothly it ran really impressed me. Different groups and classes from the Center came in at staggered intervals, so it was always busy but never too crowded. Because of the variety of programs the Center offers, there were people of all ages, and we handed out a ton of tip sheets, in both English and Spanish, and applications for HUSKY and Charter Oak. Many people also asked us specific questions about their own health care experiences, options, and situations, and one person has already called us to find out more about the information we gave him at the fair. Lots of the people we spoke to were interested in finding alternative insurance programs because they had recently lost their jobs and, therefore, their health insurance. We also heard from a young woman who has Charter Oak and who cannot find a doctor who will see her, which, as this blog has written about, is a common complaint about the program. In general, the younger students at the Adult Education Center had less interest in our table, which I initially assumed was because of the stereotype of the young invincible who believes s/he can’t get sick. Once I talked to a few of them, though, it turned out that most of them had HUSKY or other insurance from their parents already, so they didn’t need to worry about health care yet.

I also very much enjoyed seeing the other organizations at the fair and learning more about the resources available to the New Haven community. Yale can be very isolated from the rest of the community, so I had only a vague idea about the number of community organizations in the area. Everyone was very friendly, and a couple of youth and community groups took tip sheets and signed up for our newsletter. Overall, it was a very successful and enjoyable event, and I am looking forward to doing more of them.

Sabina Klein, CTHPP Fellow

New PCCM/HUSKY Primary Care outreach tools

New outreach materials for use by advocates recruiting providers and consumers into PCCM – now named HUSKY Primary Care – are available on the CT Health Policy Project website. The tools include a updated FAQs for providers and for consumers. Our new consumer newsletter is also posted in English and Spanish.

Michigan Medicaid dental cuts cause woman’s death

A Northern Michigan’s woman’s death last week is being blamed on her inability to access oral health care in Medicaid. Her untreated infection could have been prevented; she was scheduled for surgery just days after her coverage was cancelled. Her dental clinic was willing to donate the surgery but Medicaid refused to pay for hospital costs. Because of budget cuts, only emergency dental care is covered for adults in Michigan’s Medicaid program, as of July 1st.

“This woman had a chronic dental infection that ultimately killed her. If the
infection had been but a dental infection, Medicaid would have paid for
treatment, including hospitalization,” said Thomas Veryser, Executive Director
of Dental Clinics North. “We predicted cuts to the Adult Dental Medicaid Benefit
would cost lives and now it has.”

Ellen Andrews

October CT Health Policy Web Quiz

How much do you know about the CT Health Policy Project? To celebrate our Tenth Anniversary, this month’s online web quiz, the CT Health Policy Project By the Numbers, marks our accomplishments.

Courant editorial calls for DSS Commissioner search

Yesterday’s Hartford Courant editorial calls for a broad search for the next Commissioner of DSS. This echoes other voices, including ours. State health care programs have struggled in recent years. National health reforms offer Connecticut exciting new opportunities but also immense challenges that will make the last decade seem easy. The choice of a new Commissioner is critical and cannot wait.
Ellen Andrews

From the Consumer Helpline

A consumer called our helpline because she needs help paying for her daughter’s medical bills. Even with insurance, the co-pays and deductibles are adding up. Her daughter is 4 years old and has cystic fibrosis; she was in the hospital, which had a $500 co-pay and the mom has to pay for her prescriptions before she can pick them up, totaling another $1,500. It is a little more difficult to find resources for people who are insured but still having trouble paying for the care they need. There were some resources for people with cystic fibrosis and others for children with chronic illnesses. Each program has a separate intake screening and application process. The mom is already applying for HUSKY so she can try to get help through the hospital for that bill. On the phone, she sounded discouraged and exhausted. In addition to taking care of a child with a chronic illness, she has to make a lot of phone calls and fill out all sorts of paperwork to try and get her daughter the medical care she needs.
Jen Ramirez

New report estimates 28,100 new uninsured in CT this year

Based on rising unemployment rates, a new study by Families USA estimates that 28,100 more CT residents are uninsured this year than last. Unemployment in CT as of Aug. 1st was 8.1%, up from 6.1% last August. This places CT 40th in the nation in rates of uninsured; in 2008 we were 45th according to the US Census. People without health coverage are more likely to delay seeking needed care until problems are more difficult and more expensive to treat. Sixty two percent of bankruptcies nationally are caused by medical bills.
Ellen Andrews

SustiNet meeting today cancelled

Today’s SustiNet meeting at the Capitol is cancelled due to illness.
We’ll let you know when it’s rescheduled.

New resource for CT physicians on quality of care

eHealthCT together with a long list of partners is providing physicians with quality measures for their practices across payers through a new iniative, CT Health Quality Cooperative (CHQC). CHQC is the first of its kind tool in Connecticut and one of only a handful nationally to aggregate data across health plans and Medicare to provide physicians with a comprehensive set of data on eight quality measures for their practice in comparison to other physicians across the state. Partners include Aetna, Anthem Blue Cross and Blue Shield, Bridges to Excellence, ConnectiCare, the CT State Medical Society-IPA, HealthNet, UnitedHealthcare and Qualidgm. Previously physicians could only access information about their quality performance for patients from each payer separately; the new report aggregates patients to provide more meaningful information that providers can use to improve care. CHQC covers approximately 95% of insured CT residents. Initially the CHQC indicators focus on diabetes, coronary heart disease, asthma, childhood respiratory infections and several preventive measures such as testing for cervical and breast cancer, and cholesterol testing. Funding was provided by the partner organizations and from the UConn Foundation for a physician continuing medical education module to help assess and use the information to improve care in their practices.
Ellen Andrews

Medical home panel at NASHP conference

Today’s medical home panel at the NASHP conference in Long Beach focused on partnering with the private sector. RI has coordinated all the payers to make incentives salient and set common standards. OK has 420,000 enrolled in their Medicaid medical home/PCCM program and is saving millions. Most are using NCQA accreditation of medical homes. PA has 1.2 million in their chronic care model medical homes. Payments to providers can reach $95,000/year. Technical assistance, learning collaborative and other support for providers is key in all three states. The common theme is that states have to take a leadership role, as a payer, convener, and regulator; when states convene the stakeholders, payers can coordinate without worrying about anti-trust issues.
Ellen Andrews

NASHP pre-conference on payment reform

Today’s pre-conference meeting to the National Academy of State Health Policy’s annual conference took on the elephant in the health policy room – how to align incentives among payers, providers and consumers to reward quality and efficiency. Health care is a very fragmented, very large business and it doesn’t turn on a dime. But a number of states have had success in reforming payment systems both in the care the state directly purchases (Medicaid, state employees, etc.) and using its bully pulpit to move other payers. States have a unique role as a major payer and the primary regulator of health care. Models vary from pay for performance that most states have implemented (but not CT yet) to global capitation payments (proposed in MA). Spending per person varies significantly between and, in some cases, within states and there is no evidence that better quality of care or outcomes follow higher spending. States have identified significant savings and improvements in quality. There was a lot of discussion about how to develop Accountable Care Organizations, integrated health systems that can be held accountable for value across the care continuum. CT is unique in that we have alot of small physician practices that are not formally linked to hospitals or other institutions so creating ACOs here will take more organization and more time. PA has an extensive medical home program covering 1.2 million patients that is helping reform payment systems and improving coordination of care for state residents. Minnesota described their reforms that include “baskets” of bundling payments for care to promote transparency, P4P, public health improvements including obesity and tobacco prevention, medical homes, health information technology, and health care cost measurement. We also heard from Washington State legislative and administration staff, cooperating across branches of government, about their success in integrating evidence based science into payment decisions that has saved the state between $40 and 60 million in pharmacy costs alone. Fascinating stuff.
Ellen Andrews

Medical home conference

Saint Francis Health Care Partners is holding a very comprehensive Medical Home Symposium Thursday November 5th at the Hartford Marriott Farmington. If you are considering this important practice innovation or just want to know more, you will learn all you need to know. Session 1 from 1:00 to 5:00 pm includes Paul Grundy of the Patient-Centered Primary Care Collaborative, Ken Sacks from the CT State Medical Society, Robert Fortini of the Queens Long Island Medical Group, Barbara McCann of Interim Health, Mary Allegra of Masonic Care, Sandra Nichols of AmeriChoice and myself. Session 2 from 5:00 to 8:00pm includes Paul Grundy, Terry McGeeney of TransforMED, Robert Hockmuth of CIGNA, and Suneel Parikh of the Queens Long Island Medical Group. Registration is $50 for one session or $90 for both. Click here to register. For questions, contact Rose Stamilio (860) 714-6162 or rstamili@stfranciscare.org.
Ellen Andrews

SustiNet Board meeting

The Board made progress on workplans and committees at yesterday’s meeting. They added a health disparities and equity committee, and asked for input on membership for the others. The workplans for the committees and the Board we adopted with some minor revisions. Workplans and membership lists are online. All meetings will be public and subject to Freedom of Information laws.

In other news, the health care workforce task force will be holding its first, organizational meeting October 15th at 4:30 pm in Room 1C of the Legislative Office Building.
Ellen Andrews

Families report on how national health reform will benefit CT consumers

A new report by Families USA outlines how national health reform proposals will improve health care for CT consumers from current law. Issues include coverage for pre-existing conditions, premiums based on gender and health status, expanding options for coverage, affordable premiums and out of pocket costs for families and small businesses, annual and lifetime caps on coverage, limiting administrative and profit overhead, maintaining coverage when consumers become sick, covering the uninsured and low income consumers, and Medicare improvements.
Ellen Andrews

CT Health Policy Project turns ten

The number of CT residents living without health insurance is up 18% in the last ten years. Ten years ago the CT Health Policy Project began our work to improve access to quality, affordable health care for every CT resident. In the last ten years we’ve published 223 analyses, briefs and studies and mentored 43 students. To mark the occasion we asked nine prominent CT stakeholders to reflect on how health care has changed in our state in the last decade and make predictions for the future. Contributors include Pat Baker of the CT Health Foundation, Congressman Joe Courtney, former Congresswoman Nancy Johnson, Sen. Edith Prague, Rep. Betsy Ritter, Gary Spinner PA, Hillary Waldman of the Hispanic Health Council and former Hartford Courant health reporter, State Comptroller Nancy Wyman and Jill Zorn of the Universal Health Care Foundation of CT.
The CT Health Policy Project wants to thank the many students, volunteers, interns, fellows, Board members, funders, collaborators, donors, staff, clients, bureaucrats, elected officials, very supportive family and friends who have made the last ten years not only possible, but a joy. We all get five minutes to reflect, then back to work.
Ellen Andrews

Teachers lead with germiest work environments

As cold and flu season approaches, the WSJ blog has identified the occupations most likely to encounter germs. As expected, teachers lead the list with twenty times the germs per square inch of attorneys who have the cleanest offices. Teachers’ phones are the main culprit, accountants have the dirtiest desks and you don’t want to touch a banker’s computer mouse or door knob. Women’s offices are dirtier than men’s but are less likely to have MRSA.
Ellen Andrews

Heroin overdoses hit most CT towns, moving to suburbs and to older victims

A new study by researchers at the Yale School of Public Health finds that, on average, more than one CT resident died every other day from heroin overdose deaths in the last eleven years. That rate is rising; it may soon overtake automobile accidents as a cause of death. The problem is spreading out of cities into the suburbs; all but 22 of CT’s 169 cities and towns had a fatal overdose of either heroin or pharmaceutical narcotics between 1997 and 2007. At Blue Hills Substance Abuse Services in Hartford the proportion of young adults in treatment for heroin addiction has risen from 10 to 30 percent in recent years. Overdoses are rising among older victims becoming more common among middle aged residents than young adults because of changing physiology over the lifespan, according to the Yale Daily News. A series of articles in yesterday’s NY Times finds that CT is not alone – heroin use is up across the region. Experts blame heroin’s lower cost compared to other drugs and it is sold in more lethal forms now than in the 1970’s.
Ellen Andrews

Annual comparison of health plans out

The CT Insurance Dept. has released their 2009 Consumer Report Card on Health Insurance Carriers in CT. The report compares insurance plans on the number of participating providers and 14 quality measures including rates of cancer screening, immunization rates and the percent of physicians who are board certified. For example, the percentage of patients who’ve been hospitalized with heart disease who are now managed for their cholesterol levels varies from a low of 55.6% (Oxford) to a high of 74.3% (HealthNet). Eye exams for people with diabetes vary from 56.2% (Oxford) to 75.2% (ConnectiCare). Beta blockers after heart attacks ranged from 38.6% (ConnectiCare) to 100% (Aetna). The report also includes insurers’ customer appeal numbers; rates of denials that were reversed on appeal range from 25.8% (HealthNet) to 57.2% (Anthem). Medical loss ratios varied from 81.5% (Oxford) to 85.8% (ConnectiCare). The report also includes information on member satisfaction, prescriptions, mental health and substance abuse services as well as a very helpful glossary of terms. The comparisons are based on 2008 data. The report also includes insurer’s customer service phone #s and government agencies to call for help.
Ellen Andrews

CT far behind in patient centered medical homes

According to NCQA, the organization that certifies medical homes among other things, CT has no practices that have been certified. Compare that to our neighboring states – MA with 87, ME with 56, NY with 225, NH with 132, RI with 31, and VT with 32.

But we are going to fix this. CT Medicine’s current issue includes several articles featuring the promise of medical homes including one on the patient perspective authored by Sheldon Toubman of New Haven Legal Assistance and myself, and today’s CT State Medical Society’s annual conference features a panel of experts on the subject. CSMS deserves great credit for their leadership on this critical issue.
Many thanks to Rose Stamilio of St. Francis Care for the NCQA numbers.
Ellen Andrews

Danbury and Windham county lead the state in uninsured rates; large variability between CT cities and counties

A new report from the US Census finds that at 14% of residents uninsured, Danbury led CT municipal areas last year. Danbury’s rate was 60% higher than the Hartford area at 8.6%. Both the Hartford and New Haven municipal areas were below the state average of 10.2%. Among counties, Windham led the state at 14.1%, more than twice as high as neighboring Tolland County at 6.2%. The new report highlights the striking variability in uninsured rates within CT and the pressing need for health care reform. For more, see the newest CT Health Policy Project issue brief.
Ellen Andrews

Joanne Iennaco joins CT Health Policy Project Board

CTHPP welcomes Joanne Iennaco to our Board of Directors. Joanne is an Assistant Professor at the Yale School of Nursing in the Psychiatric Mental Health Specialty. She holds a PhD in Chronic Disease Epidemiology; her research focuses on the effect of psychosocial aspects of the workplace on health. To learn more about Joanne, visit her blog Mental Notes. The Board also announces the departure of Sally Cohen. Sally has moved to the University of New Mexico and will be dearly missed.
Ellen Andrews

Individual mandate may be unconstitutional

In a Wall Street Journal Op-Ed, two former Justice Dept. attorneys argue that the individual mandate included in national health reforms could be overturned by federal courts as “profoundly unconstitutional.” The attorneys make different points than the CT Health Policy Project’s paper last year, arguing that the mandate is an unfair cross-generational subsidy, infringes on personal liberties and is politically motivated. We argued that it is an unfair burden on low income people, difficult to administer or enforce, and poor public policy. It requires people who don’t have extra money to buy a product (it now seems likely from only private sources) that, if history serves, may never cover their needs if they become ill. Those consumers will have to rely on government to enforce the value of their mandatory purchase; they can be forgiven for being skeptical. It is also based on the myth that the uninsured are just greedy, selfish people who could buy insurance but prefer to spend their money elsewhere. It is a classic case of blaming the victim.
Ellen Andrews

SustiNet celebration

oin the Universal Health Care Foundation of CT and all the partners who made passage of SustiNet possible for a celebration Thursday, October 1st 6 to 9pm at Union Station in Hartford. Click here to RSVP.

Individual mandate’s drawbacks getting national attention, finally

All the current health reform bills being considered in Washington include an individual mandate, requiring every resident to have health coverage – either through a public program like HUSKY or, if not eligible, people will have to buy it. The only open question is whether they will have a publicly run option to purchase insurance from, or if our only options will all be privately run companies. Until now, the extraordinary dilemma this places working families in, with incomes too high for subsidies but too low to afford any insurance worth what you pay for it, has been ignored. Yesterday’s Wall Street Journal takes a good look at how the mandate will “squeeze those in the middle” – exactly the families that are bearing the brunt of the current economic crisis. WSJ highlights the McDonalds, a family caught in this Catch-22 by MA’s individual mandate. For our analysis of how difficult and unfair an individual mandate would be for CT families, go to our policymaker brief or longer analysis.
Ellen Andrews

SustiNet update

The second SustiNet Board meeting today was uneventful. Stan Dorn of the Urban Institute gave a presentation on the original SustiNet plan; his presentation was made possible with support from the Universal Health Care Foundation of CT and the CT Health Foundation. He congratulated CT on passing a roadmap for comprehensive health care reform in a challenging economic environment. He outlined the original plan including the self-insured pooling concept, transparency, patient centered medical home structures (modeled on planning for PCCM in the HUSKY program), health information technology, evidence based medicine, and public health initiatives. Questions focused on re-aligning incentives to support quality and reduce costs, how the plan fits with national health reform proposals, funding reforms, barriers to adoption of electronic medical records in small practices, how to encourage creation of larger provider networks (something like accountable care organizations), primary care workforce shortages, insurance market reforms, and adverse selection. Co-chairs for the advisory groups were proposed; the Board asked for bios from the candidates before they voted. The next meeting will be September 30th at 12:15 pm.
Ellen Andrews

DSS gets an earful at PCCM subcommittee meeting

Today’s PCCM subcommittee meeting of the Medicaid Managed Care Council was very heated. Again the room was packed, including four legislators in person and one on the phone. DSS reported that they still have 54 providers in the Waterbury and Willimantic areas participating; no increase from the last meeting two months ago. They are beginning to reach out to New Haven and Hartford providers and have some interest, but no firm commitments. DSS was strongly criticized for a lack of marketing, stating that they consider it the providers’ responsibility. However, language in the contracts severely restricts providers’ ability to talk with their patients about PCCM. In response to action steps from the last meeting, DSS reported that the Commissioner refused to consider either removing the Freedom of Information language from the provider contracts, or alternatively to require the same of providers in the HMO program – in the interest of ensuring equal treatment of PCCM and the HMOs. DSS refused to consider including providers from other areas of the state that have expressed interest in the program to at least one legislator. DSS also reported that the Commissioner refused to allow auto default enrollment into PCCM of new enrollees in those areas who do not choose an HMO, which had been suggested by DSS as an option to more fairly apportion enrollment among the HMOs and PCCM. When the two new HMOs entered the program last year, DSS gave them a similar advantage in default enrollment to help them increase enrollment levels and ensure sustainability. DSS stated that they considered it a “test” of the PCCM option whether consumers would choose the option over the HMOs – if the HMOs aren’t performing, people will leave them to enroll in PCCM. However that led into the next issue – the serious inequality of marketing between the HMOs and PCCM. Pages of DSS-approved marketing activities by the HMOs including an airplane banner, radio advertising, free ice cream, school uniforms, school supplies, and haircuts. Providers have had to bring in volunteers from community groups to explain PCCM to their patients, as they are not allowed to discuss the program with them. Providers are also required to copy the brochure themselves; it is not clear that PCCM brochures are even available in the local DSS office. The program has been in place for over seven months. DSS’ response was that PCCM is a work in progress, but a legislator commented that “pilots can take a year to set up, not a decade.” Another suggested that DSS was “throwing PCCM under a bus” and another characterized the provider contracts as “horrific.” Concerns were raised that DSS was not following through on their stated commitment to implementing PCCM and were intentionally undermining its chances of success. Advocates and legislators were urged to contact the Commissioner to urge him to reconsider his decisions.
Ellen Andrews

Challenges and promise of PCCM highlighted in today’s Waterbury Republican-American

An article on the front page of today’s Waterbury Republican-American describes both the potential for PCCM and the challenges in implementing the program, especially with a reluctant state agency responsible for marketing. Volunteers have been left with the job of letting people know about the opportunity and what the program is. Sandi Carbonari, a Waterbury pediatrician, commented “It's a lot of work to take on, but it's the way medicine should be for everybody”.
Ellen Andrews

The Day Editorial – He snores, so why can’t we buy health insurance?

Susan Epstein has so many good points, it is hard to know where to start. “Don't think it can't happen to you. We're ordinary people. My husband snores and I take too much medicine and therefore, we're ineligible for health insurance.”
Ellen Andrews

From the Consumer Helpline

A consumer called our helpline because he has Medicaid and can’t find a primary care provider in New Haven who takes Medicaid and will take a new patient. He tried looking on the DSS Provider Directory Search and called the doctors listed there. They weren’t taking new Medicaid patients. He tried asking his specialist, who didn’t know of any Medicaid PCPs who were taking new patients. The Yale clinic he tried wasn’t taking new patients either. When he went to the Hill Health Center for an alarming medical issue, they told him he should go see his specialist – and not because that was the specialist’s area of expertise.

I gave him a few suggestions: try looking up doctors besides general practitioners (there’s only one listed in New Haven) like internists or family practitioners and try looking them up in the towns near New Haven. He could also try some of the other community health centers in the area. I also suggested that he ask his specialist to help him find a primary care doctor and maybe his specialist could put a little pressure on another doctor to take a new Medicaid patient. He said he hadn’t thought of that but he wasn’t convinced it would work because his specialist doesn’t spend much time with him. The clinic sets aside Thursday afternoons to see Medicaid clients and he said his doctor spends about five minutes with him and gets testy if he asks too many questions. But he said he’d try at his next appointment to ask her for a referral.

This consumer would have been helped by a medical home. Medical homes offer coordinated, comprehensive primary health care that is accessible, continuous, compassionate, culturally appropriate, and patient-centered. If Medicaid patients started out with medical homes, this patient wouldn’t have had this problem. He would have had someone to coordinate his care and find and make appointments with the other doctors he needs.
Jen Ramirez

Medicaid Managed Care Council update

Today’s Medicaid Managed Care Council meeting touched on some new issues and revisited some old ones. There was a strong exchange on the Charter Oak annual $100,000 and lifetime $1 million limits. Sen. Prague talked about a patient who called her office needing treatment for cancer that exceeded the annual cap. He was eventually able to continue his care, but is facing very large bills. She asked if the department is considering allowing people to tap into their lifetime caps when they have reached the annual limit. DSS stated that they are considering several options to address this concern including her idea of accessing the lifetime cap, but most of the options might include an increase in premiums. The conversation then turned to balancing affordable premiums with some relief for people reaching the coverage limits. Options include excluding specialty drugs from the calculation of the cap, links to the state’s high risk pool, reinsurance and placing a lien on the patient’s house. DSS reported that to date, only one person had exceeded the annual cap, but four others had received letters advising them that they had incurred expenses over $50,000. In the letter, DSS urges patients to contact them to see if they are eligible for other programs or resources to pay their bills.
The revenue and expense reports for 2008 generated a great deal of comment. CHN made a profit of $1.6 million; the other HMOs reported losing money. Overall the state paid $207.30 per member per month, including dental and pharmacy costs until they were carved out. DSS defended CHN’s profits at about 2.7% saying that is to be expected. DSS also believes that the program cost more per member during the months the plans were not at risk (the PIHP model) than under capitation, but did not provide numbers to support that assertion. There was a great deal of discussion of the Comptroller’s audit and the $50 million cut from HUSKY HMO rates in the budget that just passed. DSS stated that it is their expectation/goal to recoup that savings from the plans’ rates in the upcoming negotiations, although they do not agree with the Comptroller’s report. However after further discussion, Rep. Villano stated his concern that DSS did not plan to re-bid the contracts and about their “reluctance” to aggressively pursue those savings. DSS noted that they are no longer hiring outside auditors for rate-setting, but are performing those functions in-house and are restructuring their encounter data management system and should have better information on which to base the rates in the future.
DSS also described the prior authorization process for medications, but never got to the update on PCCM.
The PCCM subcommittee meets next week on Wednesday the 16th at 10am in the LOB.
Ellen Andrews

Uninsured up 17,000 in CT last year

The new Census figures on health insurance released today show that CT’s uninsured rate was up to 10% last year. 343,000 state residents were without insurance, including 44,000 children. The really stunning finding is that private employer-based coverage was down by 107,000. Thankfully government coverage picked up more people, about evenly split between Medicaid and Medicare. This continues a trend in CT and the nation of shifting coverage from private employer-sponsored plans to public programs. And without health reform, things are not likely to get better soon – family premiums in CT grew over 7 times faster than median earnings from 2000 to 2008. Click here for our latest policymaker issue brief on the new numbers.
Ellen Andrews

Middlesex Hospital has an online ER clock

If you need an emergency room in the Middletown area, you can now go online to see what the waiting time is at Middlesex Hospital’s three ERs. As the volume of ER patients rises across the state, wait times have grown to average four hours according to the Courant. Patients in Middletown can now reduce their wait by checking the clock. As always, in an emergency you should call 911.
Ellen Andrews

More on the challenges and promise of primary care

Today’s NY Times features an article on a summer immersion program linking University of Washington medical students back into rural and underserved communities. The video is the best part. Students experience the frustrations of caring for people without adequate coverage, without the resources they need to be well, all in a few minutes for each visit. I love the moment eager, energetic, and idealistic students touch the real world – the best part of my job here at the Project.
Ellen Andrews

The best argument for primary care I’ve heard in a long time

From the WSJ blog -- http://blogs.wsj.com/health/2009/09/08/how-one-doc-discovered-the-connection-between-heart-disease-and-depression
Read down to the third paragraph for the story that makes the point.
Ellen Andrews

CT papers feature health reform

The Day has a well-considered editorial today on health reform, centering on the Cleveland Clinic. The President has publicly cited the Cleveland Clinic as an example of exceptional care at lower cost. The editorial points out that what we need is a revolution -- we need to reform our health care system, not just insurance markets. We have to change incentives, putting providers on salary as the Cleveland Clinic does. The article also urges bundling services into one payment to discourage over-utilization, consolidating providers into seamless systems of care to promote accountability, provide incentives for people to manage their own health, and improving transparency and competition – on costs AND quality. “If we insure everyone without reforming the delivery process, the costs will be ruinous.” Well said.

Today’s Hartford Courant features just the physician perspective on health care reform. Issues raised include lack of support for primary care, paperwork and an entire section devoted to medical malpractice. While the article notes evidence that defensive medicine is a very small part of rising health costs, that fact is buried. What’s interesting in the article is that CT hospitals claim that they lost more money on Medicaid patients than the uninsured in 2007.
Ellen Andrews

Foundation for Community Health Open House

The Foundation for Community Health has moved to a new home with available meeting rooms. They are holding an Open House October 7th from 4 to 6pm at 155 Sharon Valley Road in Sharon, 06069. Hear about their expanded services and give them ideas for enrichment programs they can host for nonprofits. RSVP by September 30th at (860) 364-5157 or info@fchealth.org.

SustiNet Board meeting

Yesterday’s first SustiNet Board meeting was well attended by the members. Most of the discussion was introductory remarks and process. They talked about the committees, collecting input from the Board members, developing a work plan, etc. The next meeting will be Sept. 16th at noon.
Ellen Andrews

GAO report finds reduced competition in insurance markets is associated with higher premiums and profits

After pages of disclaimers and cautions that there is not enough good research on the issue, a recent GAO report finds evidence that there has been increasing concentration in health insurance markets in the US. Market share of the top five insurers rose from 43.2% in 1994 to 49.9% in 1997. The impact varied by region with some experiencing no effect and some with increases that are “significant enough to raise antitrust concerns.” Studies generally found that more competitive markets were associated with lower premiums, and lower insurance company profits, but the impact on provider rates was mixed. Greater competition was associated with lower utilization of inpatient services; the impact on outpatient services was unclear. There is no consensus on the effect of competition on quality of care. It appears that conservative economists were right – competition is good.
Ellen Andrews

Congressional health care reform town hall

Congressman John Larson will be holding a Health Care Reform Town Hall Forum tomorrow, Sept. 2nd at 5:30 at West Hartford Town Hall, 50 South Main Street. There is very little street parking near the town hall; click here for options. Paid parking is available. Similar events are planned in other Congressional districts – we will let you know.

Test your knowledge of CT health policy premiums

Take the September CT Health Policy Webquiz to test your knowledge about the costs of health insurance premiums in CT.

Health insurance employment in perspective

Yesterday’s Hartford Courant reports that just over 19,000 CT residents are employed at CT’s large health insurers – Aetna, United, CIGNA, HealthNet, Anthem and ConnectiCare. While impressive, those numbers pale in comparison to the number of CT residents employed in providing health services, according to the CT Dept. of Labor’s July report – 198,800. That number is conservative as it does not include health services workers employed by government. Health insurance constitutes 1% of CT’s workers while health care services makes up 12%.
Ellen Andrews

CT family premiums fifth highest in nation

This won’t surprise anyone who buys their own coverage (or buys it for their employees), that a new report by the Commonwealth Fund finds that CT’s family premiums were the fifth highest in the US last year. Rates increased by one third from 2003 to 2008, as did the US average family premium -- so at least we aren’t rising any faster than the rest of the country(I guess that qualifies as good news). Single coverage fared slightly better rising 29%. But to put those costs in context, we have very high incomes here in CT as well – so I guess their point is we can afford to pay more? We are fifth lowest in the nation for premiums as a percent of median household income. Still, spending 14.3% of income on health care is no bargain. The report outlines how much CT consumers could save by modest reductions to the increase in health insurance costs.
Read the report and you’ll be able to ace the September CT Health Policy Web Quiz.
Ellen Andrews

Undecipherable health insurance documents

I was very happy when I finally received the document from my health insurance company explaining my medical coverage. Now I could finally see exactly what medical benefits are covered. Or maybe not. I decided to review it so I would know what is covered and what isn’t. I didn’t get very far. The document is extremely unreadable and hard to understand. I gave up and decided that I will read relevant sections carefully when and if I need them. Why can’t these documents be written in plain English so that average people can read and understand them? What about people who read at low grade levels? These documents seem like they are written by lawyers with the express purpose of confusing the rest of us.

Here is an example from the plan document’s “Exclusions and Limitations” section. This is exclusion number 2 out of 75: “Benefits may be reduced; or denied if subject to the Managed Benefits Managed Care Guidelines. Any reduced or denied benefits paid by the Member do not count toward any applicable Cost Share Maximums shown in the Schedule of Benefits.” I think I figured out what it means but I had to read it several times.

A recent New York Times op-ed piece discusses this issue and gives the example of a man whose chemotherapy was denied by his insurance company. He couldn’t understand his insurance policy and why he was denied. When the Rhode Island Health Insurance Commissioner’s Office called the insurance company on his behalf, they were told that the claim was denied because they were still trying to figure out if the medical services were covered. They didn’t understand the policy either.

Starting next year, Rhode Island will require that all insurance policies are written at an eighth-grade level. The US House of Representative’s health reform bill has a proposal that some parts of insurance policies should be written in “plain language.” There is other proposed legislation at the federal level that would require “uniform and simplified coverage information.” Insurance policies must be understandable to be useful.
Jen Ramirez

Does expanding health insurance improve health?

An article in today’s Wall Street Journal addresses a question that doesn’t get the attention it deserves. Health reform debates too often miss the real point – we want to improve the health of people. A plastic health insurance card does not guarantee access to care, much less improved health – ask anyone on Medicaid/HUSKY/Charter Oak. WSJ asks the question of John Auerbach, Commissioner of Public Health in Mass the question. He points to three indicators that health is improving – all process measures – to argue that MA’s health reforms are improving more than the uninsured rate. First, the rate of adults smoking is down 8%, the biggest drop in ten years. The drop is primarily due to the expansion of Medicaid, which covers smoking cessation patches and counseling. (Note: CT’s Medicaid program is one of the few in the US that doesn’t cover smoking cessation treatments.) Second, there was an increase in the number of people getting age-appropriate colonoscopies. And third, more people in MA are getting flu shots.
Ellen Andrews

Test your knowledge of national health care reform

Take CNN’s quiz on national health care reform. Only eight questions. I’m not telling how I did.
Ellen Andrews

Hospital community benefits reports out

The Office of Health Care Advocate has released their community benefits report on what hospitals are providing to residents of their communities to improve health, not just the health of their patients. Under state statute, uncompensated care does not qualify as a community benefit. The data is self-reported and there are very likely differences in definitions, but some interesting comparisons can be made. For example, Lawrence & Memorial is reporting spending over $31 million in 2007 on community benefits, 127 times the $250,000 reported by Hartford Hospital. At that rate, L&M is spending 12% of their revenue on community benefits. Hospital reports of the number of people served by programs varied from zero to 337,379. It is interesting however to scroll through the services listed in the data Appendix to see which hospitals report programs in specific areas such as mental health, substance abuse, hypertension screening, or physical exams for adults. Five hospitals report that they are not working with their local health departments to reduce the transmission of infectious disease in the community. Only Yale-New Haven and Bridgeport report participating in needle exchange programs. Fascinating stuff.
Ellen Andrews

New London getting a health needs assessment

Over the next three years, the Ledge Light Health District will be assessing conditions in the New London area that contribute to better health for residents. The study, funded by the CDC, will consider assets that contribute to healthy lifestyles, reducing smoking, and managing chronic problems such as diabetes and heart disease. The goal is to make recommendations to enhance physical activity, good nutrition and smoking cessation. The 2007 New London County Health Needs Assessment found that 19% of New London residents under age 65 were uninsured and 11% of city residents missed a needed medical visit due to cost.
Ellen Andrews

Charter Oak celebrates first anniversary

Friday, Governor Rell announced that her Charter Oak Health Plan has enrolled 10,257 previously uninsured CT residents as of the program’s first anniversary. The program is an affordable option for many people and is providing care to thousands. An important advantage of Charter Oak is that no one is denied coverage due to pre-existing conditions, a common reason for denial of private insurance coverage. The program is available to residents at any income level, with subsidies for lower-income residents. Unfortunately 24,452 people have applied for coverage through Charter Oak and were denied; reportedly most were denied because they had not been uninsured for six months. Advocates have been concerned that the state’s six month exclusion policy would leave too many people uninsured too long, risking both their health and finances. While the numbers are improving, providers have been reluctant to sign up with Charter Oak, making access to care difficult in the program. Only half of CT’s acute care hospitals have signed up and only four are participating in all three HMOs. Legislators reportedly have asked for information about what care is being delivered to Charter Oak members.
Ellen Andrews

Prescription assistance bus in CT

The “Help is Here” bus travelling across the country offering help applying for drug company assistance programs is in CT this week. Drug company assistance applications can be confusing; each company has different eligibility standards and discounts vary widely. The assistance program you apply to depends on which drugs you are taking. Questions you will need to answer at the bus include age, address, income, number of people living in your household, brand name of your prescriptions, and details about any coverage you have. The bus’ services are offered free of charge. This morning, Tuesday, from 10am to noon the bus will be on South Main Street in West Hartford, and this afternoon at Charter Oak Health Center in Hartford from 2-4pm. Wednesday the bus will be on Main Street in Manchester from 10am to noon and at the State Capitol (in a press conference with Sen. Prague) from 2-4pm. On Thursday the bus will be at Hammonasset State Park in Madison from 10am to noon and in Norwich from 2-4pm. For more info on the bus, call (202) 835-3460. If you can’t make it to the bus, you can also apply online or call 1-888-477-2669. The bus is sponsored by the Partnership for Prescription Assistance, a collaboration of drug companies.
Ellen Andrews