Wellness programs not living up to the hype

A new study finds that building effective corporate wellness programs is not as easy as it seems. Employers have blamed workers’ poor health habits for rising benefit costs and are embracing programs intended to get us to “take responsibility’ for our health, lose weight and stop smoking. However new research finds that many of these programs are a waste of money. Effective programs include personalized follow up, such as health coaching, clear commitment to the program from company leadership with a clear linkage to company goals, reasonable expectations, and careful use of incentives. Purchasing off-the-shelf, cookie-cutter programs with no employer involvement is the option most likely to fail. Unfortunately wellness, like everything else in healthcare, is labor-intensive and takes years to show financial results. WSJ blog authors offer that as they tend to lose weight on vacation, management should consider extending vacations.
Ellen Andrews

DPH public hearings on health information technology plan, privacy policy

Next month, DPH will be holding public hearings and accepting public comment online on their proposed plan for health information exchange for Connecticut. The plan includes a controversial privacy policy recommendation to default all patients into the system, unless they affirmative opt-out. Under the opt-out plan, providers would be responsible for removing any sensitive information (HIV, behavioral health, reproductive health issues, etc.) from shared records. Providers accessing information from the system will not know if the patient records are complete or whether any medications or treatments have been removed. Advocates have raised concerns about this policy. Health information technology holds great promise to improve the quality of care, patient safety and reduce costs; it is critical that privacy be a high priority to ensure public trust and the integrity of the system, especially in the case of any breach of information. Consumers must fully understand the system and their rights, both benefits and risks. Last year eHealthCT, a nonprofit dedicated to expanding health information exchange in CT , convened a privacy and security committee of CT stakeholders including providers, consumer advocates, state agency staff, legal and technology experts for a Medicaid pilot health information exchange. After an extensive public process, that group recommended an opt-in policy including patient information only after they have affirmatively agreed to participate. Massachusetts conducted an well designed, extensive, effective public education campaign that included significant consumer input for their opt-in policy and over 90% of patients choose to participate. Vermont’s exchange began with an opt-out policy, similar to DPH’s recommendation, but after operating the exchange has changed policy to opt-in. DPH intends to send their recommendations to the federal Office of National Coordinator for Health Information Technology (ONC) to access millions in federal grants to create CT’s health information exchange. DPH’s health information technology committee includes no consumer representatives.
The hearings will be August 19th from 5 to 7pm in Room 2E of the Legislative Office Building and August 26th from 9 to 11am at the Holliday Inn, 201 Washington Ave, North Haven. Online comment will be accepted August 16 thru 27 at www.ct.gov/dph. DPH reportedly expects to submit the recommendations to ONC Sept 7th.
Ellen Andrews

Aetna earnings up significantly, medical spending down

Despite higher unemployment and fewer people getting coverage at work, Aetna’s earnings were up last quarter by 42% over the same quarter last year. The company benefited from lower medical spending, allowing them to reserve more of consumers’ premiums for administration and profits. The proportion of premiums spent on medical care, the medical loss ratio, was down to 81.8% from 86.8% in the same quarter of last year. Under national health reform, insurers will have to spend at least 85% of premiums on medical care and quality improvement for large groups and 80% for small groups, effective next year. Spending over that amount must be refunded to policyholders. Several states have similar laws and policyholders in those states have received millions in refunds from insurers with low medical loss ratios. The laws are intended to keep premiums down and encourage health insurers to spend on health care rather than administration and profit. Standards for medical loss ratios under national health reform are being developed now. Under the law, the National Association of Insurance Commissioners (NAIC) will make recommendations to HHS on what to include as acceptable medical and quality expenses. Insurers, including Aetna, are aggressively lobbying NAIC to weaken the definition to include expenses such as claims processing, utilization review, and fraud detection. In a letter to NAIC Sen. Rockefeller (WV) states that the intent of the law was to hold health insurance companies accountable. Consumer and provider groups are advocating for a careful definition focused on health care and quality improvement. CT Insurance Commissioner Sullivan is on the NAIC committee which will make recommendations to HHS. In a recent meeting with advocates, he invited letters of comment.
Ellen Andrews

A place with too many primary care doctors

One of the many advantages of working with the Council of State Governments/Eastern Region is the opportunity to learn from our neighbors, especially north of the border. At times it seems that they have everything figured out, but not always. Prince Edward Island, like most Canadian provinces and the rest of the world, is facing skyrocketing health costs. The smallest province with only 141,000 residents, PEI has 94 general practice physicians. Like many governments facing skyrocketing health care budgets, the province hired consultants to outline options and make recommendations. Reportedly the consultants are focusing on reducing the number of physicians in the province up to 30% and expanding the role of nurses and nurse practitioners, although the report is not yet complete. As in other parts of the world, that suggestion is very controversial and politically charged. PEI’s health minister has stated that cutting the number of doctors is not an option.
Ellen Andrews

Reflections – Jaymie Potteiger

While working at the Connecticut Health Policy Project, I have been fortunate to see how difficult it can be to get a good thing noticed. The Connecticut free clinics are some of the most amazing organizations that I knew absolutely nothing about before beginning this job. These organizations pick up the slack where the system I am learning about in my classes seems to fall short, yet, their recognition seems to be so limited. Through this job, I have learned the need for constant networking and relationships. It is not just enough to do your job and do it well. The system runs on politics and who you know, and that is how organizations expand and continue to gain ground. While free clinics are creating opportunities for citizens in need to receive healthcare, free clinics are somewhat unnoticed in the political game. Hopefully, that will all change soon. This job has opened my eyes to see the constant need to improve social and networking skills to increase visibility to the important organizations and groups that give Connecticut residents resources and aid in their time of need. This has also taught me how to attempt to organize large groups with the same goal, and how to create suggestions to improve their networking within the system. These are skills that are invaluable in today’s world.
Jaymie Potteiger
CTHPP Summer Intern

44,000 CT small businesses eligible for health insurance tax breaks

Thanks to national health reform 44,000 CT businesses are eligible for tax credits making health insurance more affordable. Starting this year, businesses with less than 25 workers and average wages up to $50,000 are eligible for credits up to 35% of the employer’s cost of health benefits (25% for nonprofits). 12,900 CT businesses qualify for the largest credits which go to the smallest businesses (under 10 workers) with the lowest average wages (up to $25,000). In 2014, the credits increase but are limited to coverage purchased in the new (yet to be created) health insurance exchange and will expire after two years.
This is very important relief both to CT businesses and CT’s uninsured. CT small businesses pay the highest single premiums and half of CT’s uninsured work in businesses with less than 25 workers.
Ellen Andrews

Reflections – Eric Knowles

Since becoming a summer intern at the CT Health Policy Project, I've earned a greater appreciation and understanding for the difficulties and obstacles of creating effective policy change. Just last week, I attended a monthly Board of Directors meeting for the implementation of SustiNet, a law passed in 2009 that would provide nearly universal health insurance coverage to the residents of Connecticut. I had never attended a meeting of this magnitude, but quickly became aware of the different issues, players, and restrictions that affected SustiNet. The main concerns for the Board were the effects of national health care reform on their future recommendations, while also looking at what populations would be covered and possible economic impacts of SustiNet over the next decade. Many of the Board members disagreed with each other over the validity of the statistics being presented, how each population would impact SustiNet financially, and, in a somewhat heated exchange, how and when to go public with their plan. An underlying factor impacting the Board was the upcoming election that would bring in a new governor and administration, while most likely altering the composition of the Board as well. These divisive issues, opposing points of view, and constant moving parts in the political world make it very hard to get true consensus that will create lasting, effective health policy change.
Eric Knowles
CTHPP Summer Intern

Frustrating eHealth privacy meeting

Today’s meeting of the CT Health Information Technology and Exchange Advisory Committee’s Legal and Policy Subcommittee was frustrating. I was asked to come to discuss the concerns I raised in testimony at their public hearing June 23rd about an opt-out privacy policy for health IT exchange in CT. The committee members at the meeting included six or seven lawyers, some from private firms, and at least six state agency bureaucrats from DPH and DSS. They are recommending that every patient be defaulted into the health IT system unless they figure out how to opt-out. They are also requiring providers – hospitals and doctor’s offices – to edit out any legally sensitive information (i.e. HIV status, substance abuse or mental health treatment) that is protected by law. Busy providers have to assume the liability and labor involved in editing every record.

I am still not sure why I was there, because they have already made up their minds. In fact, they had already made their decision and forwarded their recommendation onto the powers that be before they ever held the public forum. If you didn’t hear about the forum, you weren’t alone. (Click here and scroll way down to find the forum notice.) They intend to continue this public input process by holding a series of public hearings in the fall, but after the final report has already been sent to the feds so any consumer input is irrelevant. (I know it doesn’t make sense but they have deadlines to meet.)

They all agree that a strong public education campaign is necessary to ensure that patients fully understand their rights and the benefits of having their information in the system, including reductions in medical errors, unnecessary duplicate testing, and reducing the costs of health care. When explained well, most people see the benefits of having all their providers know all their medications, surgeries, and allergies without having to remember them. It really isn’t necessary to default people into a health IT system and an opt-out policy doesn’t build trust. However, their weak public process for collecting input into the policy doesn’t inspire confidence in their capacity to conduct an effective public education campaign.

I left not sure why I was invited.
Ellen Andrews

eHealth privacy meeting tomorrow morning

Tomorrow morning July 20th at 8:30 – 10 am there will be a meeting of the CT Health Information Technology and Exchange Advisory Committee’s Legal and Policy Subcommittee at the state Dept. of Information Technology’s offices, 101 East River Drive in East Hartford. This is the group that has recommended an opt-out privacy policy for health information exchange in CT. This policy would default every patient into the system, unless they figure out how to opt-out (and figure out that they can). Providers will be responsible for removing any sensitive information (i.e. HIV status, substance abuse or mental health treatment) from all records including diagnosis, medication lists, doctor’s notes, etc. Providers will have to assume the liability and the all the labor costs in removing that information. Information in the records will be incomplete, with important but sensitive information missing; providers accessing the system will not know if they are seeing all the patient’s information, making treatment decisions more difficult. Advocates have raised concerns about this recommended policy and the lack of public/consumer input into the decision. An inclusive, public process by eHealthCT developed an opt-in privacy policy for a Medicaid pilot program.
Ellen Andrews

Meet Nelson Mendoza

Nelson Mendoza is a 19 year old from Houston Texas who just finished his freshman year at Yale. Nelson was one of our health policy fellows this last year. He is currently in India helping an NGO that brings vision care to rural areas of the country. He gave me permission to share his story.

Aside from a couple of months in eighth grade, Nelson did not have health care coverage until he came to college. His parents have always been uninsured to his knowledge; his father is a self-employed painter and his mother is a homemakers. His mother has several health problems including lupus. Nelson has two older sisters who are both teachers and now have insurance through their employers.

His family travels six hours each way Mexico, about twice each month, to both visit family and get health care. They cannot afford care in the US; prices in Mexico are far more reasonable. His mother takes several medications for her lupus, prescribed by Mexican doctors, and gets her prescriptions filled in Mexico. Even with more affordable prices for health care in Mexico, the family has to spread out the costs. Nelson’s father is healthy and consequently doesn’t get doctor appointments.

Growing up, Nelson didn’t see health care providers often. In eighth grade he briefly qualified for Texas’ CHIP program, but the family’s income increased slightly and he lost coverage. He remembers needing physicals for summer camp and that they were very expensive for his family. He also felt that they were very cursory – the doctor “didn’t do anything.”

His family is somewhat wary of the US health system. He is not certain that more available coverage, even with subsides, would be welcomed and an individual mandate might be resisted. There is a strong belief that doctors over treat you if you have insurance, they will “pile on services.” He thought that now as his sisters have consistent coverage and the family is having experience with insurance, that perception may be changing. He has often heard that when you are uninsured, the doctor will give you the “strongest” treatment to be sure the problem is treated, because you may not be back.
He finds having coverage through the Yale Health Plan “weird” and that he is expected to go to the health plan often. Coverage is costing him $1,800/year; he has had to borrow those costs and is worried about the loan payments when he is done with school.

He went to a dentist for only the second time in his life this summer. He had serious dental issues that he was told could have been prevented if he had gotten regular care.

He feels that his family is very lucky having few serious health problems. His mom had ovarian cancer, and had two surgeries in the US in the early 1990’s. It was very expensive; the extended family loaned his family money to cover the costs. In his community, this is the usual means of paying for large health costs. The loans are informal but there is strong social pressure to repay the family.

Nelson emphasizes that his story is not unique or “all that dramatic”. “I know lots of people in worse shape.”
Ellen Andrews

150,000 coming into already troubled Medicaid program

Finally attention is being paid to probably the largest impact of national reform – an estimated 150,000 people in CT will become eligible for Medicaid/HUSKY; an increase of 38% over current levels. Any reader of this blog knows how HUSKY has struggled since its inception. A secret shopper survey found only one in four listed providers would make an appointment, very low provider participation compared to other states, inability to implement PCCM (successfully implemented in 21 other states), and overpayments to HMOs estimated at $50 million/year to name just a few of the challenges. Today’s CT Mirror is reporting on the coming tsunami of applicants when Medicaid eligibility rises to 133% of the federal poverty level regardless of family situation on January 1, 2014. Currently Medicaid eligibility is mainly limited to low-income families with children, pregnant women, seniors and people with disabilities. This increased demand in CT’s largest health care purchasing pool (yes, HUSKY is the biggest pool – 394,114 as of July 1st) happens as the entire state is facing a growing primary care capacity shortage. This is everyone’s problem and we need to begin planning now.
Ellen Andrews

Free state employee retiree health coverage being re-considered

The CT Mirror is reporting that some members of a state panel charged with addressing underfunding of CT’s state retiree benefits are questioning the policy giving retirees and their spouses completely free health benefits for life. State employees with just ten years of service are eligible for the benefit, which is unusual in the private sector. Last year, only 12.3% of private establishments in CT offered health benefits to retirees over age 65. A recent Pew Center on the States report found that while all but four states have underfunded retiree benefits, CT was among the worst.
Ellen Andrews

New report on states and quality-based purchasing

Health care consumes 17% of America’s economy and, sometime this year, government’s share of that spending will pass 50%. A consensus is growing that the way we pay for health care is driving costs. The current fee-for-service system encourages utilization and does nothing to improve quality. States have important and unique roles in the health care system including funding Medicaid and state employee health care (generally the two largest pools in each state), licensing providers, collecting data, regulating insurers, implementing public health programs, and convening multi-payer collaboratives. The new Accountable Care Act includes numerous initiatives to reform health care payment systems including bundled payments, shared savings, and accountable care organizations; many require state action.
A new report by the Council of State Governments/Eastern Region, Value over Volume: Quality Based Health Care Purchasing for State Policymakers, outlines the problem, potential solutions, state programs that are working, lessons learned, and guiding principles for policymakers working to shift health care in their state toward quality and constrain costs. In addition to the report, the website http://www.valueovervolume.org/ includes updates, webinars and presentations on quality-based purchasing for states.
Ellen Andrews

Medicaid Managed Care Council Update

First, at Friday’s meeting the Council decided to meet in August (on Friday the 13th) – we rarely do that – because of the many challenges and opportunities facing the program. At the meeting, DSS reported that they have sent a letter to CMS seeking guidance about how to move HUSKY from the current, controversial capitated arrangement to a non-capitated ASO model, as directed in this year’s budget. The letter notes that the state expects to save $72 million this year from the switch and $17 million each year going forward. The letter incorrectly states that the legislation requires DSS to use the current HUSKY HMO networks suggesting to some that DSS does not intend to re-bid the program. Advocates have argued that opening up the program for bidding under a new non-capitated ASO arrangement could attract new entities, foster competition, and improve provider participation, resulting in better access to care for families at a better price for the state.

In describing their plans to move forward with PCCM enrollment in Putnam and Torrington, DSS modified their policies on marketing by the HMOs and allowing providers in current area towns to participate in the program. At the April PCCM Subcommittee meeting, DSS stated that providers practicing in towns that are not adjacent to New Haven, Hartford, Waterbury or Willimantic but whose patients live in adjacent towns could serve as PCPs in PCCM. When asked by Rep. Cook if this needed legislation, DSS responded that only a letter to the Commissioner was necessary. The letter went out from legislators to DSS months ago. While they have not received a response, we were told that DSS was denying the policy change. Legislators raised objections, first because they were assured that the minor change would be made, and secondly that DSS delayed responding until the session is over and legislation is not an option.

DSS also noted that, despite assuring the Council and the PCCM Subcommittee, that the HMOs were prohibited from marketing their programs, in fact “a huge amount is being done” by the HMOs in outreach, health fairs, among other marketing activities. Equivocating, DSS maintains that they only allow HMOs to market to their own members, but in open public forums with their logos on the materials. It was described as “a loophole you could drive a truck through.” DSS still refuses to devote any resources to PCCM marketing, to counter the vast marketing resources available to the HMOs. Advocates and legislators objected to the lack of a level playing field and deliberate efforts by DSS to minimize PCCM enrollment. Legislators echoed their strong commitment to PCCM as an option for HUSKY families and frustration with DSS in undermining the program.

DSS also reported that they expect to have a recommendation about the high risk pool to the Governor by July 15th on whether to take the federal option or to build on the existing HRA program. DSS outlined about thirty of the Medicaid changes in the national reform act – some voluntary opportunities and some mandatory.
Ellen Andrews

CT visit from the FMAP van, nursing homes without air conditioning, and more Medicare donut hole checks mailed

Wednesday the Driving for Quality Care RV stopped in Manchester to bring attention to Congress’ failure to pass an extension of the FMAP increase. FMAP is the matching rate the federal government pays CT for Medicaid spending. The 2009 federal stimulus bill raised the rates for all states, but that increase is scheduled to end in December. Congress is considering extending that relief to states until next June, but hasn’t acted. CT, like most states, assumed that money was coming in setting this year’s budget; CT stands to lose $304 million if Congress doesn’t act. CSG/ERC and other national groups are urging Congress to act.

Patient’s family members and staff are raising concerns about the health of CT nursing home residents during the heat wave. Unlike NJ, RI and MA, CT does not require air conditioning in nursing homes. State law does regulate maximum temperatures, but DPH has not developed regulations and is not enforcing temperatures.

About 50,000 CT Medicare beneficiaries will soon receive a second $250 check to reimburse prescription drug costs. The checks will go out to seniors who fell into the donut hole by June 30th. The rebates are part of the new national health reform Affordable Care Act.
Ellen Andrews

CT hospitals score well in quality

The Hartford Courant is reporting that new data from Medicare’s Hospital Compare site rate CT hospitals highly in quality. For example, the national average time for patients with chest pain to get an electrocardiogram is 43 minutes; in CT patients wait only 19 minutes. However, we pay more than 38 other states; hospital expenses per inpatient day in 2008 were 14% higher in CT than the national average.
Ellen Andrews

Advocacy toolbox addition – leading task forces

The CT Health Policy Project’s Advocate’s Toolbox has been updated with hints on chairing a legislative task force or committee. Advice includes organizing the issues, protocols of Co-Chairing, and how to handle bomb-throwers.

Aetna paper health files sold with used furniture

Lest any reader think that paper health records are more secure than electronic files, the Hartford Courant reports that file folders with personal information on 4,900 people were accidentally left in a filing cabinet sold or given away free. Eighteen of the members whose information was in the files are Connecticut residents. The filing cabinet was moved from an office in Pennsylvania to CT; the woman who obtained it emailed Aetna, who picked up the files and is notifying the members.
In related news, the Attorney General is investigating the recent Wellpoint breach of sensitive health and financial information.
Ellen Andrews

In first test implementing health reform, state reconsidering high risk pool plans

In our state’s first test implementing federal health reform, Governor Rell has asked DSS and other agencies to start over in their decision to build onto CT’s high risk pool. The federal Accountable Care Act provides funding for temporary programs to provide coverage to people left out of the private market due to; the programs end in 2014 when private insurers are barred from excluding people based on pre-existing conditions. States have the option to build their own program or use a common program created by the federal government; about half of states have chosen each option. The pool was supposed to be up and running yesterday; other state pools are taking applications now. CT’s share of the federal money is $50 million. In April Governor Rell notified the feds that CT would be building on our existing state high risk pool. CT’s current high risk pool, created in 1976, serves only 2,529 state residents, mainly due to very high premiums. The administration’s decision has been criticized by advocates and policymakers for very high premiums and deductibles, high administrative overhead and no clear point of contact for consumers. The plan’s administrators included five groups/agencies -- DSS, EDS, CID, HRA and United Healthcare -- and would have included three different call centers. Advocates were concerned that high administrative costs would divert resources away from medical care to people with serious health problems. The Governor has asked the agencies to reconsider using the federal program option for CT residents with serious medical issues.
Ellen Andrews

SustiNet advisory committee and task force reports posted

The final reports of the five SustiNet advisory committees on patient-centered medical homes, health information technology, prevention, quality and providers, and disparities are posted. Also posted are the reports of the three SustiNet task forces on health care workforce, obesity and tobacco.

July CT Health Policy Web Quiz – CT long term care costs

Test your knowledge of long term care costs in CT – hint: we are among the highest in the nation. Take the July CT Health Policy Web Quiz. This month’s quiz was written by Eric Knowles, CT Health Policy Project Summer Intern.