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