Webinar: National Health Reform and What it Means for CT

The video and slides from today’s webinar with Rep. Joe Courtney, Congressman from CT’s 2nd district, are posted at http://www.cthealthpolicy.org/webinars.

New Webinar: Congressman Joe Courtney on national health reform

Join CT Congressman Joe Courtney from CT’s 2nd district, and CT Health Policy Project Board Member, describe national health reform, how we got here, and what it means for CT in a webinar next Wednesday March 31st at 3:15pm. To register, go to https://www1.gotomeeting.com/register/169103624

Collaboration works – housing conference

This morning was the third in a series of conferences on housing in CT, but with a twist. The organizers emphasized the need to collaborate across issue areas – to include people who care about transportation, education, workforce, the economy, government, the environment, and health care. The conference was a collaborative effort of non-profits with government. They brought in speakers to talk about model programs in other states like Louisiana, North Carolina, Ohio, Pennsylvania and Texas (yes, Texas). They brought useful ideas that could be adopted here to improve on the housing successes CT has already achieved through collaboration. There was a lot of very productive talk about breaking down silos around housing. I left wishing we could do the same for health care in CT.
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.

Federal health reform – what it means to the real world, how to prepare now

The Wall Street Journal has a nice article outlining what people in the real world can do to prepare for national health reform. The NY Times has a great site describing what reform will mean for you, depending on your status now.

CT Medicaid wins in health reform reconciliation bill

The reconciliation bill scheduled to be considered this weekend by Congress benefits CT’s Medicaid program, and the state bottom line, in significant ways.

The bill would expand Medicaid coverage to all state residents (except undocumented immigrants) up to 133% of the federal poverty level (FPL) -- $14,620.50 for individuals and $19,669.50 for a family of two – in 2014. CT would receive full funding for all newly eligible residents in 2014, tapering down to 90% after 2019. In 2007/2008 CT had 110,200 uninsured residents living below 133% FPL. In January of this year there were 43,549 members of our state-funded SAGA program; those members would become eligible for Medicaid and, because we do not have a waiver to cover them, they should be eligible for federal funding saving the state $133 million. Because CT does not have a Medicaid SAGA waiver, coverage of SAGA members would qualify for federal funding under the reform bill (sometimes it pays to procrastinate). It is also likely that many of the 6,077 Charter Oak residents in the lowest income band (0 to 150% FPL) as of March 1st will become eligible for Medicaid and full federal funding, saving the state what we spend on their subsidies.

Medicaid primary care providers will benefit under the reconciliation bill which increases their rates to Medicare levels in 2013. In 2008, CT primary care Medicaid rates averaged 0.78 of Medicare levels, according to the Kaiser Family Foundation. The incremental cost will be paid fully by the federal government from 2013 through 2014. In 2008, CT’s rates were better than most other states (weighted average of 1.44 compared to other state’s rates). CT would receive more if our provider rates were closer to the national average, but we will be getting more than we did in the past.

In January, the CT Health Policy Project outlined a list of questions CT’s Medicaid program needs to answer in implementing national health reform.
Ellen Andrews

CT nursing school graduate survey results

The CT League for Nursing fielded a survey of 2010 nursing school graduates for the SustiNet Health Care Workforce Task Force; the CT Health Policy Project analyzed the data. The survey found that virtually all the graduates plan to stay in CT, and most intend to work full time. Two out of three are graduating with debt, most totaling between $10,000 and $30,000. Most expect to work in a hospital, but a large number of LPN graduates are seeking positions in nursing homes. Factors affecting their decision include distance, location, work environment, and finances, in that order.
Ellen Andrews

Rising uninsured in CT falls hardest on middle income families; How national health reform would help

A new report by the Robert Wood Johnson Foundation finds that between 1999/2000 and 2007/2008 the rise in the number of uninsured CT residents was concentrated among people living in households between two and four times the poverty level (now between $36,620 and 73,240/year for a family of three). The number of CT residents with incomes in that range rose by 7.2 percentage points; below that income, the percentage of uninsured dropped by 5.7 and above those incomes the rate barely changed (up 0.3). Also during those years, CT workers’ contributions to employer health insurance rose by 45% for single coverage and 53% for families; median incomes only rose 2.5%.
But in good news, the US House Committee on Energy & Commerce has posted online fact sheets outlining the district-by-district benefits of national health reform. The reports include the numbers of families and small businesses in each Congressional district that would receive tax credits to help pay for insurance, how many families would be protected from bankruptcy, how many residents with pre-existing conditions would get coverage, funding for community health centers, and how many uninsured residents would be covered.
Ellen Andrews

PCCM Subcommittee update

At today’s PCCM subcommittee of the Medicaid Managed Care Council, DSS unveiled their plans for the Mercer evaluation of the program to be completed by July 1st. Advocates raised many concerns including:
· The inability to get any meaningful information on health outcomes with only 200 members on average over the last year
· A survey of those few consumers and providers in the program is valuable, but misses exactly the population we need to be reaching out to – the far larger population of consumers and providers who have decided not to sign up – we need to know why, and adjust the program accordingly
· It is likely that consumers will say that they have not noticed a change since moving from HMOs to PCCM – does that mean the program has failed? A provider with 100 PCCM patients has received only $9,000 this year – not enough to hire a care coordinator or even to change policies significantly
· There is a lot in the evaluation about testing providers’ compliance with the contracts, but nothing to evaluate whether DSS has done any of the things they promised to do
· No evaluation of PCCM marketing (or lack of it)
· Strong concerns about measuring health outcomes at this very early stage – among 200 kids, on average only about half would have had a well-child visit this year, and of that number how many had health care needs that required coordination to even be evaluated?
· How can you test readmissions to hospitals (a relatively infrequent event) in such a small population over only a year
· Holding providers accountable for patients’ ER visits is unfair if DSS still hasn’t set up a system to notify providers when their patient visits an ER – how are they supposed to know?
· These are fairly intrusive questions that touch on sensitive areas for practices, the documentation burden will take time from overburdened administrative staff and serve as yet another barrier to signing up with the program
· Asking about EHR implementation is premature, and the contract also allows electronic disease registries – a mention was made to providers by DSS staff at one meeting that an Excel spreadsheet would work – it is completely unfair to change the rules at this point
· It is unfortunate that so far in this program DSS has spent less than $19,000 on care coordination (and zero on marketing) but is willing to shell out four times that amount for an evaluation that appears set up to label the program a failure
The Committee reviewed information from DSS that suggests that PCCM is more costly than the current HMOs; however DSS cautioned strongly that with such small numbers it is not a valid comparison. It was also noted that there is anecdotal evidence that because it is so small, the program is attracting disproportionately more medically needy and complex members than the rest of the HUSKY program. If true, this would serve to benefit the HMOs financially by removing more expensive patients from their roles. The Committee also discussed options to allow more willing pediatricians to participate and to recruit more adult medicine providers. The Committee discussed what should be included, and what should be prohibited, in an ASO contract to run the PCCM program; the Committee agreed to solicit input from other stakeholders before the next meeting. The Committee will draft a letter to DSS and CMS with our suggestions for improvements to the program.
Ellen Andrews

Medicaid Managed Care Council meeting update

Friday’s Council meeting was uneventful. After a year, there are 342 people in PCCM/HUSKY Primary Care; legislation requires at least 1,000. Despite that, DSS is steaming ahead on plans to evaluate the program by July 1st. It is fascinating that they are just now deciding to comply with deadlines in this program – they have blown through every reporting and start date in legislation until now, but they appear to be eager to get an evaluation of the program done as soon as possible. Despite promises to consult with the PCCM Subcommittee, DSS has already negotiated an agreement with Mercer on the scope of the study. They stated that it was a draft agreement, but noted the aggressive time frame for the work and did not commit to making changes in response to the Committee’s input at next week’s meeting. Advocates and legislators raised concerns about a premature evaluation that will not provide a valid assessment of such a small program and could be used to unfairly label the program a “failure” and be used to shut it down before it has had a chance to succeed. Advocates have also raised concerns about hiring Mercer for the evaluation given that Mercer receives much of its revenue from HMOs and Mercer signed off on the 24% rate increase DSS gave the HMOs two years ago, overpaying the HMOs by $50 million/year. Advocates also raised concerns over the $75,000 cost of the evaluation, especially given the growing budget deficit and proposed cuts to essential services for HUSKY families.
Other reports from the Council meeting include good news from the CT Dental Health Partnership – the number of providers and sites continues to grow and prior authorizations are being processed in under 11 business days. Concerns were raised that, while there has been progress, there are still serious problems with access to care. DSS and the Partnership are working hard to address them, reaching out to providers, consumers and advocates to improve the program. The HMOs described their Quality Improvement Projects, required under their contracts, and stated that they will be reporting on their findings, planned interventions to address concerns, and progress toward quality improvement. Concerns were raised about whether patients in the study sample are notified that their records are pulled and subjected to increased scrutiny. The HMOs will check and get back to us at next month’s meeting. INFOLINE reported on the calls and cases they receive on their helpline. Last year they received 66,200 calls for assistance – the three top problem areas were help finding a dental or primary care provider and access to prescriptions. They noted that the carve outs of dental and pharmacy benefits dramatically decreased calls to their office about those services.
Ellen Andrews

Thousands line up for free dental care

People began lining up outside this year’s Mission of Mercy clinic at 3am Friday morning. The CT Dental Association sponsors the clinics annually to provide free dental care to CT residents in need. This year’s clinic ran Friday and Saturday in Middletown but could only care for 1,000 patients each day. Almost 1,700 people, clinicians and non-clinicians, volunteered at the clinic. Over the last three years, clinic organizers have seen demand for their services increase, but because of improvements in HUSKY dental care, the number of children needing care is down. In 2004, 35% of US adults had no dental coverage; people who are poor or low-income are more than twice as likely to be uninsured than those with high incomes. Average dental expenses per American rose 68% from 1996 to 2006.
Ellen Andrews

Council of State Governments/Eastern Region state/provincial updates

The latest health policy update from CSG/ERC the Northeastern US states and Canadian provinces is online. The CT Health Policy Project has worked with CSG/ERC on health policy issues for over four years – providing policy analysis and support while shamelessly stealing great ideas to bring back to CT.

From the helpline

An uninsured consumer called our office looking for help paying bills to two hospitals. He had been placed into collections but he had received no information about financial assistance. He made $17,000 last year; not wealthy by any means but ineligible for SAGA. He has no children, so doesn’t qualify for HUSKY. I called Milford Hospital first on his behalf. The billing person I spoke to was not helpful, stating that information on their financial assistance program was printed on the back of the bill – a provision that she feels complies with CT laws requiring notification. When I pushed the issue, she wanted my name, organization and title. She read the notice from the back of the bill that my client would have received – it was the CT General Statute word-for-word. Anyone who has read CT state law knows that they are not even close to understandable. She informed me that it is hospital policy that they cannot even send a financial assistance application until the patient has applied for HUSKY and SAGA, been denied, and presented the hospital with a denial letter – something that was not explained in the notice she read me. I explained that my client is clearly not eligible for either program and this policy only creates a needless hurdle for him and senseless paperwork for DSS workers who have better uses for their time. She just kept saying that it was hospital policy and that they would have told him the policies if he had called them. I asked her to call him and later got a call back from her to let me know that she’d left him a message. (I’d already called to tell him what he needed to do.) Next I called the Hospital of St. Raphael; they just asked for his address and will send him an application packet right away.
Ellen Andrews

New plan for Dempsey hospital

The Governor and UConn unveiled their newest plan to revive John Dempsey Hospital at the UConn Health Center in Farmington. The $352 million plan will be funded with $100 million from national health reform, assuming it passes, and by re-directing $227 million from already-approved projects elsewhere. The cost is down from previous plans costing $430 million; this initiative includes partnerships with five area hospitals rather than only Hartford Hospital as in the original plan. The plan includes a new cancer center, simulation training program, bioscience zone, and primary care, clinical research translation, and health disparities institutes.
Ellen Andrews

Report finds CT long term care skewed toward nursing homes

A new report by the CT Regional Institute finds that the way we pay for long term care costs us an additional $900 million/year in Medicaid costs. Currently, CT spends 47% of our long term care funding on expensive nursing home care; we are 34th in the nation in the proportion spent on home and community based care. The study finds that current Medicaid rules and regulations make it easier to access care in nursing homes than in the community. Almost 80% of CT residents would prefer to receive care in their home than a nursing home. Over the next 15 years the number of CT residents over age 65 will increase by 40%, driving the need for long term care, but the number of residents ages 18 to 64, potential caregivers, will decrease by 5%.
Ellen Andrews

Nancy Pelosi visits New Haven to talk about health care reform

US Speaker of the House Nancy Pelosi spoke to about 100 advocates, providers, and policymakers yesterday at the Graduate Club in New Haven about women’s health and the benefits of the health reform bills being considered in Congress. She was hosted by US Rep. Rosa DeLauro and US Rep. John Larson and joined by Dr. Carolyn Mazure, Director of Women’s Health Research at Yale. Melissa Marottoli, a cancer survivor, noted that when she was diagnosed, two and a half years ago, doctors estimated that she had only six months to live. She stated that she cannot change jobs because she now has a pre-existing condition and is concerned that she would not be able to get health coverage in a new job unless the reform bill passes. The Speaker talked passionately about the millions of Americans who have no coverage and the health and financial consequences that all of us. She noted that when it passes, health reform will prohibit insurers from denying coverage due to pre-existing conditions such as women who’ve been the victim of domestic violence, stabilize the Medicare program and eliminate the doughnut hole in prescription coverage, and improve the American economy by eliminating job lock – people Like Melissa who can’t leave their jobs for health coverage. She emphasized that the bill makes no changes to women’s access to abortion services and is confident that reform will pass this Congress.
Ellen Andrews

Buying insurance can be confusing

When I was at a friend’s house recently, his parents were in the process of choosing a health plan because his mother had just gotten a new job, and they were finally going to have health insurance through her employer. There were several plans to choose from, and all of them looked similar, except that one had a significantly lower deductible. None of us could figure out why that would be, but obviously, he and his parents were ready to choose that option because the lower deductible made it much cheaper. At the very bottom of the page, however, I noticed the row listing the annual benefit limit for each option. For the plan with the lower deductible, the annual benefit limit, or the amount up to which insurance will pay per year, was only $30,000. That amount sounds like a fair amount of money for a healthy family, but I knew from my work here at the Project, that one surgery or emergency could easily use up that amount. I mentioned that to them, and after a lot of discussion and googling the price of various emergency surgeries, they decided to go with one of the options with a higher annual benefit limit. I was glad I was able to help them, but it also made me realize how difficult navigating the world of health insurance is, especially for those who have it for the first time or who come from countries with nationalized health care. Medical care costs more than most people realize, and health insurance plans and their terminology can be confusing, which often leaves people feeling lost when they make decisions concerning their health insurance.
Sabina Klein, CTHPP Fellow

PCCM bill public hearing

Tuesday the Human Services Committee heard HB-5297, An Act Concerning Statewide Expansion of the Primary Care Case Management Pilot Program. The bill would, as the title says, expand PCCM statewide as of October 1st and delay the planned evaluation of the program until next year. Advocates have raised concerns about DSS’ plans to evaluate the program prematurely, worried that it could incorrectly label the program a “failure” and serve as an excuse to shut it down. PCCM has only 322 members; legislation requires at least 1,000. DSS plans to hire Mercer for the evaluation; Mercer receives much of its revenue from HMOs.
At the hearing, legislators peppered the commissioner with questions about why DSS has not been supportive of PCCM especially marketing restrictions such as requiring providers to print their own brochures or restricting providers from talking to their patients about PCCM but allowed to answer questions if asked. Legislators noted that they have heard very positive feedback from PCCM providers and were concerned that physicians in parts of the state beyond DSS’ current four towns who want to join the program (a remarkable and wonderful thing) are being told that they can’t participate. Legislators were particularly interested in what happened to $5 million appropriated in the last two years to support PCCM. DSS answered that they used the money to cover their deficit, which includes the $50 million overpayments to the HMOs uncovered by the Comptroller’s audit.
Ellen Andrews

Governor proposes more cuts to health care

To address the growing budget deficit, the Governor’s mitigation plan includes $13.7 million in new cuts to health care programs. The cuts include higher copays and premiums for HUSKY Part B and Charter Oak families, cuts to community and school-based health centers, cuts to Medicaid providers, reductions in hospital DSH payments for the uninsured, new cost sharing for Medicaid clients, and cuts to vision, transportation, dental care and outreach. Something for everyone.
Ellen Andrews

Hearing on hospital error reporting proposal

Yesterday the Public Health Committee heard SB-248, An Act Concerning Adverse Events at Hospitals and Outpatient Surgical Facilities. Proponents argue that the bill would close important loopholes in the current weak hospital system reporting including public reporting of errors -- so consumers could use the information in their medical decisions and put pressure on hospitals to improve patient safety. There is no evidence that secret reporting has improved patient safety. The bill would also require random audits of hospital safety, protect employees who report errors, and imposes penalties on hospitals that don’t comply. The CT Hospital Association opposes the bill claiming that the current law allowing reports to remain secret encourages hospitals to report errors.
Ellen Andrews

A fresh perspective

At the beginning of February the National Association of Free Clinics ran a free clinic in Hartford, and for the entire afternoon, the sense of good will and community was a pleasure to be a part of. I had the opportunity to be a Spanish translator, and although the demand for translators had tapered off by the time I arrived at 2:45, I was able to help a couple of people and eventually switched to accompanying patients through the process regardless of language needs. Because they kept the translators in one area while we waited for patients who needed us, I was able to talk a lot with the other translators and watch the waiting areas. One thing that overwhelmed and impressed me in both my conversations and the interactions between people was the positive attitude and friendliness that marked almost every interaction. So often, we spend a lot of time griping about health care in this country and how unwilling some politicians and people are to fix the system, but at the clinic, everyone was just very excited to come together and help people. Challenges definitely existed in getting people the full care they needed, but overall, doctors, nurses, and volunteers were obviously there to help in any way possible. This sense of good will was reaffirmed when I received, as did all the other volunteers, an email that relayed a message from one of the patients who received care at the clinic. When she arrived at the clinic, doctors realized that this woman was in cardiac distress and rushed her to the hospital. There, she spent a week being treated for hypertensive crisis and congestive heart failure. She called the director of the National Association of Free Clinics when she was released from the hospital to thank her for the care that saved her life. I knew good work had been done when I left the clinic that day, but it was even more inspiring and affirming to hear that the free clinic had a lasting positive effect.
Sabina Klein, CTHPP Fellow