State panel recommends $140 million in health care budget savings

Over half the recommended budget proposals for state budget savings from the Commission on Enhancing Agency Outcomes focus on health care spending. The savings center on prescription spending in Medicaid and moving nursing home residents to assisted living. The Commission is Co-Chaired by Sen. Gayle Slossberg and Rep. James Spallone.
Ellen Andrews

Most CT doctors will reduce Medicare participation if rates are cuts

An online survey by the CT State Medical Society found that 78% of the 360 state physicians who responded would restrict access to care for Medicare and TRICARE patients if rates are cut. Nineteen percent of respondents would stop taking any Medicare or TRICARE patients at all, 31% would limit the number of new patients and 28% would only continue seeing current patients. However it is unclear whether many physicians will be able to restrict their participation in the programs that cover more than 600,000 state residents, particularly in specialties that disproportionately treat elderly health issues. Since the survey was conducted, the scheduled rate cuts were postponed from Dec. 1st to Jan. 1.
Ellen Andrews

New Book Club post -- The Treatment Trap

A study found that one third of people who were told they needed heart bypass surgery did not need it. Tens of thousands of Americans have back surgery for pain when there is no evidence to support it; studies have found that pain management and therapy are more effective. The 70 million CT scans performed in 2007 will cause 29,000 cancers in Americans and 15,000 deaths. One third of Americans believe they have received medical care they did not need. There are powerful interests heavily invested in providing too much care, whether we need it or not. The Treatment Trap, by Rosemary Gibson and Janardan Prasad Singh, collects mountains of evidence that we are being overtreated and it is killing us. Moreover, we can't afford it. The authors include heartbreaking real life stories and recommendations that are commonsense and practical. Before people get worked up about "rationing", they need to read this book.

For more additions to your gift giving list for the health policy wonk in your life, check out our CT Health Policy Project Book Club.

Advocates ask CMS to intervene in HUSKY rate reductions

Two years ago, the state increased payment rates to providers in the Medicaid fee-for-service program and required that the HUSKY HMOs pay providers at least fee-for-service rates within the managed care program. The change in HMO contracts to require higher rates was included in the program’s federal waiver and capitation rates paid to plans were raised to pay for the change. (At the time, advocates found the HMO rate increase interesting as plans maintained that they routinely paid providers above fee-for-service rates.)

At the last Medicaid Care Management Oversight Council meeting DSS reported that they have reversed that policy and exempted the plans from the requirement to pay at least fee-for-service rates, retroactive to July 1st. However there has been no reduction in capitation rates to plans allowing the HMOs to reduce their medical costs and divert more state funds to administration and profit. At the October Council meeting we learned that the HUSKY HMOs made $19 million in profit on the program last year while they were still required to pay fee-for- service rates.

A group of advocate and provider organizations have sent a letter to CMS alerting them to the violation of the terms of the federal waiver that “threatens substantial harm” to more than 400,000 HUSKY members struggling now to access care in the program. Advocates are concerned that payment rate reductions will cause more providers to leave the program that already suffers from low provider participation rates. The advocates are asking CMS to intervene and reverse DSS’ policy decision to reduce provider rates.
Ellen Andrews

From the consumer helpline: Medicaid consumers being charged

Two calls just this morning came from consumers covered by Medicaid being charged by hospitals. One was a mother on HUSKY Part A charged $281 by a hospital for services she already received. But the first call was from a man on Medicaid who was told by the hospital that they would not schedule the second surgery he needs to heal an injury and get back to work until he pays $2,000 up front. They were both sent to the appropriate authorities and strongly urged to call their Senator and Representative as well.
Ellen Andrews

Estimated costs of SustiNet options described

Stan Dorn of the Urban Institute outlined the estimated costs of six SustiNet coverage options at yesterday’s Board meeting. Under any of the options Connecticut’s uninsured rate drops by more than half, the state budget deficit is improved, small businesses save (mainly by reducing the number of workers they cover), SustiNet grows into a significant, but not dominating, market presence (which can be leveraged to drive important reforms) and there is little impact on household incomes.

The estimates are based on economic modeling by Jonathan Gruber from MIT, and are estimated for 2017 when implementation should be complete. The committee was given two scenarios -- one extremely conservative that assumes no savings due to delivery system reforms already occurring in CT such as patient-centered medical homes, and another, more likely, scenario that still conservatively estimates those savings to only reduce skyrocketing cost increases by 1%. (Other researchers estimate that delivery system reforms could save twice that much. Below are the more modest 1% savings estimates.)

· Just including state employees and Medicaid in SustiNet saves the state $371 million, saves employers $485 million and covers 620,000 people in SustiNet by 2017.
· Adding the Basic Health Plan option to the model, taking advantage of a federal option to cover people under SustiNet to higher income levels with better coverage, lower costs to families and saves federal dollars, covers 650,000 state residents, saves the state $418 million, and saves employers $459 million.
· Also allowing small employers, nonprofits and municipalities to buy into SustiNet brings coverage in SustiNet up to 815,000 people, saves the state $425 million and employers $466 million.
· Opening SustiNet to everyone covers 1 million people, saves the state $427 million and employers $498 million.
· Raising provider payment rates to private pay levels covers the same 1 million people and saves employers the same $498 million but reduces the state’s savings to a still respectable $244 million. (Note: this option does not include any potentially significant savings from reductions in private pay rates as there will be no need to cost shift to cover Medicaid underpayments and that increasing rates will attract more participating providers, keeping HUSKY families out of expensive emergency rooms.)
· The last option expands HUSKY to higher income adults before national health reform’s schedule which would cover 600,000 people in the program, save employers $217 million but costs the state $103 million. (This is the only option under which the state doesn’t save money).

The Board will consider the options next month and make recommendations to the General Assembly in January.
Ellen Andrews

Consumers protest Anthem rate hike request

Consumer advocates demonstrated their concerns at a CT Insurance Dept. public hearing about Anthem’s request to raise premiums 20% or more. The consumers outlined the enormous economic burden this places on state residents and businesses while unemployment remains high and Anthem’s parent company made millions in profits last quarter. Policymakers questioned Anthem’s documentation to justify the increases. This is the latest in a string of double digit rate increase requests by Anthem that have been approved by the department.
Ellen Andrews

CT's Medicare patient centered medical home application -- bad and good news

Unfortunately, CMS did not approve CT’s application to include Medicare in our patient-centered medical home plans for state employees and Medicaid. If it helps, we are in good company – Massachusetts and Maryland, states with sophisticated reform efforts – also did not get approved.
But the good news is that the partners are all interested in moving forward with the project anyway. And our Congressional delegation is working on finding support at CMS for our project. We should consider this Round 1.
Thank you to everyone who gave their support to this effort. We will be calling on you again soon.
Ellen Andrews

eHealthCT’s Medicaid health information exchange up and running for real patients

CT’s pilot Medicaid health information exchange (HIE) project is up and securely sharing patient information successfully. Affirmative consent is collected from patients and registered with the HIE. The system can accommodate, among other things, secure email, eReferrals, lab data exchange, radiology image viewing and should conform with meaningful use criteria. The project has taken years to develop; as an advocate I have been amazed at the enormous amount of work involved in what looks effortless to most of us. Successful, secure exchange of accurate health information is crucial to reforming, and even sustaining, our health care system – to collect data driving intelligent reform, to improve patient safety, to align incentives and reward value, and to “bend the cost curve”. Congratulations to all the collaborators – you get five minutes to rest on your laurels, then the rest of the state needs this system.
Ellen Andrews

NY Times budget deficit graphic illustrates the scope of the problem

Yesterday’s NY Times Week in Review included a compelling graphic comparison of the federal budget deficit and options to fill it. The page long piece uses blocks to illustrate the size of the hole and how much or how little each option contributes to the solution. The options include spending cuts and revenue enhancements (taxes); many are health-related. It is interesting to see how much difference each option makes. For example, eliminating farm subsidies (often linked to rising obesity levels) saves a pittance. But capping Medicare growth at GDP rates + 1% starting in 2013 makes the most difference among all the options, spending cuts or tax hikes, saving $560 billion by 2030 and filling 41% of the budget hole. That is more than allowing all the Bush tax cuts to expire on everyone or reducing the tax break for employer-sponsored health insurance.
Someone should do this for CT’s budget hole.
Ellen Andrews

State Strategies for Health Reform Implementation conference

I’ve been in DC for a fascinating conference for state-based advocates on how we can influence and support health reform at home. First, it is an incredible opportunity to connect (and reconnect) with advocates from across the states, get ideas, share stories and learn what is really happening. For example, Utah’s much publicized insurance exchange is not working and they have problems getting accurate information from their state agencies as well. We’ve heard from leaders at CMS and the new Office of Consumer Information and Insurance Oversight. We’ve heard from strategists, think tanks, state officials, advocates, and communications experts. We’ve heard from states with great success reducing Medicaid spending, without disturbing services. We’ve heard a lot about how to build insurance exchanges, market reforms inside and outside the exchange, preventing adverse selection, linking Medicaid to the exchanges, benefit design, , setting up selective contracting processes with integrity, transparency and to get the best price for consumers in the exchange. We’ve also heard about hospital community benefit requirements. The Obama administration is eager to hear from advocates – we heard over and over that they know the rubber is hitting the road in states and they want to support us in making this work (including giving us personal email addresses).

Families USA, Community Catalyst, the Georgetown Center for Children and Families, and the Center on Budget and Policy Priorities put together an exceptional conference. I usually only learn one or two new things on most trips – I am walking away from this one with a full notebook of ideas.

Wednesday I also visited with health staff in some of CT’s Congressional offices. People were generally reassuring. While there will be attempts to repeal the Accountable Care Act, they won’t succeed. There will also be attempts to defund and repeal parts of the Act, staff also felt that they would largely fail as well. I felt much better.
Ellen Andrews

Candidate briefing book online

The 2010 CT Health Policy Project Candidate Briefing Book is now available online. Password protected access was sent before the primaries to every candidate registered with the Secretary of the State’s Office for all statewide offices, Congress, State Senate and House. The book has been updated periodically and is now available without a password at www.cthealthbook.org. Many thanks to all the students who worked on the book.

Health Care Advocate position posted

The state is seeking to fill the position of Health Care Advocate. The agency assists consumers struggling to access care in an increasingly hostile environment and makes recommendations to policymakers. For more information, click here.

NY hospital takes artwork in exchange for care

28% of NY artists are uninsured. To meet the needs of their community – both artists and patients -- Woodhull Medical Center in Brooklyn gives 40 credits toward health care services for every hour artists share with the hospital. Artists in Woodhull’s Artist Access Program take professional first photos of newborns and moms, provide storytelling in the pediatric ward, perform music in the lobby, and act as surrogate patients teaching residents how to break bad news. Credits can be used for appointments, lab tests and medical procedures.
Why can’t we do something like this in CT?
Ellen Andrews

Fifteen ways to save money in CT’s health care budget

The next administration faces an unprecedented budget deficit. The good news is that CT has barely scratched the surface of policy opportunities that save money, many of which also improve health care. Taking guidance from other states and other payers, we have assembled 15 ideas potentially reaching hundreds of millions in savings. We include PCCM, patient-centered medical homes, fiscal accountability in HUSKY, wellness programs, payment reform, and engaging the power of consumers and markets to reward value. Click here for the policymaker issue brief; click here if you want the long version.
Ellen Andrews

Courant photoblog on health care salaries

One of the Hartford Courant’s online featured photo galleries compares average salaries for health care workers in Connecticut. The highest are obstetricians and gynecologists at $209,160; lowest are home health aides averaging $29,020.
Ellen Andrews

YNHH surgeries under scrutiny after wrong site operation

The New Haven Independent is reporting that on June 9th a car crash victim had a skeletal traction pin surgically inserted into the wrong leg at Yale-New Haven Hospital. The error was the result of poor communication between surgeons during a “handoff” of the patient and had to be corrected in another surgery. The mistake was quickly caught and reported to DPH. DPH found that the staff should have taken a “time out” to review the records and double check the planned surgery. Handoff and time out procedures at YNHH have been updated. YNHH’s spokesman says the patient was not “seriously or permanently harmed.” All surgeries at the hospital will be monitored by DPH staff for three months through Dec. 1st.
Ellen Andrews

November web quiz

Test your knowledge of CT managed care plan performance. Take the November CT Health Policy Web Quiz.

State Supreme Court to decide if widows are responsible for nursing home bills

The New Haven Advocate reports that the CT State Supreme Court is considering a case that could have a devastating impact on CT’s 28,000 nursing home patients and their families. The case involves who should pay the $60,795.32 nursing home bill of a man who died two years ago. The nursing home, Wilton Meadows, is suing the patient’s widow citing a law that requires a spouse to pay bills from dentists, doctors, hospitals or items bought to benefit the family; nursing homes are not listed in the law. The lawyers argue that nursing home care is an “item” that benefited the whole family but a lower court disagreed. Nursing homes claim they have no other choice than to bill families because of low Medicaid rates. Too often families bringing patients to nursing homes sign papers taking responsibility for applying for Medicaid and agreeing to pay the bills that Medicaid doesn’t cover. Medicaid applications are difficult and it can take years to qualify.
Ellen Andrews