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