Junk food makers may be open to national limits in schools

Rising childhood obesity rates and easing resistance from the food industry may result in meaningful national legislation to limit junk food in schools according to today’s Washington Post. CT was a national leader in 2005 passing a ban on soda in schools, which was vetoed by the Governor. In 2006, the legislature passed and the Governor signed a similar ban that included incentives for schools to meet nutritional food standards. Since then a dozen states have passed similar laws. According to the liquid candy calculator from the Center for Science in the Public Interest, a one cent tax per 12 oz. non-diet soda in CT could raise $18 million/year; obesity costs CT over a billion dollars annually, over half of that in Medicaid.
Ellen Andrews

CT on health reform.gov

On Friday, President Obama’s website tracking health care reform published state-specific pages making the case for reform. CT’s numbers aren’t surprising, but it’s another source for info. Family premiums in CT approximately equal the entire wages of a full time minimum wage worker. Employers offering coverage is dropping, health care costs are skyrocketing, and the quality of our care is average.

My pet peeve with these collections from national sources (and it’s not just the White House) – we are not “Connecticuters”. I’ve lived in CT thirty four years and never heard that word. Are national reformers talking to anyone outside the beltway, beyond Massachusetts I mean?
Ellen Andrews

Senate passes a budget, Governor expected to veto

Yesterday the Senate passed a Democratic budget spending $35.5 billion over the next two years. The fiscal year ends next Tuesday. The Democratic budget saves health coverage for legal immigrants, the current definition of medical necessity for Medicaid, and increases cigarette taxes by 75 cents per pack to $2.75. The budget also takes $50 million from HUSKY HMO rates, based on an audit by the Comptroller’s Office finding that the HMOs are overpaid by 5 to6%; that cut was also included in the Governor’s latest budget proposal. Five Democratic Senators and all the Republicans voted against the bill. The House will vote on the bill today. The Governor has signaled that she will veto it.
Ellen Andrews

SustiNet rally and vigil

Tuesday the SustiNet and Health Care Partnership bills were delivered to the Governor for her to sign (hopefully). The next day, the Interfaith Fellowship for Universal Health Care organized a vigil and rally to encourage the Governor to sign the bill. They started with a vigil outside the Governor’s office and then walked from there, wearing red SustiNet T-shirts and carrying signs, to the Governor’s mansion in Hartford, where about 65 people gathered for the rally. Two state legislators participated in the event, Rep. Betsy Ritter (Waterford and Montville) and Tim Rep. O’Brien (New Britain and Newington). There were a few speakers and a lot of chanting. We hope that showing our support at this rally demonstrates to the Governor how strongly we feel about having this bill signed into law.
Jen Ramirez

Former insurance executive tells the truth

We haven’t been blogging much on national health reform here at CT Health Notes. No need for it – that space is crowded with great blogs at the national level. Like everyone else, we’ve been following them and “official” developments closely. But yesterday something extraordinary happened. A former insider at two large insurance companies opened his testimony on Capitol Hill with

“My name is Wendell Potter and for 20 years, I worked as a senior executive at
health insurance companies, and I saw how they confuse their customers and dump
the sick – all so they can satisfy their Wall Street investors. I know from
personal experience that members of Congress and the public have good reason to
question the honesty and trustworthiness of the insurance industry. Insurers
make promises they have no intention of keeping, they flout regulations designed
to protect consumers, and they make it nearly impossible to understand—or even
to obtain—information we need.”

He went on to say,

“The average family doesn’t understand how Wall Street’s dictates determine
whether they will be offered coverage, whether they can keep it, and how much
they’ll be charged for it.”

He describes the single minded priority within companies for ever-rising stock values and profit. Investors are only interested in earnings per share and medical loss ratios. Not only is his testimony a refreshing and detailed look at how insurance companies do business, it is good reading. He must have been very good as chief of communications.
The industry’s responses are about what you’d expect.
Ellen Andrews

Governor vetoes common sense consumer protection

There is a loophole in the current CT law that doesn’t allow insurance companies to cancel your health insurance policy just when you need it. But Monday the Governor vetoed a bill to close that loophole. In 2007, CT passed PA 07-113, An Act Concerning Postclaims Underwriting, which was meant to stop insurers from claiming that consumers hadn’t disclosed something in their application conveniently just when the consumer became ill and the insurer is facing big bills. Lawsuits in other states found that some insurers had entire departments devoted to these investigations and paid bonuses to employees for finding excuses to rescind costly policies. The 2007 CT law requires insurers to do their investigations at the time of the application. If they approve someone and start taking the premiums, they have to cover them – except in cases of intentional fraud obviously. Unfortunately, CT’s insurance department interprets the law to exclude cases where insurers hadn’t done their job and examined consumers’ medical records at the time of application. How convenient is it to just take premiums from everyone and only do the work of investigating when someone files a claim. This year's bill, PA 09-135, An Act Clarifying Postclaims Underwriting, was meant to fix that. CT’s State Healthcare Advocate Kevin Lembo characterized the Governor’s action as “among the most callous veto messages I’ve ever seen from this Governor.” “Nowhere in her veto message is there a recognition of the impact on a patient lying in a hospital bed whose policy has been ripped away. No concern for people losing their homes or foregoing life-saving treatment because an insurance company decided it was too expensive.”
Ellen Andrews

Physician signing bonuses favor primary care, but salaries still lag

A new report on physician searches by a large recruiter shows a growing use of bonuses to attract providers. The strongest growth in searches is among family practice, general internal medicine and pediatrics. 85% of searches include signing bonuses averaging $24,850. 98% also include relocation allowances averaging $10,427. Other incentives include continuing medical education pay, malpractice, health insurance, retirement, disability and educational loan forgiveness. Family practice slots were the most common searches at 595, up from 297 in 2005/6. Starting salaries for family practice physicians averaged $173,000 (up 19% from 2005/6), for internists $186,000 (up 15%), and for pediatricians $171,000 (up 13%). Not bad, but specialists still make far more -- $401,000 for urologists, $419,000 for cardiologists, and $481,000 for orthopedic surgeons. The mean US annual wage for registered nurses is $65,130. The report covered searches for 3,800 physicians and nurse anesthetists between April 2008 and March of this year across 47 states including CT.
Ellen Andrews

Patient-Centered Medical Homes: How they can help CT’s health care system

Medical homes have been proposed as a critical piece of health care reform at both the national and state level. Medical homes are not buildings or hospitals, but a different way of practicing medicine. Care in a medical home is centered on the patient, not the health care system; it is customized for that person’s unique physical, social, emotional and cultural environment to ensure that treatments are effective. Care in a medical home is coordinated, comprehensive and family-centered. Care is also delivered by a team of providers, each doing the job they were trained to do. Medical homes emphasize and support primary care, making that field more attractive to providers easing a serious workforce shortage facing CT. By emphasizing primary care, medical homes have the potential to significantly reduce skyrocketing health care costs by reducing duplicate and unnecessary care, reducing emergency room visits and hospitalizations, and giving patients the tools and support they need to maintain their own health. The PCCM program for HUSKY families is built on the medical home concept.

Friday’s briefing brought to CT experts and providers from a nationally recognized model medical home to help us learn how this innovation can help CT patients and payers. We heard from a practice in Flushing, Queens that reduced labor costs, increased productivity, improved patient satisfaction and health outcomes by creating a nationally recognized medical home. We heard about coalitions of providers and payers working to disseminate the model around the country and the dozens of other states implementing varying forms of medical homes. We heard from Ontario which has been building a similar system, Family Resource Teams, for many years.

Resources from the briefing are available on-line. Policymaker Issue Brief No. 48 and a longer version include a description of the concept, how medical homes could improve quality and reduce the costs of care in CT, and measures policymakers can take to encourage them. The site includes a slide show of the medical home in Flushing, speaker bios and more resources. Speakers’ presentations are posted including Robert Fortini and Suneel Parikh, MD of Queens-Long Island Medical Group, Lee Partridge of the National Partnership for Women and Families, Fan Tait from the American Academy of Pediatrics, and Shafiq Qaadri, MD, MPP Ontario.
Ellen Andrews

Patient Centered Medical Home Briefing Today

Patient-centered medical homes have been featured in health care reform proposals at both the federal and state levels. Medical homes have enormous potential to both improve the quality of health care and reduce costs. Join us for a briefing today on what the concept is and what it could mean for Connecticut. Hear from medical homes in New York and Canada, national experts and a CT reactor panel. The briefing will be today at 12:30 pm in the Old Judiciary Room at the State Capitol.

CT Health Foundation internship

The CT Health Foundation is offering a paid internship for a graduate or professional student. The job includes research, policy tracking and attending hearings/ press conferences. For more information and to apply go to http://cthealth.org/matriarch/MultiPiecePage.asp_Q_PageID_E_359_A_PageName_E_healthpolicyintern. The deadline is August 14th.

White coats are history

Beyond the President’s speech, the real news from the AMA conference in Chicago is the vote to do away with white coats for doctors. Apparently those long sleeves hide MRSA and other germs, but it isn’t clear if they are transmitted to patients that way. But to be on the safe side, Britain banned white coats two years ago as well as ties, long sleeves and jewelry. Originally adopted to avoid infection, the length of his/her white coat can indicate a doctor’s status in hospitals according to the Boston Globe; a lot of symbolism and organizational politics go into choices about white coats. Who knew?
Ellen Andrews

From the consumer helpline

A consumer called our helpline about a large bill with Hartford Hospital. Her bill for two hospital stays is about $270,000 and she is uninsured. Her income of about $49,000 doesn’t make her rich but it is over the limit for any of the hospital financial assistance programs. She was making payments on one of the bills but then they all went into collections. The collection agency wants to attach her home. She considered taking out a second mortgage but even that wouldn’t cover the bill. The hospital did offer her a 53% discount if she paid it all right now, in cash. That means she would have to come up with about $126,900.

I called Hartford Hospital because I wanted to be sure the consumer had been screened for all the financial assistance programs and see if the hospital would give her a discount. She had been screened for all of their programs and they had given her a 20% discount on her bill. They were not willing to give a larger discount and seemed to be patting themselves on the back for the discount they did give her.

If her income was under 250% of the federal poverty level ($27,075 for one person) and she had been denied for the SAGA medical program for being over income, the hospital would have charged her “cost”, which is what it costs them to provide the medical care and is generally about half of charges. Since she does not fit this criteria, they can charge her more. If she had health insurance, the insurance company would negotiate a lower rate. She is being charged even more than an insurance company would pay.

I suggested that she call Congressman Chris Murphy’s office to see if they could intervene on her behalf. I also suggested that she contact a local newspaper to see if they would be willing to tell her story. She liked the suggestions and will be contacting her Congressman and the newspaper. I will follow up with her to see what happens.
Jen Ramirez

CT Health Facts updated

21% of CT residents are enrolled in a managed care plan. CT’s per person health care spending is 20% higher than the US average. One in six CT high school students smokes. Find these and more in our updated CT Health Facts. The list was updated by Selina Tirtajana, a CTHPP 2009 Summer intern.

Medicaid Managed Care Council update

At yesterday’s Council meeting DSS announced that PCCM finally has a name – HUSKY Primary Care – and a brochure for marketing. The program will be available to more consumers and providers in Willimantic and Waterbury soon.

SAGA spending is up 13.5% this year over last, however enrollment grew by 16.3% from May 2008 to May 2009. In particular, spending on dental care increased significantly due to small increases in rates and far more participating providers. The report on numbers of consumers seeking care from out of network providers was interesting. Both Aetna and AmeriChoice had significant numbers of requests for primary care providers (PCP), suggesting an inadequate network. CHN, which has 64% of HUSKY enrollment, had no out of network PCP requests. The most common reason families change plans, by far, remains “PCP not in plan.”

Charter Oak enrollment appears to be leveling off, dropping slightly to 8,179 members as of June 1st. Total HUSKY/Charter Oak applications also appear to be down – unexpected given the rise in unemployment. Clients disenrolling from Charter Oak, failing to pay premiums, was up sharply in May almost doubling from the previous two months’ numbers. Disenrollments were highest among those with incomes below 150% FPL (premiums are $75/month + $150 deductible for an individual + copays) and 185 to 235% FPL (premiums are $175/month + $400 deductible + copays). Disenrollment from HUKSY Part B for failure to pay premiums was up sharply, and not surprisingly most families contacted say they are having a hard time paying the bill. Members noted the impact of these financial burdens on consumers in the current system and concerns about budget proposals to increase cost sharing.

DSS is applying for a HRSA grant to expand mental health and substance abuse capacity in Charter Oak.

CMS has asked several questions in response to the state’s HUSKY waiver application including financial issues and questions about access to care under PCCM. DSS will be sharing a copy of the questions and their responses with the Council.

Advocates and providers expressed concern about proposals to change the HUSKY definition of medical necessity – the standard that determines if a treatment is approved. That change is estimated to save $4.5 million next year and $9 million the year after. Advocates are troubled by the lack of specificity in how that change would be implemented and worry that patients will not be able to get the care they need, damaging their health and ultimately costing the state more. The new medical necessity definition was drafted by a group of physicians at UConn.

Several personal notes: The Council recognized three retiring DSS staff – David Parrella, Rose Ciarcia and Kevin Loveland – who are leaving at the end of this month. They will be sorely missed. But in good news, Commissioner Starkowski appeared at the meeting, looking very well. It is good to see him back and healthy.
Ellen Andrews

CT uninsured hospitalizations report

In fiscal year 2008, there were 12,314 hospitalizations in CT for patients with no third party payer (government or insurance plan), down from 13, 241 in 2007 and 12,988 in 2006, according to a new report by the Office of Health Care Access. However ER visits by the uninsured rose by 2.3% from 2006 to 2008, remaining at 11% of total visits to the ER. Total charges for 2008 uninsured hospitalizations were over $239 million. This does not reflect the costs of care, but the far higher price hospitals generally charge the uninsured. While the number of uninsured hospitalizations dropped by 6.6% from 2006 to 2008, charges increased by 14%. Only 3% of CT hospitalizations were uninsured, compared to the US average of 5.7%. Uninsured hospital patients were more likely to be ages 40 to 54, black or Hispanic, and living in Fairfield, New Haven or Hartford counties. The hospitals with the highest number of uninsured hospitalizations were Hartford Hospital, Yale-New Haven, St. Vincent’s, and Norwalk, in that order.
Ellen Andrews

Support SustiNet

HB-6600, An Act Concerning the Establishment of the SustiNet Plan is on its way to the Governor’s desk after passing both houses of the General Assembly. Show your support by signing an online postcard to the Governor urging her to sign the act.

June CT Health Policy web quiz

Test your knowledge of small group health insurance in CT. Take the June CT Health Policy Web Quiz. This month’s quiz was written by Selina Tirtajana, CTHPP intern, Summer 2009.

Unemployment up, but not for health care

Friday’s national unemployment numbers for May were up to 9.4% from 8.9% in April. Since December 2007 when this recession began, 7 million more Americans are unemployed. A study published in January by the Urban Institute estimated that if unemployment reaches 10% this year, 13.2 million Americans will lose employer-sponsored coverage, Medicaid and SCHIP will rise by 5.4 million and the uninsured will rise by 5.8 million. HUSKY enrollment is up almost 20,000 from May of 2008 to May of this year. In other bad news, the average US workweek continued to decline and the number of Americans working at part time jobs for economic reasons (involuntary part time workers) was 9.1 million. Part time jobs are far less likely to come with health benefits. However if there is a silver lining, health care jobs increased by 24,000 between April and May.
Ellen Andrews

New OLR reports on PCCM, HUSKY employers

According to OLR, in 2004 when Oklahoma switched from HMOs to PCCM to run their Medicaid managed care program, the state saved money and access to primary care improved. An evaluation of OK’s program by Mathematica found that under PCCM the number of participating primary care providers rose 44%, patients’ office visits nearly doubled, avoidable hospitalizations dropped, consumer satisfaction rose, and ER visits dropped by 5% while nationally Medicaid ER visits rose by 9%.

OLR also updated their report on employers of HUSKY Part A enrollees and parents. Wal-Mart tops the list again with 3,741 HUSKY workers and dependents, up 68% from the 2005 report. Next are Dunkin Donuts with 3,153 (up 119%), Stop and Shop with 2,372 (up 19%), MacDonald’s with 1,915 (up 48%), First Student (transit co.) with 1,471 (up 160%), Target with 1,158 (up 253%), and Care 4 Kids with 1,021 (up 123%). The only companies that dropped on the list from 2005 to 2009 were Laidlaw Transit and Shaw’s. New to the top 25 HUSKY employers list are Macy’s, Kohl’s, Dattco (transit co.), Yale-New Haven Hospital, and Home Goods.
Ellen Andrews

Patient-centered medical home briefing

Medical homes have been featured prominently in federal and state health reform plans. Join us for a policymaker briefing on what the patient-centered medical home concept is and how it might work in CT on Friday June 19th at 12:30 pm in the Old Judiciary Room at the State Capitol in Hartford. Speakers include Suneel Parikh, MD and Robert Fortini from the Queens-Long Island Medical Group -- the first NCQA-accredited medical home, Lee Partridge of the National Partnership for Women and Families, Vera Tait MD, from the American Academy of Pediatrics, Shafiq Qaadri, MD, MPP, Ontario, and Pat Baker of the CT Health Foundation. The CT reactor panel will include Sandra Carbonari, MD, Tom Woodruff, from the Office of the State Comptroller, Kristin Boucher, RN, Rose Stamilio of St. Francis Care, Claudia Gruss, MD, Joanna Douglass, BDS, DDS, and Rep. Betsy Ritter. For directions to the Capitol, click here. The briefing is made possible with a grant from the CT Health Foundation.

HUSKY rate audit released

The audit of large rate increases granted to the HUSKY HMOs last year has been released. Accounting firm Milliman found that the state overpaid the HMOs between $41 and 39 million. The Governor has already incorporated over $50 million in savings from re-negotiating HMO rates based on this report in her latest budget proposal. The audit also raised concerns about the soundness of rate setting practices and assumptions including trend adjustments, data re-basing, guarding against double-counting, and incomplete documentation. The report summary includes concerns about lack of transparency and accountability; the entire $4 billion Medical budget is included in only one line item. Advocates argue that the $50 million in savings can be used to avert cuts to HUSKY families including copays, dental care, medical interpretation, medical necessity, and elimination of coverage for immigrants. The funding could also be used to improve health care in CT by covering smoking cessation in HUSKY, improving primary care rates, providing incentives for quality care, or removing the onerous requirement that Charter Oak Health Plan applicants be uninsured for six months or pay one third of their incomes on insurance.
For press reports, click here, here and here.
Ellen Andrews

From the Consumer Helpline

I am working with a consumer who called our helpline to ask for help with medical debt from two hospitals. When he was in Bristol Hospital he applied for financial assistance but he was denied because he didn’t want the Department of Social Services (DSS) to put a lien on his house. It is a requirement of most hospital financial assistance programs that the consumer has to apply for SAGA medical and it is a DSS requirement that if you are a homeowner and you want SAGA medical, they put a lien on your home to recoup the medical costs. I explained this to the consumer who also said he is disabled, although he isn’t currently getting Social Security Disability (SSD). People who are disabled can apply for Medicaid (also through DSS) and a lien is not put on your home. The problem is that since he isn’t currently getting SSD, there is a lot of paperwork for him and his doctor to fill out to determine that he is disabled for the purposes of getting Medicaid. On top of that he will also have to apply for SSD.

The consumer had been paying $10 a month to Bristol Hospital but now they sent him into collections. He said no one from the hospital ever returned his calls to say if $10 a month was acceptable and he thought it was ok since he didn’t hear anything back from them. He also disagrees with the total amount of the Bristol Hospital bill because they are billing him for a CAT scan he didn’t receive. When he called the hospital again to try to straighten this out, they told him to call the collections agency, who told him to call the hospital. I was able to get a name and phone number for the person at the hospital that he needs to talk to look into this. So far, the calls he’s made there haven’t been returned.

The other hospital he has bills from told him he isn’t eligible for financial assistance because he was never admitted to the hospital. He also isn’t eligible for a reduction to pay the “cost” of care (the actual amount that the hospital care costs as opposed to the increased prices the uninsured are usually charged), even though he is below 250% of the federal poverty level, because he didn’t complete the DSS application for SAGA medical.

When he left my office after an appointment, he had a long to-do list, including applying for SSD, applying for Medicaid (which included about 20 pages of medical paperwork for him and his doctor to fill out), contacting the hospital to straighten out the billing error, writing a letter to the collections agency to dispute the bill, and calling his state Senator’s office to see if they could help him. It is a full time job to be without health care when you have health issues and unpaid medical bills. For advice on managing hospital debt see our tip sheet.
Jen Ramirez

SustiNet and budget updates

Saturday HB-6600, AAC the Establishment of the SustiNet Plan, passed the Senate on a vote of 23 to 12. The bill passed as it did in the House, without further ammendment. The Health Care Partnership bill, HB-6582, which self-insures the state employee plan and allows municipalities, small businesses and non-profits to participate in the plan, also passed Saturday. Both bills passed the House last Wednesday and now move to the Governor’s desk.

The CT Health Policy Project has published an analysis of the Governor’s latest budget proposal and its impact on health care. Her proposal includes a reduction of just over $50 million in each year to the HUSKY HMO capitation rates based on an audit of those rates by the Office of State Comptroller.
Ellen Andrews