Health IT privacy meeting

The first meeting of the HITE-CT privacy committee will be January 11th from 12:30 to 2pm at the LOB. This committee was created in response to legislative proposals to ensure consumers agree to protect their private health information on CT’s new electronic health information exchange. HITE-CT is the quasi-public entity federally funded to create an electronic health information exchange for CT. HITE-CT’s membership is dominated by providers and state agencies. Over the objections of consumers and advocates, in an opaque and unpublicized process, HITE-CT voted against an opt-in privacy process in which requires affirmative consumer consent to share health records. Instead, HITE-CT chose an opt-out policy in which all consumers’ information is shared by default unless they hear about and navigate the as yet undefined opt-out process. The process for opt-ing out and educating consumers about their rights has not been determined, but is severely under-resourced in the HITE-CT budget. All our surrounding states use an opt-in privacy policy in their successful exchanges and between 88 and 97% of consumers agree to share their information. Several states that used to have opt-out policies are converting to opt-in. In HITE-CT’s proposed policy, providers would be required to segregate any sensitive health information in patients’ records relating to ten conditions protected in law such as HIV and behavioral health status and treatment. Providers would also be required to accept liability for accurately and appropriately segregating all legally protected information.
Ellen Andrews

Overtreatment webinar slides and video posted

Slides and video from Rosemary Gibson’s webinar on What States Can Do About Health Care Overuse are posted. Rosemary Gibson has authored several books on the overuse of medical care, how it is harming our health, fueling health costs, and what we can do about it.
The next webinar is The Promise of Shared Decision-Making - Engaging Patients and Improving Care. with Shannon Brownlee, author of Overtreated, and Ben Moulton, from the Foundation for Informed Medical Decision-making January 10th at 1pm. To register, click here.

CER Webinars

Join us for two upcoming webinars on similar themes.

The first is next Wednesday, December 28th at 10am with Rosemary Gibson, author of The Treatment Trap. Rosemary will describe the Overuse of Medical Care and what can be Done to Prevent It. To register, go to https://www1.gotomeeting.com/register/828589337.

The second is the Promise of Shared Decision-Making – Engaging Patients and Improving Care, Jan. 10th at 1pm. Hear Shannon Brownlee, author of Overtreated, and Ben Moulton, from the Foundation for Informed Medical Decision-making, talk about how policymakers can help inform patients about all their options and avoid unnecessary treatment. To register, go to https://www1.gotomeeting.com/register/968183345

Electronic health record breaches up 32% this year over last

As more patient records move to electronic formats, the number of breaches, or losses, of that information is also up sharply rising 32% this year over last, according to the NY Times. Lost or stolen laptops and phones make up almost half the breaches. Nationally, 57% of office-based physicians use electronic health records. Breaches cost the industry $6.5 billion/year but can cost patients far more. Records lost can include name, birthdate, and social security numbers in addition to sensitive health information. Breaches of unsecured protected health information that affect 500 people or more are listed online by law. The site, called the Wall of Shame, includes seven breaches in CT over the last two years together totaling 170,339 people. Organizations that lost information included providers and insurers, and involved theft, loss and unauthorized access. Unfortunately, in only some cases are entities required to notify patients that their information was breached. This highlights the need for strong security of electronic records and, just as important, patient control over their information. Informed consent is the basis of a respectful partnership between people and the health care industry that keeps us well. A breach should not be the first time any patient learns that their information is being shared.

CT Insurance Exchange News

New on the CT Exchange Watch Blog – www.ctexchangewatch.org – Mercer finishes report to exchange board, more press and more calls for consumer voices in the exchange.

CEPAC meeting – comparing treatment resistant depression treatments

Friday’s CEPAC meeting in Providence was fascinating. We spent the day comparing the clinical and cost effectiveness of some common and some new treatments for people with treatment resistant depression (TRD). Between 13 and 14 million Americans experience clinical depression each year, but only about half seek treatment and only 20% of those get adequate treatment. Unfortunately about half of those who get treatment do not respond to medications. One study found that medical and disability claims from employees with TRD are more than double the costs for other employees with depression. Options for these patients used to be limited but technology has advanced in recent years. CEPAC is a New England regional public advisory group convened to consider the clinical and cost effectiveness of competing treatments. CEPAC includes clinicians, academics, patient advocates and (nonvoting) payer representatives. Friday’s discussion centered on Repetitive Transcranial Magnetic Stimulation, a new, slightly more expensive alternative to Electroconvulsive Therapy, which has been in use for over 70 years. There are some small studies with promising results suggesting rTMS may work better for some patients with fewer side effects. We discussed the impact on subpopulations, underserved populations, Medicaid and private payers, clinicians and, most importantly, patients and their families desperate for help. We reviewed evidence that everyone agreed was inadequate and conflicting. There are almost no studies that measured long term effectiveness. And then we voted.

Upcoming webinars on overtreatment and shared decisionmaking

Join us for two upcoming webinars on similar themes.

The first will be December 28th at 10am with Rosemary Gibson, author of The Treatment Trap. Rosemary will describe the Overuse of Medical Care and what can be Done to Prevent It. To register, go to https://www1.gotomeeting.com/register/828589337.

The second is the Promise of Shared Decision-Making – Engaging Patients and Improving Care, Jan. 10th at 1pm. Hear Shannon Brownlee, author of Overtreated, and Ben Moulton, from the Foundation for Informed Medical Decision-making, talk about how policymakers can help inform patients about all their options and avoid unnecessary treatment. To register, go to https://www1.gotomeeting.com/register/968183345

New blog – CT Health Insurance Exchange Watch

A new blog, CT Health Insurance Exchange Watch, is tracking development of CT’s Health Insurance Exchange. The blog is jointly sponsored by Small Business for a Healthy CT and the CT Health Policy Project. The latest entry includes an analysis noting that the percent of small businesses in MA offering health benefits to workers rose by 2% from 2005 to 2010, while the US average fell 4% and CT’s rate dropped 7%. MA implemented sweeping health reforms in 2006, including creation of a health insurance exchange. Members of CT’s exchange Board have been hyper-focused on low small business enrollment in MA’s exchange, but they are asking the wrong question. If offer rates are up, who cares if they are buying their coverage in the exchange or outside it? If building a source of affordable, quality health care puts pressure on the rest of the market, it has done its job. CT’s Board needs to focus on building a functional exchange that exerts competitive pressure on the entire market to expand coverage options with value.
Ellen Andrews

45% of CT individual health plans last year would not have triggered consumer rebates under new federal rules

A Hartford Courant analysis of 2010 individual health plans sold in CT finds that 45% did not spend at least 80% of premiums on members’ medical expenses. A rule requiring plans to meet that standard, termed medical loss ratio, did not take effect until this year. Plans that don’t reach that standard, overspending on administration and profit, will have to refund the difference to individuals. If the rule had been in place last year, 48,300 CT residents would have received refunds. Up to 9 million Americans could be eligible for rebates averaging $164, totaling $1.4 billion according to HHS. While almost half of CT individual plans would not have achieved the new standards last year, almost all small groups plans would have comfortably met the standard.
Ellen Andrews

New slides posted to cthealthbook.org

Updated slides from a health policy undergraduate class are available online at cthealthbook.org. Class topics include CT’s health care system, health care finance, international comparisons, Medicare, Medicaid, food policy and health, drugs, long term care, and national health reform, among others.

Small businesses ask HHS for help with CT insurance exchange

Small Business for a Healthy CT, a coalition of small companies, sent a letter yesterday asking HHS Secretary Sebelius to intervene with CT policymakers and reverse insurance industry domination of the CT Health Insurance Exchange Board. SBHCT is among at least a dozen advocacy groups that have voiced concerns about the Board membership which includes three insurance industry representatives but no voting consumer representatives and only one small business owner. The exchange is being created under national health reform with federal funding and is meant to be a consumer-friendly marketplace for coverage. It is expected that one in ten CT residents will get their coverage through the exchange. State law excludes anyone “affiliated” with insurance companies from Board membership and federal regulations state that consumer representatives should be a majority of voting members. The Board will decide which insurance plans are allowed to offer plans in the exchange, what benefits they have to offer, what standards they have to meet and how much they can charge consumers. Press reports include radio reports, CT News Junkie, the New Haven Register, Hartford Business Journal, Public News Service, CT Mirror, and The Hill.
Ellen Andrews

Yalies invent 3D imaging system for skin lesions

Three Yale undergraduate students have developed the 3Derm System, a small imaging device to transmit 3 dimensional images of potential skin lesions. The device allows patients to take an image of a questionable lesion at home and send it to a dermatologist, who can assess it. It will allow doctors to monitor changes in a lesion over time. The 3D image allows doctors, wearing special glasses, to assess the texture of a lesion. They hope to be able to reduce unnecessary doctor appointments by 40%. The students have won over $100,000 in prizes in two competitions for the device. They hope to eventually sell the 3Derm System in drug stores for under $100.
Ellen Andrews

CT hospitals well below US average in patient satisfaction

Patients at New Haven hospitals are the most satisfied in CT, but the bar is pretty low. New Haven’s hospitals ranked 204th out of 295 hospital referral regions in patient satisfaction, according to a calculation by Kaiser Health News based on HHS data. Hartford’s hospitals ranked 215th and Bridgeport’s were 227th. If you were thinking of going out of state for a better experience, you’ll have to go far. Only Maine and New Hampshire among the eight Northeastern states had hospital regions with better than average patient satisfaction ratings. To see how specific CT hospitals fared, go to CT Health I-Team’s hospital search page. Medicare will soon begin paying hospitals based, in part, on patient satisfaction.
Ellen Andrews

New regional patient safety organization created

NEVER is a new collaboration of New England consumer advocates working to improve the safety of health care services in our region. Connecticut’s Jean Rexford, founder of CT Center for Patient Safety, is a leader in the new effort. The group is working to give consumers tools to improve their care, compare providers and facilities in quality, and reduce costly, harmful overtreatment.
Ellen Andrews

CT asthma rates up, cities hit hardest

A CT Health I-Team analysis of new DPH data finds that almost one in ten CT adults had asthma in 2009, up from 7.8% in 2000. Adults in CT’s five largest cities are three times more likely to visit an ER or be hospitalized for asthma than the state average. We often forget that it can be a fatal disease; urban adult state residents are also twice as likely to die of asthma. The urban/suburban divide is also reflected among children – 19.2% of children in Hartford, Waterbury, New Haven and Bridgeport suffer from the disease while only 7.4% of students in Darien, Madison and Greenwich are affected. It’s also very costly – CT spends over $17 million and $6 million annually on asthma hospitalizations and ER visits, respectively, mainly paid for by Medicaid and Medicare. The article describes nine programs and initiatives aimed at helping patients manage and prevent the disease.
Ellen Andrews

Advocates file ethics complaint over health insurance exchange insurance reps

A group of eight organizations, led by Citizens for Economic Opportunity and including the CT Health Policy Project, have requested an inquiry into the appointment of three members of the CT Health Insurance Exchange. The letter asserts that the appointments violate the law that created the Exchange which excludes membership by anyone “affiliated with or otherwise a representative of” insurance companies. The three members outlined in the letters have long work histories with insurers and little evidence of significant or recent experience outside the insurance industry.
Ellen Andrews

Super Committee and HEP, PCMH webinar videos and slides online

Webinar slides and videos are now posted for our last two webinars. Last week we heard from Kate McEvoy of the State Comptroller’s Office about the state employee plan’s Health Enhancement and Patient-Centered Medical Home Projects. Chris Whatley from CSG’s Washington office talked Monday about the Congressional Super Committee, federal budget negotiations and the impact on states.

CSG/ERC Webinar – update from the Congressional Super Committee

Join Chris Whatley from CSG’s Washington office Monday, Nov. 14th at 10 am to hear where the Congressional “Super Committee” is in their deliberations and what it means for states. The Super Committee (Joint Select Committee on Deficit Reduction) was formed as part of the budget deal this summer and includes 12 members evenly divided between the parties and the houses of Congress. The committee is scheduled to report on its recommendations by the 23rd of this month to save $1.2 trillion over the next ten years. If the committee doesn’t report or their recommendations are not adopted by the full Congress, significant budget cuts are automatically triggered. To register, go to https://www1.gotomeeting.com/register/535091305

Advocate and small business concerns about CT insurance exchange

Together with Small Businesses for a Healthy CT, the CT Health Policy Project has been meeting with CT Health Insurance Exchange Board members. The Board has been criticized for lacking consumer representation. Our concerns center on rebuilding public trust, effective outreach and public education, active purchasing to use the collective power of the exchange to get the best value for members, maintaining an even playing field inside and outside the exchange, a grownup conversation on mandates, and coordination with Medicaid. We are finding a lot of overlap and some of our best support is coming from unlikely sources. The Board is currently seeking a CEO.
Ellen Andrews

Medicaid PCMH update

Today’s Care Management Committee meeting (formerly the PCCM Committee) in Hartford was frustrating. DSS and their consultants outlined their final plan for CT Medicaid’s person-centered medical home (PCMH) transformation. Unfortunately the final plan is not substantially different than the original proposal which raised concerns among advocates. Most contentious was DSS’ refusal to match consumers and PCMHs prospectively, and to pay providers based on that linkage. Based on strong evidence of improved health outcomes, advocates argued for an enrollment/attribution process to ensure that every person knows who their personal PCMH is -- who they should call first with a problem, who is watching out for their health. It is equally important that every PCMH understand, up front, which people they are responsible for. The lack of attribution also creates the possibility that NCQA-certified PCMHs will get enhanced payment rates for services provided to patients whose care is being coordinated by another practice, similar to criticisms of retail clinics by primary care practices. DSS raised some operational issues within the department as barriers to creating that essential linkage and remains committed to an enhanced fee-for-service (FFS) payment system. Advocates and others have criticized FSS for encouraging duplication and over-utilization of services, and discouraging care coordination and non-traditional care delivery such as email, phone communication, group visits, etc. Enhanced FFS also provides practices with incentives to hire more clinicians to drive more visits while per member per month prospective payments support whatever resources are most effective to improve care, including hiring care managers. The modest increase in payment rates (10% to 20%) DSS is proposing will occur in the context of much larger Medicaid primary care rate increases in 2013 under national reform when, for example, adult medicine rates will double on average, for all providers regardless of whether they are PCMHs or not. DSS acknowledged the issue and stated that they intend the program to serve only as a bridge to a wider transformation of Medicaid and will likely only appeal to providers who already serve a significant Medicaid population and are already planning PMCH transformation. While improved over the last version, the proposal’s reimbursement model budget justification continues to emphasize physicians over other members of the PCMH team, devoting almost half of total on-going costs to physician time. They did increase upfront payments to small practices (5 FTEs or less could get up to $25,000 per year for 3 years) above the original glide path payments before practices are PCMH certified. While providers and consultants were intimately involved in development of the plan and their concerns are reflected in added costs for the proposal, advocates strongly objected to representations that the process was respectful and inclusive of all voices.
Ellen Andrews

Office of Health Care Advocate seeking attorney

The state Office of Health Care Advocate is hiring a staff attorney. OHA is an incredible resource for CT consumers struggling to access care from their insurer. OHA assists individuals, but also collects those experiences and makes recommendations for legislative and executive policy changes as needed. The position requires experience with health insurance or health care and at least two years of practice. Applications are due by Nov. 4th.

Webinar: State employee plan new health enhancement program

Join Kate McEvoy, Assistant Comptroller/Policy Director of the CT Office of State Comptroller, to hear about the goals for the new Health Enhancement Program and how it works for state employees. Kate’s webinar will be Wed. November 9th at 10:30am. To register, click here.

Small businesses know health insurance exchange is a jobs issue

In a CT News Junkie opinion piece, Kevin Galvin of Small Business for a Healthy CT, wrote -- When asked to identify their biggest challenges, small business owners in Connecticut and across the country have said that one of the greatest is the prohibitively high cost of providing health insurance. CT cannot become a business-friendly state without addressing the difficulty of insuring workers. He also notes that the insurer-dominated CT Health Insurance Exchange Board does not inspire confidence. He calls for the addition of consumer and small business representatives to that Board, as does proposed federal regulation. He calls on the Governor and General Assembly to include those representatives in the upcoming jobs bill and special session.
Ellen Andrews

Health Insurance Exchange CEO job description out

CT’s health insurance exchange is moving very quickly to hire a CEO. The job description includes good language about consumer education and policy background. It mentions management skills but does not mention familiarity with active purchasing on behalf of consumers. Applications are due by Nov. 9th. The Board will choose three finalists but the Governor chooses the CEO from that list. Board membership has been criticized for having no consumer representatives and including three members with strong ties to the insurance industry.
Ellen Andrews

OHA Recovers $2.9 Million for Consumers in Third Quarter 2011

The state Office of Health Care Advocate has recovered for consumers $2.9 million in the third quarter of 2011 and $9.3 million thus far in calendar year 2011. The case load this year is expected to be double last year’s number. Through public outreach, their website and a toll-free assistance line, OHA helps patients who have been denied services or payment for services by insurers, private and public. OHA prepares cases for consumers and can appear in-person for appeals. The office also identifies trends and challenges in CT’s health insurance system keeping people from getting the care they need and advocates with policymakers to fix those policies for all state residents. OHA was created in 1999 as part of CT’s managed care reform law.
Ellen Andrews

Anthem piloting plan that shares savings with consumers

In a national pilot program that includes two self-insured employer groups in CT, Anthem is giving rebates to consumers who choose lower cost providers for their care. Rebates can reach up to $250 in CT (up to $1,000 elsewhere in the US) for each procedure. The company claims that only “common, elective medical procedures and diagnostic tests” are included in the program but clinical experts dispute that. The CT State Medical Society is concerned because the rebate is based solely on cost and does not integrate quality ratings. A large employer collaboration in Maine has had great success incorporating both cost and quality into consumer incentives.
Ellen Andrews

New CT Insurer report card online

The CT Insurance Dept. has published the 2011 insurer report card. The report card compares HMO and indemnity plans’ performance across dozens of quality measures including prenatal care in the first trimester, adult access to care, cancer screenings, childhood immunizations and controlling high blood pressure. The report includes statistics on plan enrollment, number of participating providers by county, and utilization review stats for each plan. The report card is an incredibly useful tool for anyone making choices about health plans but also includes consumer assistance contact information for each plan.
Ellen Andrews

Grove health events

I co-work with amazing people doing exciting things at The Grove in New Haven. Among those amazing things are two upcoming events sponsored by the Transforming Maternity Care Partnership, a national multi-stakeholder collaboration working to implement a consensus Blueprint for Action to improve the quality and value of maternity care. The Nurse-Midwifery Week Celebration and Symposium this Sunday from 11am-3pm will feature two speakers - Tina Smillie talking about breastfeeding and Tricia Pil talking about patient safety in maternity care from the patient, provider, and systems perspective. And next Wednesday evening, October 12, they are hosting health economist and Health IT leader, J.D. Kleinke who has written his first novel about ob-gyn practice. He will be reading from his book and leading a discussion on system transformation. The Grove is at 71 Orange St. in New Haven. For more information on either event, contact Amy Romano at romano@childbirthconnection.org.
Ellen Andrews

Courant OP-ED raises concerns about Medicaid PCMH proposal

An Opinion piece in today’s Hartford Courant by Sheldon Toubman of New Haven legal aid outlines many problems with DSS’ proposal for person-centered medical homes. PCMHs have been used by payers, including many other state Medicaid programs and CT’s state employee plan, to improve the effectiveness of health care, reduce duplications and errors and rein in skyrocketing costs. However, DSS’s proposal varies significantly from best practices identified in other states. The current PCCM program, used by a majority of states, provides a set amount of funding to providers upfront to encourage investment in care coordination. DSS’s proposal asks primary care practices, on very thin margins, to pony up with the potential for funding/reimbursement later. It also builds on the current fee-for-service system that has been blamed for over-utilization that drives up costs. Most funders are moving away from fee-for-service payments.
Ellen Andrews

October webquiz, webinar slides and video online

Test your knowledge of CT’s uninsured. Take the October CT Health Policy Webquiz.

Slides and video of Friday’s webinar with CEPAC are posted.

State chooses CHN to run Medicaid

The administration announced that they will be negotiating with Community Health Network to administer the entire state Medicaid program as of January 1st. Based on the state’s community health centers, CHN has been a participating managed care provider for HUSKY since its inception sixteen years ago. The managed care program will expand beyond the current 400,000 children and families to include 120,000 seniors, single adults (formerly SAGA members) and people with disabilities. The new program will not be capitated and will focus on coordinating care and building patient-centered medical homes to both improve quality and rein in costs. CHN’s contract is estimated to be between $70 and 73 million for the first year. CHN expects to contract with McKesson for intensive care management and data analytics and with Value Options for intensive case management.
Ellen Andrews

Friday webinar: Cutting costs and improving quality through research

New technologies and treatments are a significant driver of skyrocketing health costs and the resulting overtreatment is harming our health. Join us for a webinar Friday at noon with The New England Comparative Effectiveness Public Advisory Council (CEPAC) to learn more about comparative effectiveness research and how it is being evaluated and applied in New England. CEPAC is an initiative of the Institute for Clinical and Economic Review in Boston, funded by the US Agency for Healthcare Quality and Review. To make informed healthcare decisions policymakers, patients and clinicians need rigorous evidence on the comparative risks and benefits of care options. But that science must be integrated with patient values, individual clinical needs, costs, current patterns of practice, local health system characteristics and public values. CEPAC provides a forum to discuss all these considerations. CEPAC’s mission is to provide objective, independent guidance on how information from AHRQ evidence reviews can be used across New England to improve the quality and value of health care decision making. CEPAC includes clinicians, scientists, policymakers and patient advocates with members from all the New England states.
Ellen Andrews

CTHPP brief: One in ten CT residents still uninsured last year

Results of two new Census surveys found that the rate of uninsurance in CT was stuck at one in ten last year. The number of uninsured in CT is higher than the populations of five counties and exceeds the total populations of Hartford PLUS New Britain PLUS Stamford. Not surprisingly, Black, Hispanic and lower income state residents were more likely to be uninsured, but noncitizens were at highest risk. Among cities, Stamford leads the list with 24% of city residents without coverage; nearby Norwalk had the lowest rate among cities at 10%. Among counties, Fairfield had the highest uninsured rate at 11.7%; Tolland was lowest at only 5.1%. The new numbers reinforce the need for health care reform.
Ellen Andrews

Editorials support consumer representation on CT health insurance exchange

Today’s Hartford Courant and yesterday’s New Haven Register have both run editorials calling on policymakers to add consumer and small business representatives to the CT Health Insurance Exchange Board. Advocates have raised concerns about insurance industry dominance in the Board membership and the lack of consumer and small business representation. One in ten state residents are expected to rely on the exchange to purchase coverage in 2014 when the federal individual mandate becomes effective. An estimated 140,000 state residents will have no choice but to purchase coverage in the exchange to access affordability subsidies. The Board will make important decisions about which plans are included in the exchange, how much they can charge, and what services they will cover. Consumer voices must be at the table, with a vote.
Ellen Andrews

Health care jobs bubble?

An entertaining video from Marketplace explains the folly of policymakers who expect health care to solve their economic troubles.

Oh The Jobs (Debt?) You'll Create! from Marketplace on Vimeo.

eHealth conference

October 20th at Capitol Community College in Hartford there will be a conference explaining health information technology implementation and options. The conference, Connecting Connecticut: EHRs, Meaningful Use and Health Information Exchange, is designed for providers, administrative staff, and payers. The conference is cosponsored by Capital Community College, DPH, DSS, HITECT, and the UConn School of Medicine. CME applications are pending.

CT Health Policy Project comments on DSS proposal for Medicaid person-centered medical homes

To implement the administration’s directive to develop person/patient-centered medical homes for every Medicaid consumer, DSS has proposed a payment model very different from other successful state programs. CTHPP has submitted comments on the proposal including concerns about reliance on retrospective enhanced fee-for-service and P4P payments, the lack of risk adjustment, opaque incentives, and a weak attribution system. For example, under an enhanced fee-for-service arrangement, a provider would have an incentive to bring a healthy child who had recovered from a routine infection back into the office to get paid for care management costs making the child take time from school, a parent time off from work, exposing the child to a waiting room full of sick children, incurring transportation costs, and taking up a slot on the schedule of a busy primary care practice. To read our concerns, click here for comments.
Ellen Andrews

New Census numbers on uninsured – no progress

The number of uninsured CT residents remained essentially unchanged from 2009 to 2010, according to new Census numbers; however that number is up 54% from 1999. CT’s unemployment rate rose from 8.3% in 2009 to 9.1% last year. One in nine (11%) state residents remained without coverage in 2010. Six percent of children had no insurance last year and only 2.2% of seniors over age 65. The percent of CT residents with employer-sponsored coverage is down from 73.4% in 1999 to 65.2% last year, while the percent of us covered by Medicaid rose from 6.6% to 12.4% over those same years.


Ellen Andrews

Study finds new brain stent actually associated with More strokes, approval process faulted – CEPAC webinar

A study of the effectiveness of a brain stent, designed to reduce strokes, instead caused so many more strokes in patients (14.7%) than a control group (5.8%) that the study was quickly halted. The expensive stents had been approved by the FDA under a humanitarian exemption from usual safety reviews. The stent has been implanted in thousands of patients.

The study adds to a growing set of evidence that medical treatments are not always based on the best evidence of safety, effectiveness or cost effectiveness. To learn more about comparative effectiveness research and evaluations of treatments, join us for a webinar with CEPAC September 30th.
Ellen Andrews

Uninsured Cincinnati man dies of untreated tooth decay

Kyle Willis, an unemployed, uninsured 24-year old father, died Tuesday of an infection in his wisdom tooth. He couldn’t afford to have the tooth removed, but went to an ER when his face began to swell and the pain grew. He was prescribed an antibiotic and a pain killer. He could only afford to fill one prescription and he chose the pain killer. The infection spread to his brain. A potent reminder that dental care is integral to health and that uninsurance kills.

An expert commented "He [Willis] might as well have been living in 1927. All of the advances we've made in medicine today and are proud of, for people who don't have coverage, you might as well never have developed those."
Ellen Andrews

September CT health policy quiz – CT health care quality

Test your knowledge of health care quality in CT. Take the September CT Health Policy Webquiz.

NC employers buying into Medicaid patient-centered medical home system, CT NASW job posting

NC’s Medicaid patient-centered medical home network is so successful that large employers, including state employees, in the state are buying in for their workers. Bucking the private HMO-style managed care trend of other states in Medicaid, NC has had impressive improvements with a community-based PCMH network in improving access to and quality of care while enjoying significant savings. Could CT’s new and improved PCCM program (or whatever they plan to call it) eventually attract private employers here in CT?

NASW/CT is seeking a part-time Director of Political Advocacy. They are specifically seeking an individual with a MSW degree and experience in policy and community organizing. NASW/CT has a broad agenda that includes both guild issues and social justice issues.
Ellen Andrews

Comparative effectiveness council webinar

New technologies and treatments are a significant driver of skyrocketing health costs and the resulting overtreatment is harming our health. Join us for a webinar September 30th at 1pm with The New England Comparative Effectiveness Public Advisory Council (CEPAC) to learn more about comparative effectiveness research and how it is being evaluated and applied in New England. CEPAC is an initiative of the Institute for Clinical and Economic Review in Boston, funded by the US Agency for Healthcare Quality and Review. To make informed healthcare decisions policymakers, patients and clinicians need rigorous evidence on the comparative risks and benefits of care options. But that science must be integrated with patient values, individual clinical needs, costs, current patterns of practice, local health system characteristics and public values. CEPAC provides a forum to discuss all these considerations. CEPAC’s mission is to provide objective, independent guidance on how information from AHRQ evidence reviews can be used across New England to improve the quality and value of health care decision making. CEPAC includes clinicians, scientists, policymakers and patient advocates with members from all the New England states. Our first meeting was in June in Boston and focused on treatment strategies for atrial fibrillation.
Ellen Andrews

Health Insurance Exchange Board meeting moved

Monday’s scheduled meeting of the new CT Health Insurance Exchange Board has been moved to Sept. 15th at 9am in Room 1A of the LOB.

Exceptional example of medical homes in a safety net clinic

A New England Journal of Medicine article highlights the success of Clinica Family Health Services, a safety net clinic serving a largely low income, Latino population near Denver. Half of Clinica’s patients are uninsured. Over the last thirteen years, Clinica has implemented both the chronic care and PCMH models of care. Important lessons include the power of teams, improved access to care, and re-orienting the entire process and culture of care to center on patients. The transformation also significantly improved working conditions and job satisfaction for providers. Allowing every team member to work at the top of their license allowed clinicians to see 30 to 40% more patients per hour. More pregnant women are coming into care earlier in their pregnancies, more women are getting Pap tests, more children are getting immunizations, more diabetic patients are controlling their hemoglobin levels, and blood pressures are down among patients with hypertension. Please go to the PCMH video on Clinica’s home page – it is the best investment of 23 minutes you’ll make this week. I urge you to get to the description of patient activation – they buried the lead but it is the whole point of patient-centeredness. Highly recommended.
Ellen Andrews

Insurance Exchange Board members dominated by insurance interests, no consumer representatives

Members of CT Health Insurance Exchange Board were announced last evening. Despite federal law calling for a majority of members to represent consumers, there are no consumer advocate voting members. (Thankfully Vicki Veltri, State Health Care Advocate, will sit at the table but cannot vote.) In addition, three members have long ties to insurance companies as recent employees. This is despite CT law barring members affiliated with insurers, among others, in strong conflict of interest language that has been a beacon among states. Advocates are concerned that representatives of the insurance industry lobbied hard to stop passage of health reform in Washington but are now placed in charge of implementing it here in CT. One in ten state residents are expected to rely on the exchange to purchase coverage in 2014 when the individual mandate becomes effective. It is critical that consumers eligible for Medicaid who apply through the exchange are appropriately referred to that program rather than diverted into insurance plans in the exchange. Advocates sent a letter to members urging them to set aside insurance ties and make consumers their top priority. For press reports, click here, here, here, here, here and here.
Ellen Andrews
Ellen Andrews

Updated CT health policy 101 primer

The updated primer on health policy in CT used for CT Health Policy Project student and volunteer training is online. The primer covers background on health financing, public coverage programs, private insurance, the uninsured, Affordable Care Act implantation, SustiNet, politics and trends in CT and what you can do about it.

Boston hospital gives doctors treatment price list

Beth Israel Deaconess Medical Center has taken the revolutionary step of giving primary care providers a one page price list for 56 services they routinely order for patients. Doctors generally have no idea what services cost and many are shocked by the list. Just providing the information has changed ordering habits and challenged the traditional medical practice of doing “everything possible” without regard to cost. Much care is delivered just because the technology is available, not because it is necessary or better than less expensive options. Doctors are becoming more aware of the harm to patients that can come from rising costs. A recent study found that 62% of US personal bankruptcies are due to medical costs. There are growing efforts to inform physicians about prices and resources for patients to compare costs.
Ellen Andrews

Advocates urge CT Health Insurance Exchange Board members to consider consumers’ needs

In a letter to the newly appointed members of the CT Health Insurance Exchange Board, eleven consumer advocacy organizations offered to help in their important work and urged the members to keep the needs of consumers in mind in all decisions. The insurance exchange was created in response to national health reform; most states are taking the option to create their own exchange with federal start up funding. The exchange was designed to provide CT consumers and small businesses with a rational, fair marketplace to purchase health insurance. It is critical that this market be a trusted credible source for consumers who will be required to purchase health insurance in 2014. It is estimated that one in ten state residents will secure coverage through the exchange by 2016 including 140,000 eligible for federal premium subsidies who will be required to purchase coverage through the exchange. The Board will have a number of difficult and controversial decisions to make including whether to allow any willing insurer to participate, as Utah has chosen, or actively purchase coverage to get the best deal for consumers, the Massachusetts model. The Board will have to decide which state mandates, if any, beyond the federal essential benefit package (EBP) to require of exchange plans, with the state likely paying the cost for those benefits. The proposed EBP is expected to be announced this fall. The Board will have to decide whether to create separate exchanges for individuals and for small businesses, whether to merge the small group and individual markets, and hire staff to run the exchange. CT’s law creating the exchange included very strong conflict of interest language supported by advocates, excluding people currently affiliated with the insurance industry among others. We expect that all members will honor the spirit of the law, regardless of background. The first meeting of the Board is scheduled for next Monday August 29th at 10am in Room 1A of the LOB.
Ellen Andrews

Regulations making insurance easier to understand; Survey finds businesses expect big increase in health costs next year

Yesterday HHS released long-awaited proposed rules for the Summary of Benefits and Coverage to be given to every consumer by March 23, 2012. The Summary is a brief document, explaining in simple, consistent language basic information about each health plan offering including what is and isn’t covered, consumer costs and how they are broken out (copays, deductibles, etc.), and the rules for out of network providers. Every insurer and employer offering coverage will have to provide the same forms and the Summary will include a standardized comparison tool allowing consumers to clearly compare options. The Summary will be accompanied by a Glossary of Terms and was tested with consumers to ensure it is understandable. The proposal was developed by the National Association of Insurance Commissioners and a working group of stakeholders.

A survey by the National Business Group on Health finds that large American employers expect health benefit costs to rise 7.2% next year and most plan to shift those costs onto workers. While that increase is lower than the 7.4% increase in health costs this year, it is still twice the rate of overall inflation. Cost shift plans including increasing employee share of premium (53%), increased deductibles (39%), increased out of network deductibles (23%), and increased out of pocket maximums (22%). 73% expect to offer at least one consumer-directed health plan option, up from 61% this year. The survey found that national health reform is having little impact on most employers’ plans for next year.
Ellen Andrews

Comparing US and Canadian health systems

Last week’s CSG/ERC annual meeting in Halifax, NS featured a plenary session comparing health systems across the border. Despite distinct financing mechanisms there were many common challenges including skyrocketing costs, struggles to improve quality and ensuring adequate workforce. Speakers included Rep. Laurie Harding (NH), Asm. Richard Gottfried (NY), Paula Roy (DE Health Care Commission), MLA Bill Fraser (NB), and Minister of Health Maureen MacDonald (NS). Anya Rader Wallack (now health policy advisor in the VT Governor’s Office, but SustiNet members will remember Anya’s excellent work helping us develop CT’s plan) rounded out the panel describing VT’s single player plan. Canadians spend just over half what we do per person on health care on average. Despite a government-funded single payer system, just in average government funding they spend 18% less than we do per person. Canadians also spend about one third less than we do out of pocket on average. They also live two years longer than we do, have fewer low birth weight babies, and are half as likely to go without health care due to cost, on average. We have a lot to learn.
Ellen Andrews

August webquiz – CT premium and deductible trends

Test your knowledge of trends in health insurance premiums and deductibles. Take the August CT Health Policy Webquiz.

Health care spending growth last year matched growth in the economy – almost

Today CMS published health spending growth numbers for last year; US health care spending grew only 3.9% while the overall economy grew by 3.8%. Consequently health care as a share of GDP stayed at 17.6%. This is a significant slowing of health care costs which had increased by double digits in past years. Unfortunately the good news is not expected to last. In 2014 CMS estimates a blip in health care spending as 22.9 million Americans gain coverage. However that trend is expected to return to more modest levels by 2015, slightly below what would have been expected without reform. Government’s share of the health care pie is expected to continue to grow. The share of health care spent on drugs and physician/clinic services is expected to rise and hospitals’ share of spending is expected to decrease under reform. CMS predicts that taxes on more expensive health plans scheduled for 2018 will cause the rate of growth in health costs, both premiums and use of health services, to slow.
Ellen Andrews

NCQA slides and video online

Slides and video of Monday’s NCQA patient-centered medical home webinar are online. You can also register for next Monday’s webinar on URAC’s patient-centered medical home accreditation program.

Gov. Malloy letter outlines impact of federal debt ceiling crisis on CT and a better option for Medicaid savings

In a letter to Congressional leaders sent Friday, Governor Malloy estimates the harm to CT from proposed Medicaid state funding and GME cuts. As an alternative, he offers a proposal by MD Governor O’Malley for gainsharing between Medicare and Medicaid that would save as much as the current proposals but would improve options and ease the burden on the health care system. The current funding arrangement for dual eligibles provides no incentives for states, responsible for most nursing home care, and Medicare, responsible for hospital stays, to coordinate efforts to keep people in their homes when preferable. Risk sharing between Medicare and Medicaid would support development of home and community based options and better discharge planning. The Governor estimates that resulting savings would equal what has been estimated from cutting Medicaid funding to states.
Ellen Andrews

URAC patient-centered medical home standards webinar

Join us for a webinar August 1st at noon to hear from Christine Leyden, Senior VP at URAC, about their new patient-centered medical home program. URAC, an independent nonprofit organization, is a leader in promoting health care quality through accreditation, education and measurement programs. To register for the webinar, go to https://www1.gotomeeting.com/register/931344113

Health cuts in budget deal

The new plan to balance the state’s budget was unveiled Friday. Proposed cuts touch most areas of state spending, including health and the safety net. The Governor’s office was clear that these cuts were not their first choice and they worked hard to avoid making them. Health care cuts include $7.7 million in Medicaid fees for durable medical equipment, physician and behavioral health services, $2.65 million from community health centers, $1.3 million from school-based health centers, $1.6 million from AIDS services, closes detox and rehab beds, an asset test for low-income adults in Medicaid, and cuts to dozens of safety net programs. The plan also closes two DSS offices, nine respite centers and four group homes. Thousands of laid off state employees will add to the number of unemployed in CT placing more pressure on families and health services in the state.
Ellen Andrews

CT third least obese state in US

A new report by the Trust for America’s Health confirms CT’s status as relatively less obese compared to other states. However obesity is a growing problem everywhere, including CT. The authors note that the lowest state’s rate now (Colorado) is higher than the lowest state’s rate fifteen years ago. 21.8% of adults in our state are obese; fifteen years ago our rate was about half that (11.8%). 10.4% of CT high school students are obese. Hispanics in CT are 39% more likely to be obese than Whites and Blacks are 90% more likely. But even in our increase, we are better off than other states; we are among the three slowest growing states in obesity rates. Related to obesity, CT’s diabetes rate is 6.9%, our hypertension rate is 25.7% and both rates are growing. The report includes important policy options states can adopt to reduce obesity.
Ellen Andrews

Medicaid Council update

Friday’s Council meeting was mixed. DSS described their process for developing person-centered medical homes -- a far better name. Their provider advisory group will be guiding the department in choosing which PCMH standards providers will have to meet, how they will be paid and the outcomes they will be measured against. Doctors are well-represented (a very good thing – 17 of 19 members are MDs), but other PMCH team members (care managers, nurses, practice managers, and other providers) are in the back of the room and not allowed to speak. There is another separate provider group just for pediatricians. DSS will have one-time focus groups with consumers to include general care experience of care questions but not vetting standards, payment methods or outcome measure options, and as focus groups they are not open meetings. DSS will also be coming back to the PCCM Committee – open public meetings at which anyone can speak, including providers in the other groups, HMOs, consultants, job seekers, advocates, etc. – and the Council for input. Other concerns about PCMH development include an over-emphasis on electronic medical records (there is a lot more to person-centered care and teamwork) and the need to integrate DSS’ plans for PCMHs with other payers. Most CT providers receive payment from many sources – expecting them to comply with different standards and reporting requirements just for Medicaid could be a disincentive to participation.

In other news, the Dental Health Partnership reported on continued progress in engaging providers and limiting over-treatments such as multiple X-rays. Advocates raised concerns about limited panels in Windom County. DSS described their plans to raise premiums on existing Charter Oak plan members, included in this year’s budget, and plans to shift new applicants with pre-existing conditions to the CT Pre-Existing Condition Insurance Plan. They also plan to shift that program from the current age-based rate system to a flat rate. Current rates vary between $243 and 893 per month per person; DSS is seeking permission to charge $381 per month for everyone. This will save most members on their premiums and allow the state to better draw down our federal allotment. Charter Oak currently costs $307 per member per month (unsubsidized) but that rate will increase Sept. 1st.

Selina Tirtajana and I presented the results of the CT Health Policy Project’s Fixing Medicaid report on provider participation in Medicaid and recommendations for improvement.
Ellen Andrews

Governor vetoes insurance rate review bill

Governor Malloy vetoed SB 11, An Act Concerning the Rate Approval Process for Certain Health Insurance Policies. The act would have required the Insurance Dept. to hold public hearings if insurers sought permission to raise rates by 10 percent or more. Consumers have been repeatedly hit with double digit rate increases, despite very large profits reported by insurance companies. The federal government recently gave the department $1 million to improve rate reviews.
Ellen Andrews

CEPAC meeting

The New England Comparative Effectiveness Public Advisory Council held its first meeting last month in Boston. CEPAC is an initiative of the Institute for Clinical and Economic Review, funded by the US Agency for Healthcare Quality and Review. To make informed healthcare decisions policymakers, patients and clinicians need rigorous evidence on the comparative risks and benefits of care options. But that science must be integrated with many other considerations such as patient values, individual clinical needs, costs, current patterns of practice, local health system characteristics and public values. CEPAC provides a forum to discuss all these considerations. CEPAC’s mission is to provide objective, independent guidance on how information from AHRQ evidence reviews can be used across New England to improve the quality and value of health care decision making. CEPAC includes clinicians, scientists, policymakers and patient advocates with members from all the New England states. Our first meeting focused on ablation strategies for atrial fibrillation.
Ellen Andrews

Webinar: NCQA Patient centered medical home standards update

Join us for a webinar Monday July 25th at 2pm to hear about NCQA’s updated standards for practices seeking recognition as patient-centered medical homes. The new standards emphasize organizing care around the patient and include integration of behavioral health care and care management, a standardized patient experience survey, and ensuring that patients and their families are involved in quality improvement. The standards also reinforce federal regulations on meaningful use of health information technology. To register for the webinar, go to https://www1.gotomeeting.com/register/796189832.

Vacation

Staff of the CT Health Policy Project will be out of the office until June 27th. See you then.

Health care highlights in the 2011 legislative session

Health care took a leading role in this year’s legislative session.

Health reform/pooling/SustiNet
http://cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=6308&which_year=2011&SUBMIT1.x=9&SUBMIT1.y=8

Health insurance exchange
http://cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=921&which_year=2011&SUBMIT1.x=0&SUBMIT1.y=0&SUBMIT1=Normal

Paid sick days
http://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=913&which_year=2011

Value based health care for state employees
http://inthistogetherct.org/wp-content/uploads/2011/05/DEL_SEBAC_05_27_11_2.pdf

Budget deal
http://www.ctmirror.org/story/12328/social-services-budget

Insurance rate review
http://cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=11&which_year=2011&SUBMIT1.x=0&SUBMIT1.y=0&SUBMIT1=Normal

UConn Health Center expansion
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/uconn_health_center_expansion_receives_final_passage/

Comments on federal ACO proposal, Changing Face of Medicaid

CMS has issued the proposed rule under national health reform to implement Accountable Care Organizations (ACOs) for Medicare beneficiaries. ACOs are a new way of paying for health care, moving away from fee-for-service to paying for value. An ACO is a network of health care providers spanning the care spectrum paid to provide for all the needs of their patients. The proposed rule has been controversial for many reasons, but a less noticed provision includes an erosion of patient privacy protections. The proposal would allow CMS and providers to share sensitive medical information unless the patient chooses to opt-out of the system. The proposed opt-out process is unrealistic and would be very difficult for many Medicare beneficiaries to access. Unfortunately, it is very likely that the first time many patients learn that their information is being shared will be after a breach. The CT Health Policy Project submitted comments to CMS yesterday opposing this provision of the proposed rule.

Slides on the extensive changes coming to CT’s Medicaid program are online. The slides were part of a talk for the Community Health Center Association of CT’s board member conference this weekend.
Ellen Andrews

Health insurance exchange bill passes Senate

Yesterday the Senate passed SB 921 creating the Connecticut Health Insurance Exchange. The Exchange, authorized under the Affordable Care Act (ACA), will create a standardized, understandable marketplace for consumers and small businesses to purchase health insurance. The Exchange must be operational by 2014 when the ACA’s individual mandate becomes effective. Individuals eligible for premium subsidies under the ACA are required to purchase their coverage in the Exchange. The ACA provides funding only to establish the Exchange. Most states are passing similar legislation to create exchanges this year. CT’s Exchange will be a quasi-public agency and includes members with relevant areas of expertise. The bill also includes strong conflict of interest provisions important to advocates. Insurers, brokers, representatives of health care facilities or clinics, and trade groups are excluded. Providers may serve if they are not currently compensated for delivering health care services or invested in a health care practice. The Exchange may create advisory committees including consumer and broker issues and hire independent navigators to help individuals and small businesses understand health insurance and make wise purchases. The Exchange will work with the SustiNet Cabinet to assess the feasibility of exercising the ACA’s Basic Health Option to cover lower income adults not eligible for Medicaid but who may not be able to afford private coverage even with subsidies. The Exchange will also coordinate applicants’ Medicaid eligibility. Next the bill goes to the House.
Ellen Andrews

Health reform bill passes the House

The health reform bill agreed to by the administration and legislative leaders, HB 6308, passed the House Friday. The bill allows the municipalities to join with the state employee plan Jan. 1st of next year, and brings in nonprofits that do significant business with the state a year later. It directs the state employee plan to implement patient-centered medical homes and creates a working group to develop a multipayer data base to inform health care planning. Under the bill, hospitals will begin reporting data on service use as most states already report.

The bill also creates an Office of Health Reform and Innovation within the Lieutenant Governor’s Office to be headed by the Special Advisor to the Governor on Healthcare Reform. The office is charged with coordinating state health reform efforts, maximizing stakeholder and public input into health reform, and transparency in implementation. The office will work to ensure coordination of enrollment between programs. The SustiNet Cabinet includes official appointments to include the health care industry, providers, labor, faith community, small business, and a consumer advocate, in addition to relevant Commissioners. The Cabinet will address health care workforce capacity, assess the feasibility of exercising the Basic Health Program Option under national health reform, and create a business plan to provide new coverage options to individuals and small businesses. The Cabinet may create working groups on payment and delivery reforms, as well as multi-payer initiatives. The bill also creates a Consumer Advisory Board, a long overdue addition to CT’s health care policymaking environment.
Other provisions of the bill include provider network capacity standards, compliance with national health reform, and claims payment, contracting, and insurance reforms. The bill now goes to the Senate.
Ellen Andrews

Fixing Medicaid: Healing CT’s Largest Health Care Program

Access to care in CT’s public programs has always been a struggle; it is difficult to find a provider who takes Medicaid. In 2008 CT significantly raised Medicaid payment rates but a survey by the CT Health Policy Project before, during and after the increase found that physician participation in the program didn’t improve. With enrollment growing recently due to the economy, an expected 140,000 new enrollees in 2014 due to national health reform, it is critical that CT improve provider participation. Focus groups and interviews with physicians and practice managers identified other significant barriers to participation including administrative hassles, billing and claims processes, audits, and poor communication with the state. Interviews with providers, practice managers and Medicaid agency staff from states with better provider participation rates, and often lower payment rates than CT, led to recommendations to improve access to care.

Paid sick days bill passes Senate

CT is likely to become the first state in the nation to require some employers to offer paid sick leave. SB 913 passed the state Senate yesterday 18 to 17. The bill would give workers in companies with 50 or more employees one hour of sick leave for every forty hours worked. Leave can be taken for a worker’s illness or for a spouse or child’s illness. Workers can begin using that leave after working 680 hours and are limited to using only five days per year. The measure is intended to keep workers from coming to work sick and passing their illness on to customers and other workers. The measure is estimated to cover 300,000 workers in CT and becomes effective Jan. 1st . The bill is expected to pass in the House and be signed by the Governor.

DSS implementer bill allows agency to cut benefits without legislative approval

Section 116 of SB 1240, passed by the Senate yesterday, would allow DSS to cut benefits provided to consumers in the LIA program, formerly known as SAGA. Cuts could include, but is not limited to, office and hospital visits, therapy services, medical equipment and supplies, medications, non-emergency medical transportation, and home care. If unchanged, the language would also allow DSS to develop lesser benefit packages for the estimated 140,000 new Medicaid enrollees entering the program in 2014 under national health reform. Section 100 of the bill allows DSS to create a patient-centered medical home program for people with chronic illnesses, a hospital bundled payment demonstration, and create an Accountable Care Organization for pediatricians. The bill also requires that DSS ensure provider rates are sufficient to ensure access to care and reduce inappropriate ER use, possibly including cost sharing and intensive case management. The bill now goes to the House of Representatives.

Consumer and provider brochures on Affordable Care Act

CT’s Office of Health Care Advocate has published four new understandable brochures, in English and Spanish, for consumers and providers, about changes in our health care system with national health reform.

SustiNet moving forward

An agreement has been reached on SustiNet, CT’s plan for health reform, with supporters, the administration and legislative leadership. Funding for the initiative was included in the budget that passed Text of the bill is expected to be public soon.

News Round Up and a wonky quiz

Medical marijuana bill advances
http://www.ctmirror.org/node/12621

Gridlock in DC on medical malpractice
http://www.ctmirror.org/story/12629/medmal

Paid sick days
http://www.ctmirror.org/story/12656/senate-poised-pass-paid-sick-days-slimmest-margins
and
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/paid_sick_day_bill_will_be_amended_but_passage_is_still_uncertain
and
http://blogs.courant.com/capitol_watch/2011/05/malloy-visits-senate-chamber-t.html

UConn Health Center funding advances
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/malloy_increases_investment_in_uconn_health_center
and
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/frustrated_with_a_rushed_process_finance_passes_uconn_health_center_improve

Labor response to budget deal
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/state_workers_react_to_labor_agreement

Hookah lounges
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/hookah_lounge_bill_passes_planning_and_development
and
http://blogs.courant.com/capitol_watch/2011/05/ban-on-new-hookah-lounges-narr.html

School cafeterias not inspected
http://newhavenindependent.org/index.php/health/entry/school_cafeterias_lack_local_health_inspections

More mosquitoes likely this summer
http://www.courant.com/health/connecticut/hc-weir-mosquitoes-0520-20110519,0,6524849.story

Test your knowledge of the differences/similarities between the Affordable Care Act (ObamaCare) and MA health reform (RomneyCare)
Many thanks to Arielle Levin Becker from the CT Mirror for the link

http://www.politifact.com/truth-o-meter/article/2011/may/18/romneycare-and-obamacare-can-you-tell-difference

Connecticut patient-centered medical home first adopters

Transforming a busy medical practice into a patient-centered medical home (PCMH) can be daunting but the benefits are worth it, according to a report by CTHPP intern Kim Kushner. With 113 NCQA recognized patient centered medical homes, CT is far behind surrounding states. Kim interviewed a solo practitioner, a safety net community health center and a large practice in CT that had achieved PCMH recognition to identify challenges, solutions and solicit their guidance for other practices considering recognition. She found very similar challenges and benefits among the three practices, some unique solutions, and reassurance for providers considering becoming a PCMH. Dr. Edward Rippel’s Hamden practice recouped the costs of transforming his solo practice within two years through streamlined workflows, increased patient volume, and incentive programs. Seventy percent of his patients with diabetes now have hemoglobin A1c levels at treatment goal, up from 50% before PCMH, and all his patients with cardiovascular disease are now consistently taking appropriate stroke prevention medication.

SustiNet and labor deals announced

Supporters of SustiNet, the state’s plan for health reform, the administration and legislature have come to an agreement that includes creating a SustiNet Cabinet to shepherd the implementation of reforms in CT. The Cabinet will develop a business plan for a public option of health coverage and study the feasibility of exercising the Basic Health Program Option under national health reform to cover low income state residents not eligible for Medicaid. The Cabinet would be led by Lt. Gov. Nancy Wyman. The agreement also creates an Office of Health Care Reform and Innovation in the Lt. Governor’s Office to be headed by Jeanette DeJesus, currently Deputy Commissioner of Public Health coordinating CT’s health reform efforts. The agreement also allows municipalities to begin purchasing coverage through the state employee health plan this July and nonprofits who do business with the state can buy in next July.

Details of the labor agreement negotiated between the administration and state employees are becoming more clear. An important part of the deal is implementation of value-based purchasing including preventive care, screenings, disease management, and incentives for maintenance medications. Employees who do not opt to engage in these wellness programs will pay more for their benefits. There are also a disincentive to ER visits that do not result in admission and increased support for the retiree trust fund.
Ellen Andrews

Medicaid Council update

Today’s Medicaid Council meeting was overwhelming – DSS has made a lot of very detailed decisions about how to structure and finance the Integrated Care Organization (ICO) proposal for dual eligibles and outlined them in 45 complex slides at the meeting which were not made available at the time. After the meeting, Comm. Bremby stated that nothing is set in stone and the department will be open to comment from stakeholders and the public in revising any of those decisions. Advocates will have an opportunity to comment beyond today’s meeting, by email/letter or in the ABD Committee meeting. DSS expects to have three to six ICOs (similar to Accountable Care Organizations) available for consumers to join voluntarily, however a decision has not been made about whether clients will be defaulted into the ICOs with an opportunity to opt-out, or will have to affirmatively sign up to join. ICOs are consortiums of providers across the care continuum that will be paid on a fee-for-service basis but may also share in any savings from expected costs for their patients. Initial concerns include very detailed expectations for these Medicaid ICOs that may not be compatible with ACO development in the rest of CT’s market. If Medicaid has very different standards and requirements than other payers in the state, it is not clear that there will be enough incentive for potential ICOs to create something new from scratch just for this population. Medicaid has not traditionally been an attractive business for providers or insurers in CT. Concerns were also raised by the description of how shared savings will be identified – it is critical that each ICO’s financial gains be tied to their own performance and not contingent on others in the state also saving money to access any federal savings. Continuing payment of Medicaid and Medicare through separate systems could be problematic and encourage cost shifting or fragmentation. Use of the Medicare Advantage SNP risk adjustment methodology to identify expected costs for each patient also raises concerns. We’ll have more details as we get them.

In very good news, the department has agreed to remove the unnecessary and intimidating Freedom of Information clause from PCCM provider contracts, removing a large barrier to participation in the program. DSS committed to creating an open, respectful public input process in the next few months to develop the new person-centered medical home/ASO program. They will also be developing a physician advisory process. They have received nine letters of intent to bid in response to the RFP. They received three hundred questions in response to the RFP, including some from this advocate, but responses to the questions have been delayed. DSS intends for DMHAS to take a lead role in developing health homes for consumers with behavioral health conditions.
Ellen Andrews

Health IT privacy consent webinar

Slides and video of yesterday’s webinar on patient privacy protection in health information exchange are online. The webinar included Ted Kremer of the Rochester RHIO and Steve Allen of Steve of Western NY Health e Net. Both RHIOs, like the rest of all New York, Rhode Island and Massachusetts exchanges operate on an opt-in privacy policy – consumers must affirmatively consent before any medical information about them is shared on the system. Both exchanges have secured consent from hundreds of thousands of patients, Rochester RHIO has consented over one third of the entire population in the area, and both have tens of thousands of new consents coming in each month. In Rochester between 97 and 98% of patients sign consent forms; Western NY’s rate is 94%. Both exchanges made the very respectful decision not to incorporate their form into a HIPAA form to ensure that patients are really making informed consent decisions – they aren’t trying to sneak anything by consumers. Both have undertaken successful, grassroots public education campaigns by engaging community groups and trusted organizations; patients now ask for a consent form at their provider visits if they aren’t offered one. A poll found that 83% of the public supports the exchange but only 37% support others viewing their information without consent. CT is now developing a health information exchange and the General Assembly is considering legislation to require an opt-in policy like NY’s and all of our surrounding states. For more about privacy concerns in CT’s health information exchanges, go to our privacy webpage.
Ellen Andrews

Health reform brings down Aetna individual health premiums up to 19.5%

Aetna policyholders will enjoy 10% rate cuts on average for policies starting Sept. 1st because of national health reform. The national Affordable Care Act (ACA) set standards limiting how much insurance plans can spend on administration vs. medical care. The federal standards, requiring that insurers spend at least 80 to 85% of premiums on medical care, are forcing Aetna to issue rebates and reduce premiums. Aetna reports spending only 54.3% of individual policy premiums on medical care. Aetna credits the rate reduction with lower than expected medical costs in CT.

Alternate budget ugly, especially for working parents’ health care

Budget options being considered by the administration if negotiators are not able to agree on labor concessions include cutting HUSKY parent eligibility from the current 185% of the federal poverty level ($34,281/yr for a family of three) to 133% ($24,645 for that same family). The Rowland administration made a similar cut in 2003, causing thousands of working families to lose coverage. A qualitative study of the impact at the time (www.intheirownwordsct.org) described eight families’ stories including Elizabeth and her son Sean. Elizabeth was a substitute teacher with heart disease who lost HUSKY coverage and was no longer able to afford her blood pressure prescription. A few months later she had a heart attack and was admitted to Yale-New Haven Hospital, incurring $40,000 in medical bills she had no way to pay. She was reinstated on HUSKY due to those bills and recovered with the help of many medications. Unfortunately her six months of coverage ended just after our study and she again stopped taking vital medications. Within a month she had another attack and was wheeled out of her classroom to an ambulance. For the sake of $3,144 in HUSKY coverage CT could have avoided paying $40,000 in hospital bills for her first attack, and likely more for her second, as well as preventing serious damage to Elizabeth’s heart and her family.
Ellen Andrews

Health IT privacy consent webinar

Join us to hear from Ted Kremer of Rochester RHIO and Steve Allen of Western NY HealtheNet about how they have successfully implemented health information exchanges with opt-in privacy policies that protect consumers’ rights. The webinar will be May 11th at 2pm; to register go to https://www1.gotomeeting.com/register/478088016. For more on health IT privacy in CT go to www.cthealthprivacy.com

News Round up

Public hearings for rate increases approved by Appropriations Committee
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/insurance_dept._public_hearing_bill_clears_appropriations/

Medical marijuana bill passes Public Health Committee
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/medicinal_marijuana_passes_public_health
and
http://www.ctmirror.org/story/12453/federal-prosecution-remains-uncertain-legislators-move-forward-medicinal-marijuana-propo
and
http://www.courant.com/health/connecticut/hc-weir-medical-marijuana-0504-20110503,0,6931683.story

OP-ED -- Why I’ll be opting out of CT’s health information exchange
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/op-ed_why_ill_be_opting_out_of_connecticuts_health_information_exchange/

SustiNet press
http://www.ctmirror.org/story/12394/sustinet-rally
and
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/red_shirts_rally_for_public_option
and
http://www.ctnewsjunkie.com/ctnj.php/archives/entry/op-ed_why_we_still_need_sustinet/

Paid sick days debate continues
http://www.newhavenindependent.org/index.php/health/entry/paid_sick_days

Questions about pooling plan and nonprofits
http://www.ctmirror.org/story/12467/nonprofits-state-employee-plan

VT single payer plan moves forward
http://www.burlingtonfreepress.com/article/20110503/NEWS03/110503023/Health-reform-compromise-passes-Senate?odyssey=tab%7Ctopnews%7Ctext%7CFRONTPAGE

Elder abuse funding lower, fewer reports substantiated in CT

In 2009 CT officials received 3800 reports of elder abuse but substantiated only 446 after investigations, a rate in the bottom fifth of states reporting, according to a report by the Health I-Team. Our rate of reported abuse cases is higher than most states, but most are not fully investigated including for possible criminal referral. CT spends far less than other states on adult protective services and receives no federal money to support those services. DSS claims that CT’s focus is on meeting needs rather than punishment. Advocates for the elderly believe that the reports may be hiding a larger problem – that many elders do not report abuse, especially financial abuse, due to fear or embarrassment – and that CT needs to devote more resources to protecting the elderly.

May webquiz – health reform and CT

Test your knowledge of the impact of health reform on CT. Take the May CT Health Policy Webquiz.

PCCM update

There is good news and bad news from the Medicaid Council’s PCCM committee meeting last Friday. The good news is that the department has agreed to revise the PCCM evaluation to be a constructive tool to move the program forward. PCCM program plans unfortunately are not as hopeful. There are no current plans to expand the program beyond Putnam and Torrington, as directed under a law that passed unanimously last year.

DSS is beginning from scratch to re-design the program with a lot of open questions. While advocates and providers have had difficulty having input, DSS has promised to update us regularly on their decisions. Advocates and providers expressed frustration that DSS will not be pursuing a more collaborative process or building on the work already done three years ago in a collaborative group with DSS staff. DSS expressed goals of having 30% of Medicaid members in patient-centered medical homes (PCMHs) by January 1, 2012, 60% by Jan. 2013, and 100% of Medicaid members in PCMHs by January 2014. DSS suggested that the new PCMH program might be based on national standards, but they did not make any commitment.

In a troubling suggestion they opened the door to changing the definition of provider from an individual to an entity. While the paperwork burden is higher for large clinics, literature suggests that better health outcomes are linked to a strong patient-provider relationship. Research on best practices was the basis for this decision by the prior DSS/advocate working group. PCMH patients have far better outcomes if they are connected in a continuous relationship with an individual and they know that person’s name. This is a problem in large clinics, where turnover and large staffs make a continuous, productive relationship most difficult.

The department also opened the door to changing the hard-fought $7.50 pmpm care management fee negotiated in the DSS-advocate working group. They expect to conduct a survey of other states’ care management rates, and will likely find that rates are often lower elsewhere; however it is critical to also survey expectations of providers, supports and resources available and fee structures in those states. Any reduction in the care management rate will be a significant barrier to engaging and retaining participating providers. The $7.50 pmpm is far below the $18.18 pmpm rate paid to HMOs in HUSKY during the recent ASO arrangement, for a different but largely administrative set of services requiring far less labor-intensive patient contact. Some states link reimbursement to accreditation levels.

Other design questions include voluntary vs. mandatory assignment of patients to PCMHs, hospital inpatient rates, patient attribution to PCMHs, marketing restrictions, and performance incentives. We are puzzled by DSS’ need to review removing the unnecessary and intimidating Freedom of Information provision in provider PCCM contracts; this is one place DSS could easily free up some of their staff time and resources. Thankfully, their documents make clear that risk-adjusted capitation rate setting and gain sharing are “not applicable” to the PCCM program. Unfortunately DSS’ plans are silent on monitoring and enforcement, always a weak point for CT’s programs. There was a troubling suggestion of tying PCMH performance incentives to health IT meaningful use measures – a symptom of general misunderstanding about the nature of the PCMH model. Technology is only a small part of PCMH practice transformation and is linked to many other health reform initiatives. Advocates urged DSS to acknowledge the integrity and commitment of current PCCM providers who agreed to participate in a program that was not historically supported by DSS, because they believe strongly in empowering patients, care coordination, and the PCMH model.

Advocates renewed concerns about including care coordination responsibilities in the ASO contract, especially in the absence of evaluation and monitoring to ensure conflicting interests do not inhibit PCMH development. In a promising development, DSS plans to hire consultants to help design, research and gather stakeholder input for this process – a very welcome change that has potential to move past barriers and get this program off the ground.
Ellen Andrews

Health IT privacy consent webinar

Join us to hear from Ted Kremer of Rochester RHIO and Steve Allen of Western NY HealtheNet about how they have successfully implemented health information exchanges with opt-in privacy policies that protect consumers’ rights. The webinar will be May 11th at 2pm; to register go to https://www1.gotomeeting.com/register/478088016. For more on health IT privacy in CT go to www.cthealthprivacy.com
Ellen Andrews

Health Equity forum

Join the CT State Medical Society this Thursday, May 5th for Health Equity & Quality of Care: They ARE Connected. The forum will be in the Old Judiciary Room in the State Capitol Building from noon to 4pm. To register for this free event go to https://events.csms.org

New on cthealthbook.org

Two new pieces have been added to the policymaker briefing book (formerly the candidate briefing book) on www.cthealthbook.org – health insurance exchanges and CT free clinics

Rally shows deep support for SustiNet and the public option

Hundreds rallied last night at the Hartford train station to show their support for SustiNet. Speakers said the reported compromise legislation does not go far enough to reach the original vision – providing a decent, affordable coverage option to desperate consumers and small businesses. Supporters emphasized the need for a public option, SustiNet, to make national health reform work for Connecticut consumers. For more on the rally, click here and here.

Join us to show your support for SustiNet

Come to show your support for the SustiNet bill, CT’s hope to provide a publicly accountable, affordable insurance option for individuals and small businesses. Join us at a rally 6pm next Wednesday, April 27th at the Hartford Train Station, One Union Place in Hartford. For more on SustiNet, go to www.healthcare4every1.org.

Public hearings on health insurance exchanges

The state will be holding hearings on plans for creating a health insurance exchange for CT under national health reform. The exchange is meant to be a standardized, regulated, easy-to-understand marketplace for individuals and small businesses to purchase coverage and apply for assistance. Advocates have sent a letter to the state outlining our recommendations for development of the exchange. The five hearings will be held around the state in the evenings from April 25 to May 17.

Bad news on health information privacy for CT patients

The HITE-CT Board met last night and approved the insufficient opt-out privacy model for CT’s health information exchange that defaults people into the system unless they figure out how to get out. Board membership is dominated by bureaucrats, large health care institutions and attorneys who represent them.Consumer advocates raised many objections, did significant research on other states but were ignored. For example, in our three surrounding states which all have opt-in policies that require consent before personal health information is released between 86 and almost 100% of patients sign the consent form. UT, CO and VT have recently switched from opt-out to opt-in policies. Under HITE-CT’s proposed opt-out policy, CT providers will have to identify and segregate every indication of legally protected “sensitive” information in every medical record such as HIV, mental health, or substance abuse treatment – and accept the liability for ensuring no mistakes. None of these or a dozen other concerns raised by advocates were addressed. In fact, this advocate had difficulty being allowed to speak at meetings, despite being an appointed member of the Board.

Their current plan is that a sentence would be added to the HIPAA form patients already sign to acknowledge that the patient received an accompanying “Bill of Rights” about the HIE. The Bill of Rights (still not developed or even described) would include a phone number and website where patients could go to opt-out. This would require that, even if the patient ever actually sees the Bill of Rights, they would have to copy down the phone number or website, go through their doctor visit, go home, and call or go online to opt-out.

They also plan to have a general public education program, to notify people about their rights, but no budget or specifics are designated for it. Their poor record of engaging the public in the policymaking process does not inspire confidence.

This process makes it even more clear why we need legislation to protect our rights.
Ellen Andrews