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