Courant editorial critical of CT physician oversight

Authorities in CT are too lax in approving physicians to practice here, according to the Hartford Courant’s editorial page. The editorial was based on an article by the CT Health I-Team. The authors highlight numerous cases of disciplined doctors who’ve lost their license in neighboring states who are later approved to practice in CT. Hospital error reporting has improved in our state, but physician oversight lags. The authors blame a stubborn cultural bias of excusing bad practitioners over patient safety. Physicians in CT are regulated by a volunteer board including mainly other physicians. A recent report by Public Citizen ranks CT 47th among states in regulating doctors; we’ve been in the bottom ten states for each of the last three year reporting cycles. The report lays out qualities of top states with the best records of protecting patients including adequate staffing, independence of the board, and reasonable legal standards. Both Norma Gyle, Deputy Commissioner of Public Health, and the CT State Medical Society have proposed changes to improve patient safety.
Ellen Andrews

Waterbury uninsured have a place to get care

Yesterday’s CT Mirror highlights Waterbury Project Access, a free health clinic program providing care to uninsured patients in the area. Because of the program Dennis Hayes, a truck driver with no coverage and $50,000 in medical bills from a heart attack, doesn’t have to ration his medications or doctor visits – keeping him working and out of the hospital. The program, led by Leslie Swiderski since 2003, brings together volunteer providers, donated labs, medications, and hospital care with uninsured patients who aren’t eligible for any public programs. In the last four years, the program has helped over 1,200 patients and provided $4.6 million in donated care. A Project Access program opened this summer in New Haven.
Ellen Andrews

Factoid: Even wealthier Americans more likely to face barriers to health care than lower income consumers in most countries

It’s no surprise that low income Americans are almost twice as likely to encounter at least one barrier to accessing health care than the wealthy. But an analysis of an international comparison study finds that higher income Americans are more likely than even low income residents of seven out of ten industrialized countries to face barriers to health care. The only country with no income disparity, the UK, also had the lowest level of barriers overall. So much for the US having the best health care system in the world – rich or poor.
Ellen Andrews

Reading for the holiday break

The Wall Street Journal Blog has health care book recommendations for the end of the year promising ideas on how to fix a flawed system. Let us know what you think of them. Send us your suggestions for the Book Club. From the reading obsessed at CT Health Notes.

It’s official – 2010’s biggest lie of the year . . . .

PolitiFact, the Pulitzer-prize winning antidote to deliberate misinformation, has named the assertion that national health reform is a “government takeover” of health care as the biggest lie of the year. If only it were true -- no public option, consumers required by law to purchase a costly product from private companies, reliance on weak state regulators to enforce value in the product – it’s laughable. And 2009’s Lie of the Year? Death panels. Why does health care attract lies? How did we get so lucky?
Ellen Andrews

New estimates of savings needed for medical care in retirement

Too many people assume that Medicare will cover their medical costs after age 65 and fail to save. While Medicare does pay almost two thirds of seniors’ health costs, a new analysis by EBRI finds that an average American 65 year old man retiring this year without employer-sponsored premium assistance needs $109,000 in savings just to be 50% sure of covering his future medical bills. Women need to save even more at $146,000. To be 90% sure, they would need $211,000 and $242,000 respectively. That man, if he retires in 2020, needs $183,000. Retirees lucky enough to have employer subsidies are not off the hook – men retiring in 2010 need $66,000 and women need $88,000 in savings to meet just median likely health costs. Not surprisingly, CT is the most expensive state for Medigap coverage and we should be saving even more.
Ellen Andrews

Vote for the most influential health policy articles of 2010

For all the wonky types, RWJ is taking votes online for this year’s most influential research articles. You may have missed one or two (I did) so it’s also a chance to catch up.

A constituent who made a difference

Eva Bunnell was a mother whose husband was about to lose his job because he was spending time with their daughter with complex medical problems when she spoke to Sen. Christopher Dodd. Out of that conversation came the Family and Medical Leave Act. Eva told that story to advocates assembled to honor Sen. Dodd’s service to Connecticut. Sen. Dodd persisted for decades to make that law a reality in 1993. The law protects the employment of people who need to take time off for their health or that of a family member. Because of the law, Eva’s family was able to be with her daughter at the end of her life earlier this year. Defying the experts, Jacinta lived to the age of 27.
Full Disclaimer: In addition to being an inspiring advocate, Eva Bunnell is a former CTHPP Board member and a dear friend.
Ellen Andrews

Cost cutting commission final proposals

The state Commission on Enhancing Agency Outcomes issued its final recommendations to save money in the state budget including over $145 million from health care spending. Proposals include more efficient Medicaid drug purchasing, drug recycling, preventing falls, and reducing the number of nursing home beds in the state and re-balancing long term care to emphasize care delivered in the community.
Ellen Andrews

Almost half of CT physicians are using electronic medical records

A new survey from the CDC finds that 48% of office-based physicians in CT are using some form of an electronic medical record/health record (EMR, EHR) this year, just under the national average (50.7%). State rates varied from 38% (KY) to 80% (MN). But only 10% of US physicians have fully functional EMRs; most are using basic systems. The national rate has been increasing since 2003 when it was 17%. Interoperable electronic health information is a critical driver of health care system reform in our state, will improve patient safety and is one of the few ways to save money in the system that improves efficiency and does not involve shifting costs between stakeholders, most often onto consumers.
Ellen Andrews

Medicaid Council update

Financial numbers released at Friday’s Medicaid Care Management Oversight Council meeting highlighted the need for more sophisticated accountability or, even better, moving the program to a self-insured ASO model and removing any HMO incentives to game the system. The Council first heard about Aetna’s underwhelming and vague performance improvement programs; Aetna’s quality performance for members varied between the 25th and 90th percentiles among states. No numbers were given to quantify any efforts by Aetna to improve members’ health. In several areas, it was not clear that Aetna’s programs were making any difference at all given considerable efforts by public health programs such as Healthy Start and community health centers.

Interestingly, Aetna was the only plan among the three HUSKY HMOs to make a profit on every program – HUSKY A, B and Charter Oak – in both 2009 and 2010. Aetna was paid more per person than either of their competitors for each program in each year, in one case 31% higher, and spent less on medical care than any other HMO or program in both years. The three Mercer actuaries at the meeting (yes, three actuaries at the meeting) stated that they build in a 1% profit margin into their rate estimates – that would be about $8 million/year for all three HMOs. Aetna alone made $14.7 million in profits on HUSKY and Charter Oak in 2009. In fairness, their profits were down to only $5.3 million on HUSKY A in FY 2010, but both AmeriChoice and CHN reported losing money last year. Aetna’s unique profit experience in the program raises concerns about adverse selection, especially given that the plans were given essentially unlimited authorization for marketing during the time frame. From the poor performance measures described at the beginning of the meeting, Aetna’s profits are unlikely to be due to keeping members healthier than the other plans.

DSS was then questioned about their decision in August, retroactive to July, to allow the HMOs to reduce provider payments below Medicaid-fee-for-service levels. The Council only learned of the policy change at last month’s meeting. DSS claims they don’t believe the policy change will impact access to care and that they are monitoring it. Concerns were raised that it is not reasonable to assert that reductions in rates will not reduce access in a program that has struggled with poor provider participation over most of its history. Advocates also questioned relying on DSS’ inadequate monitoring, which even if it can pick up a reduction in access, would not find it until months or years have passed, and serious damage has been done.

In response to the rate reduction policy change, each of the HMOs reported that they have no intention and have not reduced provider rates below the Medicaid fee-for-service floor. However, this advocate reported that I have seen a letter to a provider citing the new policy and reducing rates to 70% of Medicaid fee-for-service levels.

All these concerns would be erased if the program moved to an ASO-model as was included in the latest budget passed by the General Assembly and signed by the Governor projected to save the state $79 million this year. Advocates, policymakers and the plans could get back to working on improving care in the program.
Ellen Andrews

New journalism focusing on CT health

The CT Health I Team, led by veteran CT journalists Lisa Chedekel and Lynn DeLucia, will publish original investigative reports on health and safety in Connecticut and surrounding states. Top stories include Disciplined Docs Practice Freely in State and PTSD Cases in State Up. C-HIT is sponsored by the Online Journalism Project.

CT fourth healthiest state

America’s Health Ranking has placed CT as the fourth healthiest state in the nation, behind only VT, MA and NH. Since 1993 CT has been in the top ten healthiest states. However performance on specific indicators varied widely. CT was the top state in recent dental visits, but 27th in air pollution and 31st in public health funding. Measures of the nation’s health used in the rankings improved by one percent from last year, however from 1990 to 2000 health measures improved by 1.5% annually.
Ellen Andrews

Rally for SustiNet December 14th

The Interfaith Fellowship for Universal Health Care is holding a rally for SustiNet December 14th from 5:30 to 6:30 pm at the Emmanuel Lutheran Church, 311 Capitol Avenue, Hartford. Governor-elect Malloy will join the Rally. For more information, go to http://www.ctneweconomy.org/

OLR reports on major issues for 2011

The Office of Legislative Research’s annual list of issues likely to be addressed in the coming session includes:
· Considering alternatives to HMOs for the troubled HUSKY, including statewide PCCM
· Reconsidering last year’s budget requirement that HUSKY move from the current capitated HMO-based model to a self-insured ASO model, as is common to most large insurance groups
· Cuts to eligibility and/or benefits in DSS programs, but higher caseloads due to the economy will require more funding
· Creation of a state health insurance exchange
· Health insurance premium rate review – directing the use of federal funds to the insurance dept. to improve capacity for reviews and requiring public hearings on excessive rate increase requests
· Requirements that employers provide workers with paid sick leave
· Possible implementation of the SustiNet plan and the recommendations of its taskforces and committees

What the report does not include is any mention of re-balancing long term care spending (LTC). At 53% of all Medicaid spending, CT is second in the nation in the proportion of Medicaid spending that goes to LTC. CT’s is 12th highest among states in the share of our LTC that is spent on nursing homes. Advocates have long called for re-balancing our LTC spending, making community-based care options more available – letting seniors stay in their homes and saving the state money.

For 15 other ways to save money in CT’s health care budget without harm, and in most cases improving quality and access to care, visit our brief and paper. There are many alternatives for thoughtful, sensible and responsible budget reforms in CT. Let’s hope the new administration is open to new ideas and new voices.
Ellen Andrews

CT insurance premiums up more than 30% from 2003 to 2009

An analysis by the Commonwealth Fund finds that single health insurance premiums in CT grew 34% and family coverage by 39% from 2003 through 2009. Interestingly, the rise in premiums was greater for employees of large firms than for workers in small firms, both in CT and nationally. CT family premiums were the 7th highest among states last year, but one of the lowest as a percentage of median income. Nationally premiums rose 41% and deductibles by 77% between 2003 and 2009. Without health reform, premiums would be expected to grow another 79% by 2020. If health reform slows the growth in health care spending by 1.5% (hopefully we can do much better), the average CT single policy will be $1,283 lower annually and $3,674 less for family coverage by 2020.
Ellen Andrews

SustiNet Board update

The SustiNet task force met yesterday to refine their final recommendations for proposed legislative language to the General Assembly. In an earlier survey of task force and ex-officio members there was agreement that the plan should merge state employees, Medicaid members and municipal employees. However, there was disagreement about including small businesses, nonprofits and the uninsured. Sal Luciano noted that the original intent of SustiNet was universal coverage and it is critical to provide access to an affordable, transparent public option to CT’s uninsured. The group also decided to “encourage” patient-centered medical homes, although Norma Gyle noted how important delivery reform is to the success of SustiNet and the larger health system and suggested substituting the stronger language of providing incentives for medical homes. There was also lengthy discussion about whether to raise HUSKY and Medicaid provider rates to private pay rates or leave them at the current lower rate. It was proposed that rates be raised only after compensating savings can be demonstrated in the program. Cristine Vogel argued that the group needs to make a “bold statement” about raising provider rates. Rates for care provided to poor children should be equal to those for state employees’ children. The group will deliberate further before their recommendations for proposed legislation are finalized. Special thanks should go to Sal Luciano, Norma Gyle (CTHPP Board members) and Cristine Vogel for their thoughtful, principled and consumer-centered comments.
Ellen Andrews

Courant Live Chat today on why insurance rates keep skyrocketing

Join Matt Katz of the CT State Medical Society and Jackie Aube of CIGNA today at noon for a live chat to discuss why health insurance rates continue to climb. If you can’t join at noon, you can email questions ahead.

SustiNet public briefings scheduled

Two SustiNet public briefings have been scheduled.

Monday Dec. 6 6pm to 9pm Hill Regional Career High School, 140 Legion Avenue, New Haven
Tuesday Dec. 7 9am to noon Legislative Office Building Room 1D, Hartford

A legislative briefing has been scheduled for Dec. 16th from 9am to noon at the LOB Room 2C.