CT second lowest state in obesity rates

In 2007 to 2009, CT ranked behind only Colorado in the lowest rate of obesity among adults according to a new report by the Trust for America’s Health. The bad news is that obesity affects one in five state adult residents (21.4%) and is up 9% from 2006-2008. And the news just gets worse -- more than half of CT adults are either overweight or obese, and 21% of us are physically inactive. The future doesn’t look much better -- 12.5% of CT children ages 10 to 17 are obese and only 22% are vigorously active every day. The rate of obesity among CT black adults was 65% higher than for whites, but Latinos in CT were only slightly more likely to be obese than whites. Black women in CT had the highest rates of obesity at 38%. CT ranks pretty well in setting healthy school policies; we regulate food in schools, set standards for physical education, require health education and have farm to school programs. However, the state does not collect weight data on students. CT has some child care regulations in place about physical activity and healthy eating for children but is lacking many protections, especially for home day care centers.
Ellen Andrews

WellPoint data breach put sensitive medical information on 5,600 CT residents at risk; Reinforces need for privacy protections

The Hartford Courant is reporting that between October and March, sensitive financial and health information about 470,000 Americans who applied to WellPoint for individual insurance was at risk of public disclosure, including 5,600 Connecticut residents. WellPoint is the parent company of Anthem Blue Cross Blue Shield in Connecticut. The breach only affected people who applied online for individual coverage; people covered by an employer or other groups were not at risk. The flaw in the online system was discovered by someone applying for insurance online, not by the company. WellPoint reports that during those five months, less than ten unauthorized computers accessed the information.
This latest breach highlights the critical need for an informed privacy policy for health information exchange in CT.
Ellen Andrews

State considering eHealth privacy policy that defaults everyone into the system

A DPH state planning committee announced that they are recommending a privacy policy for state health information exchange that would default consumers into the system unless they affirmatively opt-out. The process to opt-out, or even how consumers would be informed of their rights, is unclear. The recommendation also requires providers – hospitals and doctor’s offices – to remove any sensitive information from files shared on the exchange and to accept liability for anything that is missed. This would require scouring medical records for any reference to a drug or a doctor’s note that signals any HIV/AIDS, mental health or substance abuse issues, which state law prohibits sharing without affirmative patient consent. The committee, which includes no consumer representatives, held a public forum Wednesday evening to discuss the policy and the larger strategic plan that was not well publicized or well attended. DPH is taking comments on their plan which is to be submitted to the federal Office of National Coordinator in September.
Last year after a thoughtful public process, eHealthCT, a nonprofit group, developed an opt-in privacy policy for a Medicaid pilot health information exchange scheduled to begin operation next month. Every patient will have to affirmatively consent to sharing their information on the pilot exchange. Other states with opt-in polices find that the vast majority of patients give their consent. All our neighboring states have adopted opt-in policies. The eHealthCT privacy committee developed our policy after convening a diverse group of providers, technology and legal experts and consumer groups. We held forums at the capitol, collected input online, and created a consensus policy with wide support.
If you would like to submit comments on the state’s plans, email Meg.Hooper@ct.gov.
Ellen Andrews

Cheap solutions to big problems work better; small is the new big

In a hilarious TED talk, marketing expert Rory Sutherland points out the counter productive trend to throw big money at problems when, in fact, small changes are often more effective. The talk does touch on health care – at about four and half minutes into the video he describes a link between childhood immunizations and lentils. At the end of the video (only 12:37 total, you will be hooked after 30 seconds) he describes the job I want – Chief Detail Officer.

In another TED talk, Paul Bennett of Ideo gives convincing evidence that small is the new big and the importance of finding design in the details. The health care hooks include tracking experience of care from the patient’s perspective (I know, but it is new for the people who run hospitals) and data input device designs that allow nurses to hold patients’ hands during scary procedures. My favorite quote from the video – the blinding glimpse of the bleeding obvious. I’ll be using that a lot.
Ellen Andrews

Health IT strategic plan public hearing tomorrow; opt-out policy being considered

DPH’s health IT planning group will have a public review of their strategic plan tomorrow evening, June 23rd from 5 to 7pm at the Legislative Office Building. DPH is heading the state’s HIT planning in response to CT winning federal funding to build a health information exchange. The group is accepting input online until June 30th as well as tomorrow night.
Of concern are reports, not discussed in the strategic plan draft online, that the group is planning to adopt an opt-out privacy policy. In opt-out policies, every patient is assumed to have agreed to share all their health information with the exchange (and anyone who has access to the exchange) unless they affirmatively find and sign a form asking to keep their information private. eHealthCT developed an opt-in privacy policy for the Medicaid health IT exchange pilot, after a lengthy process engaging a large and diverse group of advocates, providers, legal experts, and other stakeholders. The eHealthCT group considered all the options, held several public forums, gathered comment online and solicited significant legal advice which all led to an opt-in policy where patient information is only shared after patients affirmatively make an informed choice to share their information, after learning about all the benefits and risks.
Ellen Andrews

Health benefits consuming more of total employee compensation, Northeast most expensive

Between March 2000 and 2010, health care benefits grew from 5.5% to 7.5% of total compensation costs nationally, according to the Bureau of Labor Statistics. In March 2010, health insurance averaged $2.08/hour worked in private industry -- more than disability, retirement, Medicare, Social Security, unemployment insurance, workers’ compensation, life insurance or paid leave. Not surprisingly, the Northeast led the nation in health insurance costs at $2.40/hour. Nationally, union workers’ health benefits ($4.38/ hour) were significantly higher than for non-union workers ($1.82/hour). Health costs were higher in goods-producing industries ($2.88/hour) than service-providing industries ($1.92). Among occupational groups, costs were highest for management, professional and related health insurance ($3.03/hour) and lowest for service jobs ($0.92/hour). Costs at larger establishments were higher than for smaller businesses; establishments with over 500 workers averaged $3.38/hour for health benefits compared to $1.34 in establishments with fewer than 50 workers.
Ellen Andrews

Utah program reduces non-urgent Medicaid ER visits by 55%

Safe To Wait, a Utah Medicaid educational program, reduced non-urgent visits to emergency room visits by 55%. Medicaid savings for some patients were as high as $156/month. In the Safe to Wait program, members were provided with information on which conditions were true emergencies and which could wait. After the first non-urgent ER visit, members received a letter outlining the costs of emergency room care and urging them to find a primary care provider. After the second visit, they received another letter listing local urgent care clinics. After the third trip, members were required to see a family physician to get prescription refills.
Ellen Andrews

Hispanic Health Council unveils new website

Visit the Hispanic Health Council’s re-designed website. The Hispanic Health Council’s mission is to improve the health and social wellbeing of Latinos and other diverse communities. Programs include substance abuse and recovery, nutrition assistance, farm workers health, HIV/AIDS, breastfeeding, diabetes, cancer and parenting support. Join the Hispanic Health Council for their 30th Anniversary on October 21st from 5 to 8 pm at their offices at 175 Main Street in Hartford.

Judge denies parts of nursing home lawsuit

A federal judge has denied an injunction in the CT Association of Health Care Facilities’ lawsuit against the state, but the lawsuit is moving forward. The nursing homes had asked for an injunction to stop $300 million in cuts scheduled over the next two years; the state asked the court to throw out the entire suit. The nursing homes argue that the state’s system of payments underfunds them by $100 million, considers only finances and ignores the quality of care, and violates federal law. About two thirds of nursing home revenues are paid by Medicaid program with payment levels set by the state. In total, nursing homes cost CT $2.5 billion/year; 22 homes have closed since 2002, in part because of low Medicaid reimbursements. The judge also removed Governor Rell as a named defendant in the suit leaving only Commissioner Mike Starkowski. The association contended that the Governor has an important role in setting the state budget and, consequently, for underfunding nursing homes.
A recent study found that CT relies more heavily on nursing home care for fragile seniors and people with disabilities than other states, costing an additional $900 million/year. Other state Medicaid program regulations and administration make accessing care in the community easier. Almost 80% of CT residents would prefer to receive care in the community rather than a nursing home.
Ellen Andrews

Medicaid Managed Care Council update

Friday’s Council meeting focused mainly on plans for the $50 million temporary high risk pool opportunity created by national health reform. DSS joined the CT Insurance Dept. and the Health Reinsurance Association (HRA) to describe their plans. They intend to piggyback on the current high risk pool administered by HRA which was created in 1976 to provide coverage to CT residents with pre-existing conditions denied individual insurance. Insurance coverage will be provided through United Healthcare. After more than three decades HRA enrollment is only 2,529. HRA was criticized at the meeting for very high premiums, high deductibles, and a very confusing website. There will be at least three call centers for the various stakeholders involved in the program, including DSS, CID, ACS, HRA and United Healthcare. Concerns were raised about fragmentation, that consumers would be left with no clear point of contact, and the risk of very high administrative costs, especially given the limited federal resources available. Concerns were also raised about benefits and cost sharing under the plan. DSS admitted that the plan does not comply with state law, but doesn’t have to under federal law. Even more controversial, DSS intends to seek legislative approval to shift any eligible Charter Oak members with pre-existing conditions to this new plan; consumers moving from Charter Oak to the new plan would face significantly higher costs, potentially reaching over $1,000 more per month. DSS refused to outline how they would use the savings in the Charter Oak plan; suggestions from Council members included reducing premiums, lifting benefit caps, raising the pharmacy cap or eliminating the requirement that applicants be uninsured for six months.

In other updates, DSS described the increases in copayments and premiums in Charter Oak and HUSKY Part B. ACS will track cost sharing for families and alert both the HMOs and families when they have reached the federal limits and will no longer be charged copays. DSS is still pursuing the conversion of SAGA into Medicaid with CMS. For the first time since its inception and despite stubbornly high unemployment rates, enrollment in Charter Oak dropped in May when members were notified of the increase in premiums.
Ellen Andrews

Patients asked to leave medical practice after filing complaints for excessive billing

Two Hartford Medical Group patients have been told they are no longer welcome at the practice for complaining about fees charged to them above the payments by their insurers for routine physicals, which are 100% covered. Three complaints have been filed with the Attorney General’s office for excessive and unjustified billing; one patient was told that she could come back to the practice if she withdrew her complaint with the AG. The AG’s office is investigating the allegations which they characterized as “potentially unjustified charges added to consumer bills for services that should have been included in the physical or were never provided.” The practice claims that one patient was belligerent and “nasty” about the extra bill. According to their online policies and procedures, Hartford Medical Group charges $35 to patients who don’t show up for appointments and $45 for “administrative fees” related to nonpayment and collections costs.
There is a small but growing national trend of doctors tacking on extra fees to patients, but for services insurance does not pay for including filling out school and camp forms, no-shows, and flat “non-covered benefits” fees.
Ellen Andrews

Risk adjusting rates webinar slides and video posted

you missed Wednesday’s webinar with Diane Laurent and David Williams of Milliman, the slides and video are now online. Diane and David described the methodologies to adjust rates based on each patient’s utilization history and diagnoses. Some models can predict future utilization and events, such as hospitalizations, for each patient providing an important tool to care managers in patient-centered medical homes.
Ellen Andrews

Immediate impact of national health reform for CT

The White House has developed a list of the benefits of the Affordable Care Act to CT this year. The list includes small business tax credits, closing the Medicare donut hole, funding for early retirees, no lifetime limits on coverage, no rescissions, no pre-existing condition exclusions for children, all children to age 26 can stay on their parents’ policies (and parents don’t have to pay taxes on those benefits), Medicaid coverage (and matching funds) for SAGA, $50 million for a high risk pool, funding for community health centers, and to train more providers. And that’s just part of the list.
Ellen Andrews

CT hospitals left out of Medicare bonuses

No CT hospitals are among hospitals nationally receiving Medicare bonuses under the new national health reform act. The bonuses were designed to equalize payments between high and low cost hospitals – none of CT’s 30 hospitals qualified as lower cost. The provision was prompted by research led by Dartmouth Atlas showing no link between high cost areas of the US and hospitals with quality.In fact Dartmouth researchers have evidence that higher cost areas are associated with lower care. That research is very controversial and other researchers disagree with Dartmouth’s findings.
Ellen Andrews

New report outlines long term cost of fully funding state retiree health benefits, Gov. Rell aggressively pursuing funding opportunities in national h

An early estimate to the state’s Post Employment Benefits Commission estimated that fully funding health benefits for the state’s 42,000 retired workers would average $1.9 billion over the next 28 years. The state now pays these bills as they arise; just over $490 million is budgeted for these costs in the fiscal year that starts next month. While full funding would cost more now, it would reduce future costs. The Commission includes representatives from the Comptroller’s and Treasurer’s Offices, the administration, and labor and is charged with analyzing long term funding of the state’s health and pension benefits system. The report was prepared by Milliman.

Governor Rell’s administration is aggressively pursuing federal funding opportunities in the new national health reform act, despite criticizing the reforms. The state will not be pursuing any new opportunities to cover Connecticut’s 343,000 uninsured under the act, but is only considering options to replace current state funding including $53 million to move current SAGA recipients into Medicaid and another $50 million to fund our high risk pool. The Comptroller’s Office has also applied for $100 million over the next four years to support coverage for state employee early retirees not yet eligible for Medicare. As funds for early retiree benefits are limited, the Comptroller’s Office responded to the opportunity quickly to apply early.
Ellen Andrews

Are hospitals more dangerous in July?

Anyone who has worked around hospitals has heard the warning to stay away in July when new residents start. But is it true? The Wall Street Journal examines the evidence, which is mixed. The bottom line is that it’s always wise to be an informed consumer. For tips on making your hospital stay safer and more go to the monthly columns by Carolyn Clancy of AHRQ. And for more on patient safety click here.
Ellen Andrews

CT Health Information Exchange meeting

DPH, DSS, and eHealthCT are hosting a CT Health Information Exchange Leadership Meeting June 10th from 8:30am to 12:30pm at the CT Hospital Assoc. Offices in Wallingford. Anyone interested in health IT and how CT is progressing toward creating a network is welcome. Attendees will hear updates on the DSS Medicaid HIE pilot project, eHealthCT’s Regional Extension Center program and DPH’s strategic and operational planning. Following the updates will be a town-hall style meeting to answer questions and collect input. To register go to http://www.ct.train.org/ for course #1022441 or email lynn.townshend@ct.gov.

Test your knowledge of CT’s individual insurance market

June’s CT Health Policy Webquiz tests your knowledge of CT’s non-group insurance market.

Obesity tools: CT middle of the pack in physical education report; improved home ec classes described

25.7 % of CT children are overweight or obese and policymakers are looking to the quality of physical education as one tool to address it. A new report by the National Association for Sport and Physical Education finds that CT’s state policies are better than some states and worse than others – we require physical education in elementary and high school, but not middle school. CT does not collect height and weight data on students making policy decisions, targeting resources, and evaluation of initiatives more difficult.

The Wall Street Journal Blog reports on what is needed in effective PE classes as well as other pieces of the solution to obesity including healthy eating. The authors argue that schools should require revamped home economics classes as well as physical education. The blog quotes a JAMA commentary describing improved home ec classes as giving students “the basic principles they will need to feed themselves and their families within the current food environment,” including “basic cooking techniques; caloric requirements; sources of food, from farm to table; budget principles; food safety; nutrient information, where to find it and how to use it; and effects of food on well-being and risk for chronic disease.”
Ellen Andrews

Report finds one in five CT residents have pre-existing conditions and risk of insurance denial

A new report by Families USA finds that 593,000 CT residents have been diagnosed with one or more condition that could result in denial of insurance coverage. In September, under the new national health reform act, insurers will be prohibited from denying coverage to the 44,200 CT children with pre-existing conditions, but the other half million adults in our state will have to wait until 2014 for protection. Every income group is affected but low income residents are at higher risk. Whites, African-Americans and Hispanics are about equally likely to be affected. Near elderly residents (ages 55 to 64) are the most likely to be at risk. Pre-existing conditions that often cause coverage denials include any diagnosis of cancer, diabetes, arthritis, obesity, heart disease, or sickle cell disease.
Ellen Andrews

$266 million in Medicaid funding at risk

Congress is considering a bill that extends the badly needed enhanced Medicaid matching rates to states for another six months. Without the legislation, the extra funding is set to expire at the end of this year. CT stands to lose $266 million in federal funds. Along with thirty other states, CT has assumed receipt of those funds in the state budget that passed this spring. The version that passed the House Friday did not include the extra Medicaid funding; an earlier version in the Senate does include the funding. The Council of State Governments/Eastern Region and other groups are urging Congress to continue this vital lifeline to states struggling with declining revenues and surging enrollments in these critical safety net programs.
Ellen Andrews