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.