SustiNet 60 day report released

Yesterday the SustiNet Board released their report to the General Assembly on how Connecticut’s 2009 health reform law fits with recently passed national reform. The report outlines significant new resources available to support SustiNet and three steps for the state to take advantage. In all, SustiNet tracks closely with the parameters of national reform.
Ellen Andrews

New webinar on risk adjustment models

The success of health care payment reforms rests on the ability to fairly adjust provider rates to reflect the expected health costs of each patient. Accurate risk adjustment can reduce incentives to over treat or avoid high cost patients. The science of risk adjustment has evolved significantly. Hear from experts about the methodologies and models to ensure that resources go to the patients who most need them. Register for our webinar June 9th at 2pm at https://www1.gotomeeting.com/register/441699025

Patient-Centered Medical Home updates

There are several opportunities in the new federal health reform act for CT to embrace, and fund, patient-centered medical homes. Currently, CT has no (zero) medical homes certified by NCQA, the national accrediting body. The SustiNet patient-centered medical home committee is considering the options and how they fit with Connecticut’s unique health care environment. At this week’s meeting, the committee heard from Ron Preston, formerly Regional Administrator at CMS in Boston, about an exciting collaborative of New England states to apply for a Medicare waiver allowing a multi-payer medical home initiative. Unfortunately CT is the only New England state not participating; it is unclear how the current administration made that decision. In addition to accessing Medicare funding, the collaborative is also working to set common standards for data collection and evaluation across patient-centered medical homes in the region to identify best practices and share resources. The committee was very interested in engaging CT with that collaborative, accessing new federal resources for our state, and learning from others about successful practice transformation to benefit every CT resident. The committee meets again this coming Wed. May 26th at 10am in the LOB.
Ellen Andrews

Only CT and DC take early expansion option

To date only CT and the District of Columbia have submitted early option applications to expand Medicaid under the new federal health reform law. CT applied April 15th and DC submitted their application May 13th. CT plans to cover our 45,000 SAGA members under Medicaid, providing expanded coverage and eliminating the SAGA asset test, while bringing in $53 million in new federal matching funds over the next fifteen months. DC expects to save $56 million over the next four years. Twenty nine states, including CT, are also taking advantage of the new federal option to create a temporary high risk pool; eighteen states are going to use the federal high risk program rather than creating their own pool.
Ellen Andrews

Medicaid Managed Care Council update

We ran out of time at Friday’s Council meeting, so we will devote the entire June meeting to discussing how the state plans to implement the new budget provision to self-insure the HUSKY/SAGA/Charter Oak program. Some of the decision points are whether to keep the program capitated but without financial risk (not sure how that works), whether we can continue to allow some providers to be paid more than others, whether to re-bid the contracts for one or more ASOs (or just keep the current HUSKY HMOs as happened last time), and whether we can have (or need) more than one ASO. Other HMOs are interested in applying now that the program does not carry financial risk. Apparently, responses from the current HUSKY HMOs to the RFP to provide non-risk care management services to the current Medicaid fee-for-service population were not cost effective.

In other reports, the Council heard about important work being done by the Women’s Health Subcommittee and Community Health Center, Inc to prevent low birth weight babies and improve breastfeeding rates by getting pregnant women into prenatal care early, ensuring access to dental care, smoking cessation and identifying and treating depression during pregnancy. The committee is planning a prenatal care summit in the fall.

Mercer gave their usual, glowing evaluation of the HMOs. Under questioning, it became clear that their evaluation is only of processes, and does not reflect actual access to care for members. Performance studies were not promising; at best, there was little progress on any health outcome or process measures. The CT Dental Health Partnership continues its impressive progress to enroll more providers and expand access to oral health care. And PCCM enrollment is up to 388 as of May 1st; up from 359 a month before.

And the Council’s name changed to the Council on Medicaid Care Management Oversight.
Ellen Andrews

Health care reform training session

The Universal Health Care Foundation of CT will hold Building Public Awareness: Building Public Will, a training session for community leaders and advocates to help us get the truth out about health reform, at the state and federal levels, and how to counter the myths and misinformation about health care. The session will be June 5th from 9am to 2pm at Middlesex Community College. If you are interested in getting involved, contact info@healthcare4every1.org or call (203) 639-0550 X320. For more on myths and truths about the federal health care reform bill, check our latest brief.

The Pill turns 50, CT took a little longer

Today, Mother’s Day, marks the 50th anniversary of the birth control pill’s approval by the FDA. Today one in five American women between the ages of 15 and 44 use the pill, spending $3.5 billion in 2008. The pill’s development hinged on the discovery of the Barbasco root, a type of wild yam that Mexican women had been chewing to prevent pregnancy for generations. It was the first US drug developed for use by healthy people. Controversial throughout its history, the pill neither destroyed nor perfected American society and family life as was predicted fifty years ago. Because of health concerns associated with the pill, the FDA changed their approval process including more extensive clinical trials, referrals to outside experts, and ongoing assessment of medication safety. The pill also led the FDA to communicate directly with patients rather than relying only on physicians to relay safety information.
Connecticut has a long history in women’s access to contraceptives. Attempts to shut down a New Haven family planning clinic led the US Supreme Court in 1965 to toss out a state anti-contraceptive law from 1879. The Court ruled that contraceptive use is a private issue. The decision made use of the pill in CT legal, as in the rest of the US.
Happy Mother’s Day.
Ellen Andrews

Fewer physicians accepting visits from drug reps in the office

The Wall Street Journal blog reports on a new survey of US physicians that found the number who are “rep-accessible”, or willing to meet with drug company sales rep.s in the office, is down 18% from last year. However, still 58% of doctors take meetings with at least 70% of the reps who call and only 9% see fewer than 30% of calling salespeople. Drug companies have significantly reduced their sales forces in recent years. By 2012 it is expected that the number of drug reps will be down to 70,000; that is still one for every ten practicing US physicians.
Ellen Andrews

Sen and Mrs. Dodd to host food allergy forum

Sen. Christopher and Mrs. Jackie Clegg Dodd will host a forum on managing food allergies at home, in school, away at college and in restaurants. The forum will feature Dr. Hugh Sampson of Mt. Sinai Medical Center, Eva Bunnell, parent of a child with a food allergy, Cheryl Resha, RN from the CT Dept of Education’s Bureau of Health and Nutrition, Dr. Jeffery Factor, Timothy Larew, a college student with food allergies, and Gary Crowder, from Resort Operations at the Mohegan Sun. The forum will be Sat. May 15th from 10am to noon at Founders Hall, CCSU, 1615 Stanley St., New Britain CT. Parking is available in Welte Garage. To RSVP email foodallergy@dodd.senate.gov or call (860) 258-6940.

Budget agreement reached

The Governor and General Assembly have reportedly reached an agreement on changes to next year’s budget, beginning July 1st, to cover a $2 billion deficit. The agreement includes converting HUSKY to a self-insured ASO model saving $77 million and increases in copays and premiums for HUSKY Part B families, saving $576,000. The legislature is expected to vote on the package today – the last day of the regular session.
Ellen Andrews

CT woman files one of first actions under federal genetic anti-discrimination law

Pamela Fink, a Fairfield resident, filed complaints last week with the US Equal Opportunity Commission and the CT Commission on Human Rights and Opportunities under the new Genetic Information Nondiscrimination Act. Ms. Fink argues that her employer, MXenergy of Stamford, eliminated her job after learning that she carries a genetic risk for breast cancer. Ms. Fink stated that she received excellent job evaluations, merit increases and bonuses for years until she told them of the genetic test results when she was targeted, demoted and eventually fired. President Bush signed the bill into law in 2008, but the employment provisions only became effective last November. The bill had been debated in Congress for 13 years. The law prohibits discrimination in health coverage and employment based on genetic information. Coverage nondiscrimination provisions of the law began taking effect last May and will be fully effective this month.
Ellen Andrews

Rell administration will not challenge national health reform law

At yesterday’s Health Reform Cabinet meeting, the Rell administration announced that they will not join twelve other states in a lawsuit challenging the Patient Protection and Affordable Care Act. All twelve Republican state senators signed onto a letter urging the state to join the suit. The senators argue that the federal law usurps states’ rights in regulating health care delivery and individual freedoms including the individual mandate. So far the administration has signaled that they will be pursing two opportunities under the new law – the Medicaid early expansion option to bring 43,000 SAGA recipients into Medicaid saving the state over $50 million and another $50 million or more available for CT’s high risk pool to cover people with pre-existing conditions.
Ellen Andrews

Governor interested in creating a CT high risk pool

Among other things, national health reform gives states an opportunity to create an insurance pool for people with pre-existing conditions. The law gives CT up to $50 million, possibly more, to implement a high-risk pool through 2014. At that point the law prohibits insurers from denying coverage to adults based on pre-existing conditions and it is expected that people with prior health problems will be able to secure affordable coverage in the private market and public exchange. Insurers are prohibited from excluding coverage for children with pre-existing conditions this year. CT has had a high risk pool since 1975 operated by the Health Reinsurance Association, however it has provided relief to few CT consumers due to very high costs. In a letter to HHS yesterday, Gov. Rell indicated that CT is interested in providing the new pool coverage through the existing HRA administration but offered by DSS. DSS does not have a promising record of promoting or administering health coverage programs. The Governor made clear that CT is not willing to devote any state funding to the pool due to the budget crisis and is not making a commitment to developing a program.
Ellen Andrews