Comment on eHealth exchange privacy policies

eHealthConnecticut has created a portal to collect public comment on evolving privacy and security policies for CT’s health information exchange. Posted so far is the draft Universal Medical Records Release form that patients will sign to indicate if they agree to share their information and materials from our two input forums held at the Capitol. Coming soon will be privacy and security policies that will govern the exchange. You can comment with attribution or anonymously and sign up to receive alerts when new documents are posted.
Ellen Andrews

CVE meeting in DC

I’ve spent the last two days at a fascinating meeting of data geeks, providers, employers, health plans, quality organizations and consumer advocates from across the country all working to improve the quality of health care. It was a meeting of Chartered Value Exchanges from 25 communities/states; eHealthConnecticut was designated as a CVE in a very competitive process. The program is administered by the federal Agency for Health Care Research and Quality (AHRQ), part of Health and Human Services. The best part of the conference is the strong emphasis and clear commitment of AHRQ and the CVEs to serving consumers’ needs. The first sentence on the website sums it up -- “Consumers deserve to know the quality and cost of their health care.” Everything flows from there. It isn’t just a set of platitudes, but it permeates everything they do. It is refreshing – consumer advocates in CT don’t get that a lot.

Eventually, through eHealthConnecticut CT consumers will be able to get comparative quality information about our providers across payers online– for example how many patients with diabetes are being well managed, and STD or cancer screening rates. In a few communities, this ability already exists. A great example is the Puget Sound Health Alliances’ Community Check up. They also have a special report comparing care in Medicaid with other coverage. There was a lot of talk about fair, nationally certified, consensus approved measures and standards, as well as lots and lots of discussion and research about how best to meet consumers’ needs and questions, how to present the information to ensure it is useful, and how to market the tools. CVEs are devoting significant resources to answering all these questions – making sure the system is consumer-centered. It is a fantastic model that CT policymakers should be studying.

Another great benefit from the conference was getting to spend two days with the rest of the CT delegation, including a health plan, a large employer, a primary care physician, a hospital rep., and a quality organization. It is critical for stakeholders to understand and respect other perspectives, and the opportunities for that in CT are rare, unfortunately.
Ellen Andrews

Hospital stay points out need for health information technology

A recent stay in Hartford Hospital has highlighted the importance of electronic medical records for my personal health care. My doctor’s office, which is located in Hartford Hospital but is apparently not really part of the Hospital, has electronic medical records but Hartford Hospital does not. When I was admitted to the hospital, my doctor’s office faxed over some general information about me, but not a complete medical history. This meant that I had to review my medical history with a doctor even though it was all in the chart in my doctor’s office. The doctors (I saw different ones over the couple of days I was in the hospital) asked me repetitive questions and questions that could have been better answered by a doctor or my medical chart. What if I accidentally gave them the wrong information or forgot to include important facts? Even if Hartford Hospital does get electronic medical records of their own, it is important for them to be able to access information from different doctor’s offices outside of the hospital.

Before my hospital stay, my doctor had sent me to see a specialist, also located in Hartford Hospital but not part of it, and because they were both located in the Hospital, I assumed the specialist would have access to my electronic medical records from my doctor. They did not. This meant that there was information I had to make sure the specialist knew about my situation so they could give me a thorough checkup. It would have been much easier if the specialist’s office had access to the electronic medical records from my doctor’s office. I worry about the care of patients who aren’t organized, with failing memories or because of their illness cannot answer doctors’ questions.
Jen Ramirez

Charter Oak after one year – mixed returns

One year after the implementation of the Governor’s Charter Oak Health Plan, the program is still struggling to make a difference for CT’s 326,000 uninsured as outlined in a Stamford Advocate article yesterday, updated today. Currently there are just under 9,000 members accessing care who may not have any other option. However, a year ago the Governor estimated that there would be 15,000 people in the program by now. Over 20,000 people have been unable to qualify for Charter Oak and the program has had difficulty getting providers to sign up.
Ellen Andrews

How scientists think

Kary Mullis won a Nobel prize for figuring out how to make multiple copies of short pieces of DNA. While that doesn’t sound revolutionary, his polymerase chain reaction (PCR) forms the cornerstone of current and future genetic innovations including genetic testing and sequencing the human genome. His latest great idea came to him after watching a friend die from an antibiotic-resistant infection. He explains it better than I can in this video from the TED conference.
Another TED conference talk worth three minutes of your time is here, especially if you think you always hated math. For more on statistics and why you should care, go to our Book Club and scroll down to the bottom. Start by re-reading How to Lie with Statistics.
Some days I really miss science.
Ellen Andrews

OLR insurance acts report out

The Office of Legislative Research’s annual report on acts that passed this year concerning insurance is out. Eighteen public acts are described covering a range of issues including autism, expedited external appeals, a program to review the social and financial impact of mandated benefits, insurer medical loss ratio disclosure, coverage of stepchildren, and prohibiting payments for “never events” as defined by Medicare. Among the four insurance bills vetoed by the Governor are an expansion of coverage benefits, post-claims underwriting limitations, and the Health Care Partnership bill. She also vetoed the SustiNet bill, but the legislature overruled that veto on Monday.
Ellen Andrews

Governor’s SustiNet veto is overturned

The Senate just voted 24 to 12 to overturn the Governor’s veto of HB-6600, An Act Concerning the Establishment of the SustiNet Plan. Earlier this afternoon, the House also voted to overturn her veto on a largely party line vote. The bill now becomes law.

eHealth report finally out, privacy forum tomorrow

The long awaited report by DPH to assess CT’s health information technology landscape and develop a plan was released Friday. The 170 page report finds that eHealth activities in CT are fragmented and that CT is not yet prepared to take advantage of the opportunities. Recommendations include creating/anointing an official RHIO (regional health information organization) to herd the cats, devoting sufficient resources to the effort, and hiring grown-ups to run it. The report highlights eHealthConnecticut as the “most developed RHIO in the state . . . that represents virtually all healthcare constituencies across the state.”

The report devotes a great deal of attention to the importance of engaging consumers in development and oversight of all health information policymaking and implementation. It also highlights the importance of strong privacy and security policies and an inclusive process to develop them.

“Consumers and consumer representation organizations are as eager to discuss their desire for health IT/HIE to make improvements in quality of care and overall health as they are to reveal their fears and concerns. Consumers should be consistently and proactively engaged relative to their perspectives on health IT/HIE.”

eHealthConnecticut, AARP and the CT Health Policy Project have been leading just such a process in creating policies for a pilot Medicaid health information exchange scheduled to begin operation this fall. Our second consumer input forum to share policy drafts developed by a broad stakeholder working group is being held tomorrow, July 20th, at 10am in Room 1C of the Legislative Office Building. The working group includes consumer advocates, legal aid, providers, and state agencies, with legal and technical privacy experts. There will be on-line opportunities to comment on the policies as well.
Ellen Andrews

Veto override session Monday

It will be a busy day Monday at the Capitol. Both houses of the General Assembly will go into session to consider overriding the Governor’s vetoes. It is unclear how many of her 19 vetoes will come up for a vote. The legislature has three days to decide. Among her vetoes are the SustiNet and Healthcare Partnership bills which have been cited as priorities by leadership.

Also on Monday, the CT Health Policy Project is cosponsoring an eHealth privacy and security consumer input forum at 10am in Room 1C of the LOB. Also at 10am but across town, the CT Insurance Dept. will hold a hearing on whether to approve Anthem’s request for premium increases up to 32%.

Anthem rate hike hearing Monday

Our state Health Care Advocate and Attorney General have been granted intervenor status in the Insurance Dept.’s public hearing to consider Anthem’s request for rate increases of up to 32% on health insurance premiums. These hearings are a rare opportunity for public input on the impact of such rate increases on consumers during these trying economic times. Consumers will have an opportunity to share their testimony at the hearing Monday July 20th at 10:00 am at the CT Insurance Dept., Room 701, 153 Market St. in Hartford. If you plan to attend, even if you don’t want to speak, contact Michael Mitchell in the Health Care Advocate’s Office. He can be reached at Michael.F.Mitchell@ct.gov or (860) 297-3847.

PCCM update

The bad news is that only 165 people having signed up for PCCM – now called HUSKY Primary Care, according to DSS at yesterday’s PCCM Subcommittee meeting. The dept. is spending a lot of time with a small number of providers developing care management plans, procedures, comparison charts, etc. A three page notice about PCCM was sent, along with a not-as-bad pamphlet on the program, to about 16,000 households in the Waterbury and Willimantic areas. However, few consumers or providers in the area know anything about the program, and even fewer are signing up. DSS has no plans to do more outreach, relying on providers to do all that work. Providers however are not confident about the program or DSS’ commitment to it. DSS is not even printing their own brochure, but expect providers to do that. And DSS is limiting what providers may do to promote the program. DSS is also steadfast in insisting that providers must sign a contract that includes irrelevant and unreasonable freedom of information burdens on individual doctors.

Many at the meeting noted that HUSKY families have been through a lot of painful and confusing transitions recently; voluntarily signing up for a new, unfamiliar program is not a high priority. Calls to the HUSKY phone line printed on the brochure do not offer PCCM as an option unless asked about it and if a patient’s doctor is not participating nothing is said about asking him/her to join. There are no provider recruitment materials or FAQ. One provider in the room stated his belief that mainly children with special health care needs are signing up for PCCM, creating a financial windfall for the HMOs by removing expensive patients from their membership.

The good news (yes, there is some) is that DSS appeared to hear the concerns. First, the room was packed including six legislators – Rep. Walker, Rep. Cook, Sen. Prague, Rep. Villano, Rep. Hamm and Rep. Ritter – all holding DSS accountable. After a contentious discussion about the need for parity between the massive resources devoted to the HMOs and the meager resources devoted to PCCM, as the meeting wore on, DSS came to understand that perspective. The good news is that DSS is looking into changing the default process so that the 20% of new clients who enroll in HUSKY from Waterbury and Willimantic but do not choose a program will be enrolled in PCCM. This was done in the past for AmeriChoice and Aetna to increase their share of the program. And DSS’ contractor agreed to train the staff that answer the phone about PCCM.

No mention was made of expanding the program to New Haven and Hartford as agreed in the waiver application hearing. In fact, a Hartford-based provider group that learned about the program got a frosty reception from DSS when they called to ask about participating. The next subcommittee meeting is Sept. 16th. We only meet every other month to accommodate DSS’ staff concerns. We will see what progress is made by then.
Ellen Andrews

Courant poll on health care today

Today’s Hartford Courant online poll is again on health care. Should Congress tax the wealthy to pay for reform?

16,220 CT residents likely to lose coverage this year without health care reform

If we don’t address our broken health care system, 16,220 more CT residents this year will join the 326,000 already uninsured in our state, according to a new report by Families USA. Between the beginning of 2008 and the end of 2010 it is estimated that 48,660 more CT residents will lose coverage if nothing is done. These estimates are likely to be conservative as the researchers did not include the impact of rising unemployment which is 8% in CT.
Ellen Andrews

Pedometers on dogs

According to the Wall Street Journal blog, some 11 and 12 year old children in East London participating in a study on exercise and obesity clipped their pedometers to their dogs to raise their results. The use of pedometers was designed to get around study subjects’ natural tendencies to over-report how much they exercise.

Book Club: The Economic Naturalist

Why were CEOs of large tobacco companies willing to testify under oath that nicotine is not addictive? Why might a patient with a sore knee be more likely to receive an MRI exam if he has conventional health insurance than if he belongs to an HMO? Why do physicians tend to overprescribe antibiotics? Through questions, The Economic Naturalist: In Search of Explanations for Everyday Enigmas makes fundamental economic principles understandable and relevant. See the rest of our review and others at the CT Health Policy Project’s Book Club.

Take the CT Post poll on the Governor’s health care vetoes

Debate: Was Governor Rell right to veto the uninversal health care bill?Record your opinion – vote today.

CT’s air gets an F

The American Lung Association has a new online scorecard of air quality across the US. Every county in CT gets an F for high ozone days. Litchfield and New London get C’s for particle pollution but Fairfield, Hartford and New Haven get an F on that measure as well. High levels of ozone and particle pollution are linked to heart attacks, allergies, and premature births among other problems. Thankfully there are steps you can take to minimize your risk, as well as advocacy links to support policies that make the air cleaner for all of us.
Ellen Andrews

Medicaid Managed Care Council update

According to DSS at today’s Medicaid Managed Care Council, the number of dental providers participating in the CT Dental Partnership grew by 20.8% from December to June. There are now 924 dental providers at 541 locations across the state caring for HUSKY and SAGA consumers.

DSS also reported that there were only 366 HUSKY appeals filed in 2007 and even fewer, only 174, in 2008. It is not clear that consumers know that they have the right or know how to appeal treatment denials.

SAGA medical expenses per member per month declined by 0.6% in the fiscal year that ended June 30th after rising 7% in 2008 and 8.2% in 2007, probably because spending in the program is capped and enrollment grew by 12% this year. The average per member per month cost in the program is $424.47. Pharmacy costs decreased by 6.5% because, after carving out pharmacy benefits, drug company rebates rose significantly. Other states have also increased rebate recoveries after carving out pharmacy benefits. The SAGA provider panel has increased by 181 providers this year and utilization of physician services is up 33% from last year. The increase in primary care access may be the reason that ED visits are down by 7% in the program.

Charter Oak enrollment is up to 8,979 as of July 1st, however 824 people stopped paying their premiums in June and dropped out of the program.
Ellen Andrews

Take the Courant poll on Governor’s health care vetoes

Today’s Buzz poll at the Hartford Courant website: Was Governor Rell right to veto health care bills?

New Book in the Club

It’s Too Hard to be Sick in America: Stories of Chronic Illness is new by CT’s own Jennifer Jaff, Executive Director of Advocacy for Patients with Chronic Illness. The book details the stories of people struggling with long term illness, including Jennifer’s own story. No statistics, no analysis and no political spinning can make the case for fundamental system reform the way narratives from the real world do. Read the review by Karen Nepomuceno, CT Health Policy Project intern.

CSG/ERC regional health updates

The latest health updates from the Eastern Region of the Council of State Governments is online.

Governor vetoes SustiNet and Partnership bills

Late today Governor Rell vetoed both the SustiNet bill, which would have created a board to develop a plan to cover CT’s uninsured , and the Health Care Partnership bill, which would have self-insured the state employee plan and allowed municipalities, small businesses and non-profits the option to buy into the plan. The Governor estimates that the bills would have significant costs to the state, although she did not consider the costs of doing nothing and did not incorporate any estimates of probable federal funding in her estimates. She was concerned that the SustiNet board did not include representatives from the insurance industry, hospitals and business. In an accompanying Executive Order she creates a 15 member Health Care Reform Advisory Board to make recomendations in response to federal reforms. The majority of members are to be appointed by the Governor or her commissioners; she includes no consumer representation. The bills now go back to the General Assembly for a potential override.
Ellen Andrews

eHealth privacy drafts ready, share your thoughts

Monday, July 20th at 10am in Room 1C of the Legislative Office Building eHealthConnecticut, the CT Health Policy Project and AARP-CT will hold a forum to collect consumer feedback on draft privacy policies and a universal consent form. eHealthCT is creating a pilot health information exchange for CT Medicaid members to go live this fall, but the privacy work done in this process will serve as a foundation for future exchanges in CT. The exchange will allow providers to access health records, history, test results, treating providers, prescriptions, etc. electronically saving time and money while improving quality and reducing errors. Protecting patients’ privacy and the security of data is paramount. We are planning an opt-in policy for the exchange, but that will require a substantial public education campaign. A group of consumer advocates and providers has been working with attorneys to draft the policies, but we need your help. The forum builds on input we received at our April eHealth privacy forum. The drafts will also be available on eHealthConnecticut’s website for comment. For more information on eHealth, visit our resource page.
Ellen Andrews

CT Voices seeking budget analyst

CT Voices for Children is hiring a Senior Policy Fellow for Economic and Fiscal Analyst to work on family economic security and state/federal fiscal analysis. CT Voices is an advocacy organization dedicated to promoting the well-being of all CT’s young people and their families by advocating for strategic public investments and wise public policies.

From the Consumer Helpline

Unfortunately there are times when there aren’t many options for affordable, comprehensive health care for callers to our Consumer Helpline.

One consumer caller, a man in his early 50s is looking into early retirement because of a disability. He is gathering information about his options and his main concern is finding health care for himself and his wife. I have discussed some options for health care with him – but none of them are great. Some are very expensive – like the high-risk pool and COBRA. Some have very low income and asset limits – like SAGA and Medicaid. He most likely won’t be eligible for individual insurance because of pre-existing conditions. Then there’s the Charter Oak program, which will cover pre-existing conditions but doesn’t have a lot of doctors who will take it and he hasn’t been uninsured for six months. His wife is self-employed, part-time and relies on him for health insurance so there’s no option of being added to her insurance. I’ve mailed him some information so he can look into it further.

Another caller works for a non-profit and found out that his health insurance premium for himself and his wife is almost doubling. His wife has stopped working because of a disability and is in the process of applying for social security disability. We talked about Charter Oak for her but she hasn’t been uninsured for six months. I sent them some information about a program through the Department of Social Services for Medicaid for the Employed Disabled – it has higher income and asset limits than regular Medicaid. But there are still not many good options.
Jen Ramirez

July CT Health Policy Webquiz

Test your knowledge of cigarette smoking in CT. Take the July CT Health Policy Webquiz.

SustiNet rally at the Capitol Tuesday

The Governor has until Wednesday to sign, veto or let the SustiNet bill pass into law without her action. Organizers have been holding a vigil outside her office every day at 3pm. On Tuesday, a large rally/vigil will be held from 3 to 5pm on the north steps of the Capitol – rain or shine. (Let’s hope for shine). Click here for more info.

Stunning photos at the Capitol

The pictures on the walls of the underground walkway between the Capitol and the Legislative Office Building in Hartford are stunning. The pictures of various scenes in Taiwan stopped traffic in the hall this morning. Definitely worth checking out. The Capitol is closed tomorrow and Monday, reopening Tuesday.
Ellen Andrews

Budget update

I may have spoken too soon earlier today when I said the Governor’s July allotments reflect a maintenance budget. Further drilling down into the allotment amounts announced by the Governor to bridge essential services until there is a budget agreement finds that some large line items are funded significantly below what was spent last July. Medicaid is down by over half from $733 million in July 08 to $340 million in this July’s allotment. DSH payments to hospitals for medical emergencies and for urban hospitals are both zeroed out; last July the state spent $13.4 million and $7.8 million in those accounts, respectively. Significant cuts were also made in the SAGA and TANF line items. It is possible that the state expects to delay payments to providers and HMOs to improve the financial picture for this budget year.
Ellen Andrews

July budget allotments out

As the Governor and General Assembly have not agreed on a budget, the Governor has released July allotments for state expenditures. It is important to note that while some line items, including important health care services, have been zeroed out, that does not mean they will be cut in the new fiscal year budget. Our sample of health care line items that have a zero allotment did not have any expenditures in July of last year – the expenditures were paid in later months. We understand that this is meant to be a maintenance budget; OPM asked state agencies what bills they need to pay in July. We also understand that the state met or exceeded the target number of employees taking early retirement, so that projected savings should be secure.
Budget negotiations are continuing.
Ellen Andrews