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