National gridlock on health reform misses the point

A new report by Families USA estimates that 2,100 residents of Connecticut have died because they were uninsured since the last time Congress considered health reform but did not act. The report predicts that without reform another 1,700 will die by 2019. The report used methodology from an Institute of Medicine study with updated numbers.

“The findings in this report are truly shocking and underscore the urgent need for health insurance reform. We cannot afford to stand idle as individuals and families in Connecticut and across our nation continue to suffer and even die because they don’t have health insurance. I thank the Connecticut Health Policy Project and Families USA for bringing this issue to light and for their work on behalf of the uninsured,” said U.S. Rep. John Larson, D-1st District “We are closer than ever to bringing real reform to the health insurance industry – reform that will end discrimination based on pre-existing conditions, lower health insurance costs for all Americans and strengthen Medicare for the long term. Just this week, the House passed important legislation that would force the health insurance industry to compete fairly and honestly like every other industry in America, ending the health insurance industry’s anti-trust exemption. I also applaud President Obama for bringing together Republicans and Democrats for today’s health care summit. Health care reform is not a Republican or a Democratic issue, as this report proves it is an American issue and one we must confront.”

“For many, the health care reform debate is a matter of life and death,” U.S. Rep. Joseph Courtney, D-2nd District, said. “ This debate is about providing coverage to those who are without and controlling skyrocketing costs for small businesses and families whose health is threatened by a dysfunctional system.”

U.S. Rep. Rosa DeLauro, D-3rd District, said, “It is simply appalling that in my own state of Connecticut, 2,100 adults have died due to lack of health insurance since the last attempt to pass health care reform legislation—and another 1,700 will die in the next 10 years if we fail to act. For far too long, the American people have waited for Congress to act, and this report makes it starkly clear: the cost of inaction is too high. We must continue the work we have done over the past year and work to pass legislation that will ensure every American has access to quality, affordable health insurance reform. It is literally a matter of life and death.”

Pressure is building to improve health insurance premium regulation

Calls are increasing from advocates, legislators and public officials to better regulate health insurance rates in CT. A bill being heard today in the Insurance and Real Estate Committee, SB-194 An Act Concerning Rate Approvals for Individual Health Insurance Policies, would tighten the CT Insurance Dept. procedure for approving insurers’ proposed rate hikes. A recent report by the Office of Legislative Research found that the Dept. rarely denies insurer requests. The US Dept. of Health and Human Services released a report last week highlighting CT among states with very large insurer rate requests and predicts 20 to 40% rate increases into the future. The President’s recent health reform plan proposes to regulate premiums at the federal level rather than the states.
Ellen Andrews

CT a leader in children’s oral health

Some good news for a change – CT is recognized as a national leader in getting dental care to children in a new report by the Pew Center for the States. The proportion of children on Medicaid receiving dental care has been rising since 2005 up to 41.4%. It’s true that is low, well below the rate for children with private insurance at 58% (and far below 100%, every child deserves decent health care) but it is above the US Medicaid average of 38.1%. We met six of eight benchmark oral health policies, so we are far ahead of most states. Oral health advocates (current and former) at the CT Oral Health Initiative, Greater Hartford Legal Assistance, and champions in the General Assembly deserve all the credit.
Ellen Andrews

Why is getting healthy so hard? Find out April 21st

The Donaghue Foundation’s annual meeting will focus on behavioral and cultural perspectives on taking responsibility for our health. The meeting will be Wednesday, April 21st from 7:30 am to 12:30 pm at the Hartford Marriott Farmington. Registration is free. For more information click here.

What if news was run like health care?

Building on the idea of running an airline the way we run the US health care system, yesterday’s NY Times column by Nicholas Kritof, I Cost More But I’m a Specialist, envisions news delivery like health care delivery. Very funny.

CT state retiree health and benefit system underfunded by $26 billion

A new report by the Pew Center on the States finds that while all but four states have underfunded retiree benefits, CT is among the worst. We are one of eight states with over one third of our liability unfunded. In 2008 CT’s pension liabilities totaled $41.3 billion, but we had only $25.45 billion in assets and health care and other benefits are 62% of the retirement funding shortfall. This doesn’t count last year’s early retirements which have significantly added to that liability. Pew has rated our health care and benefits fund as needing improvement but our pension fund earned their lowest rating – serious concerns.
Ellen Andrews

Webinar on DPH health care workforce programs, addition to medical home webinar

Thursday, Feb. 25th at 3pm, speakers from DPH will join the SustiNet Health Care Workforce Task Force on a webinar to describe their health care workforce programs. Kristin Sullivan will discuss the public health workforce, Jennifer Filippone will describe J-1 Visas and online licensure, and Johanna David will present on the National Health Service Corp. To join the webinar, register at https://www1.gotomeeting.com/register/402604745

Jim Hester, Director of Vermont’s Health Care Reform Commission has agreed to join the SustiNet Medical Home Committee webinar scheduled for Tuesday, Feb. 23rd. We will begin at noon with Jim; Ann Torregrossa of the Pennsylvania Governor’s Office of Health Care Reform will join us at 1 pm. To register, go to https://www1.gotomeeting.com/register/596582016

For a list of upcoming webinars and materials from prior talks, go to the CT Health Policy Project’s Webinar page.

Tolland is healthiest CT county, Windham least healthy

A new study ranking US counties based on health finds Tolland county is CT’s healthiest for outcomes and Middlesex for health factors. Windham is the least healthy for both outcomes and health factors. Outcomes measured include premature death, fair or poor health status, and low birthweight. Health factors include smoking, uninsurance and liquor store density. The study was released by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute; they plan to repeat the rankings annually.

Free Dental Clinic March 12 and 13

The CT State Dental Association will be sponsoring a Mission of Mercy free dental clinic again this year on March 12th and 13th at the Aetna Building on Industrial Park Rd. in Middletown. The clinic will start at 8am each day. There are no eligibility or income requirements; both children and adults are welcome. Patients will be seen on a first-come-first-served basis – no appointments. Services include fillings, cleanings, extractions, root canals, and interim partial dentures on a limited basis. Sign up to volunteer through February 21st – both dental/medical professionals and community volunteers are needed. For more information, call 866-539-9372.

Another webinar

Wednesday, February 24 at noon the SustiNet Patient Centered Medical Home Committee will hear from Lee Partridge of the National Partnership for Women and Families. Lee is a national consumer advocate and expert on patient-centered medical homes. To register for the webinar, go to https://www1.gotomeeting.com/register/524374993
For more on the Partnership’s medical home project, click here.

For information on our other webinars, click here.

New webinar – Medical homes and payment reform in PA

On February 23rd at 1pm, the SustiNet Patient Centered Medical Home and Health Care Quality and Provider Committees will hear from Ann Torregrossa, director of the PA Governor’s Office of Health Care Reform, about her state’s progress implementing medical homes and payment reform. To register, go to https://www1.gotomeeting.com/register/596582016

February 22nd at 3pm the SustiNet Health Care Workforce Task Force will hear from Tanya Court of the Fairfield County Business Council, Margaret Flinter from the Primary Care Authority and Alice Pritchard and Mary Ann Hanley of the Allied Health Workforce Policy Board. To register, go to https://www2.gotomeeting.com/register/795515106

Videos and slides from our first two webinars are on-line. The first included Mina Hawkins from NCQA about patient-centered medical home certification; the second was with CT provider professional organizations about the future of CT’s health care workforce.

Check this page for upcoming webinars and archives.

New Britain dentists providing children with free care this Friday

The New Britain Herald is reporting on several New Britain dental offices opening their offices this Friday to children who cannot afford care including screenings, cleanings and fillings. The “Give Kids a Smile” program was started by the American Dental Association in 2003 as part of National Children’s Dental Health Month. For information on participating offices, call (860) 347-6971 X3701.

New addition to the Book Club

What would happen if there was an earthquake in an American community, the Red Cross came into town and provided disaster relief, but a couple of months later everyone got a bill for those services, marked up tenfold, and people who couldn’t pay were sued? There would be outrage; it wouldn’t be tolerated. But that is what happens to the uninsured at nonprofit hospitals every day. Do No Harm is the story of a doctor and an accountant who brought attention to the finances of their local Georgia hospital. For a review of this movie and other works, at least marginally about health policy, check out the CT Health Policy Project Book Club.

PCCM forum highlights DSS barriers to implementation

Friday the Appropriations Committee heard about DSS’ lack of progress in implementing the PCCM option for HUSKY passed into law three years ago. The panel included Dr. Patrick Alvino, a pediatrician practicing in Branford, who would like to participate but because PCCM is not statewide he and his 2,000 patients do not have the option. The committee also heard from Tawana Bourne, a HUSKY mom from Middletown who has struggled to access care for her family and would also like the option of receiving care though PCCM’s medical home model but it is not available in her town. Christine Bianchi of Staywell Health Center in Waterbury, a participating provider, talked about the lack of support or guidance she has received from DSS in trying to implement the program that started in Waterbury a year ago. Sabina Klein, a Yale senior and CT Health Policy Project Fellow, outlined to the committee the provider recruitment and public education activities she and other students/volunteers working with the Project and New Haven Legal Assistance have been providing in the absence of DSS efforts including phoning and visiting provider offices, putting up posters in schools, churches and health care sites, manning tables at community events, holding provider forums, and providing mass mailings to consumers and provider groups. Because DSS marketing guidelines prohibit providers from telling their patients about the PCCM option, but can answer questions if asked, the CT Health Policy Project purchased “Ask Me About PCCM” pins that the students/volunteers have distributed to hundreds of PCCM providers. The committee also heard from this advocate about PCCM experience in other states including OK where the shift from HMOs to PCCM saved $85.5 million in medical costs in the first full fiscal year, participating providers increased over 40%, outpatient visits went up, and ER visits went down. DSS responded that they believe the program is reaching its goals and they have no plan to improve enrollment or provider recruitment beyond what they are doing. The committee discussed advocate recommendations to hire an Administrative Services Organization to run the program for DSS and to appoint a Special Master to take over the program if DSS does not improve their efforts and performance.
Ellen Andrews

Why we need patient centered medical homes

Government is taking over health care

Sometime next year government will overtake all other payers and fund more than half of all US health care, according to actuaries at CMS. Last year health care consumed 17.3% of our economy, the largest one year climb since 1960. We spent $282 million per hour last year on health care. Just government’s share of US health care spending last year was equal to all health care spending – government plus private payers -- in Britain and Italy. How long can we keep this up?
Ellen Andrews

Governor’s budget proposal – lots of cuts and a plan to reform HUSKY HMOs

In her budget proposal released yesterday, the Governor proposed shifting the current HUSKY HMOs away from capitation back to a non-risk arrangement. For a few months in early 2008, the Governor ordered a similar switch from capitation to an Administrative Services Organization (ASO)-model, in which the HMOs administered the program for DSS but passed all the medical bills onto the state. There is evidence that the state saved money under that non-risk arrangement. At the time, the HMOs were paid $18.18 per member per month (pmpm) for those services; a back of the envelope calculation suggests that the state expects to pay about $15 pmpm this time. Under PCCM, a new alternative to HUSKY HMOs, providers are paid only $7.50 pmpm for services that include care coordination. The 2008 switch resulted from advocacy efforts for transparency and accountability in the program. This year’s switch is prompted by cost pressures. An audit by the Comptroller last year found that HUSKY was overpaying the HMOs by $50 million/year. The Governor estimates that switching HUSKY to an ASO model will save the state $29 million next year.
Unfortunately, the Governor’s proposal also includes copays on Medicaid services, eliminating coverage for non-prescription drugs, vision services for adults, cuts to subsidies and increased premiums in the Charter Oak Health Plan, increased premiums and copays in HUSKY Part B, vision and transportation cuts to SAGA, and cuts HUSKY outreach. Those cuts total $53 million. None of these cuts is necessary; we have thirteen ways to save money in CT’s state budget that improve health.
Ellen Andrews

Free clinic makes a difference

Yesterday’s massive free health clinic at the CT Convention Center in Hartford had provided care to 700 uninsured people in just the first three hours. Almost 1,100 people signed up to volunteer. The clinic was run by the National Association of Free Clinics; CT has over a dozen free clinics providing care to the uninsured. I was an exam room runner – getting patients where they needed to be, getting supplies and answers to questions, and generally filling in. I spent a lot of time talking with patients – most were working, some at more than one job. Most had been uninsured for a long time and hadn’t seen a doctor in over a year. Unfortunately, I saw three people whose problems were so serious that ambulances needed to be called. Volunteers came from all walks of life; I met doctors, nurses, medical administrators, PAs, social workers, students, an investor, community organizers, retirees, some people who are unemployed, and a computer programmer. Services provided included physician services, seventeen specialties, lab tests, help with prescriptions, counseling, HIV testing, immunizations, dental and vision testing. Everyone was connected with follow up care, appropriate public and private medical and social programs at check out. The organization involved was mind-boggling and carried off with professionalism and good humor. It was a tremendous treat to be involved, a nice break from policy analysis and advocacy, but it was exhausting.
Ellen Andrews

February webquiz – PCCM/HUSKY Primary Care

Test your knowledge about CT’s PCCM program -- HUSKY Primary Care. Take the February CT Health Policy Webquiz.
This month’s quiz was developed by Sabina Klein, CTHPP Student Fellow and soon-to-graduate Yale senior. Sabina is one of the “army” of students/volunteers working to get out the word about this exciting new option for HUSKY families. (Sabina is second from the right in the picture).

PCCM update for Appropriations Committee

Friday from 10am to 1pm at the Legislative Office Building the Appropriations Committee will receive a report from DSS about their progress in implementing PCCM/HUSKY Primary Care. Following the department’s report will be a panel including physicians, a consumer, and this advocate about the program.
Ellen Andrews

Quality and Valerie Jarrett at Families

Regions of the US with higher health care spending actually have worse health outcomes, according to Elliott Fisher from Dartmouth. Friday’s Families conference started with a fascinating plenary about the disconnect between what we spend on health care and what we get, followed by concrete guidance for providers who want to improve the quality of care they deliver. As a state based advocate, I found the workshops on exchanges, subsidies, benefit packages, and states’ roles in reform were very useful. At lunch, Valerie Jarrett, White House Senior Advisor, came to thank us for our advocacy and to urge us on.
Ellen Andrews