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.