CT providers won’t benefit as much from Medicaid rate increase as other states

Effective January 1st, the Affordable Care Act includes a payment increase for Medicaid primary care providers bringing rates up to Medicare levels. The federal government is reimbursing states 100% of the cost of the rate increase for two years. While nationally that averages a 73% rate increase, CT providers will see only 41% increases in primary care rates, according to estimates. A survey by the Kaiser Family Foundation found that CT physician Medicaid rates are already close to Medicare levels. This confirms previous studies which also found that CT Medicaid rates are among the highest in the US. Despite these higher rates, CT is forth lowest among states in physician Medicaid participation. A study by the CT Health Policy Project found that a 2008 significant rate increase had no impact on CT physicians’ likelihood to participate in Medicaid. Barriers included billing issues, delayed reimbursement, administrative hassles, poor communications and poor provider relations. Fortunately, since that study was published last year, DSS has systematically worked to address all the recommendations.

Exchange staff back off eroding essential health benefits

At yesterday’s CT Health Insurance Exchange meeting we learned about an attempt by Exchange staff and the Insurance Dept. to reduce the Essential Health Benefit Package that had been agreed to earlier this year in a contentious but inclusive and public process. Like the last process that rejected active purchasing, this process happened in evening conference calls not open to the public in a very short time frame. This time, however, providers and advocates on the committees voted down the benefit package erosion (active purchasing was not part of the reconsideration) and the staff finally agreed to pull the proposal from the Board committee agenda yesterday. However at the meeting, staff stated that they plan to lobby the fed.s to let them re-consider, and lower, the agreed-upon essential benefit package. The issue is CT mandates for coverage in state law – whether they cost or save money in premiums and how much. A public commenter noted that affordability is very important, but eroding mandates may not work to keep costs down. Active purchasing is proven to reduce costs, but the Board and staff have rejected that proven tool and have indicated no interest in re-visiting that decision. Other news included a strong theme of affordability in the Healthy Chat public events. Staff noted that many people were new faces to health care, not traditional activists. They also noted that people had “done their homework” and were very sophisticated in their understanding of active purchasing and its potential for affordability. The staff is still working on the details of the health plan benefit standards and benefit design, how plans will be rated for innovation and plans for quality monitoring. Advocates will be watching this process carefully for further standards that erode consumer protections, if there is any transparency or opportunities for meaningful public input.

31 Ways to Save Money in CT’s Health Care Budget

The state budget is facing a billion deficit next fiscal year. We have 31 ways to both save money and improve quality and access to care. The options focus on payment reform, re-engineering care delivery, engaging consumers, quality reforms and prevention, learning from experience, removing waste and excessive administration. In 2010 we only had fifteen ways to save. One of those, shifting HUSKY from capitated managed care to self-insured, coordinated care. We recently learned that the shift is saving the state millions.

Evidence of ancient health care

A story in today’s NY Times describes mounting evidence of compassion and dedication to caring for the ill among human communities living thousands of years ago. Multiple burials provide evidence of years of care, in some cases it would have likely been around the clock care, for people with disabilities and illnesses. The provision of that care would likely have cost the community dearly in scarce resources. One woman buried on the Arabian Peninsula probably suffering from polio and unable to walk, showed evidence of severe dental disease, unusual for someone of her age. Experts believe she may have been fed many sweet dates to make her happy. It’s nice to know we are hard wired to care for those who need it.

Medicaid Council meeting clears up misinformation on HUSKY parents fate under ACA

The CT Health Insurance Exchange staff’s presentation to the Medicaid Council Friday described the “opportunity” under the Affordable Care Act for significant state savings by shifting HUSKY parents into the exchange. They described subsidized premiums ($45 to $243/month), some caps on out of pocket costs, and a list of covered services. However, with questioning from legislators, providers and advocates, the rest of the story emerged. Now those low-income, working HUSKY families (this year $31,809 to $42,643 for a family of four) pay no premiums and benefit from a comprehensive benefit package covering important services that the exchange does not cover or charges more for. A legislator confirmed that the ACA does not require the state to cut HUSKY parents off the program and that the state always had that “opportunity”. It was also noted by a questioner that, many low-income working families are just getting by on what they make and paying even subsidized premiums is not realistic; their alternative, if HUSKY is cut, is to pay a $95 tax penalty the next April that will be very difficult to implement in any case. So for policymakers the “opportunity” is to cut people off HUSKY, save the state some funds, but force tens of thousands of CT working parents into paying much higher costs or into uninsurance.

Luckily there is another ACA option – the Basic Health Plan -- that saves the state millions and gives those families, and thousands more, comprehensive coverage with little or no cost. Several economists have crunched the numbers and found that available federal subsidies would more than cover the costs of care for the population with funds left over to raise provider rates. When asked about the BHP option they had not included in their presentation, exchange staff answered that the feds have not yet released regulations on the option and that they have heard that some other states are not planning to use the option.

In other news, we learned that some primary care Medicaid providers who do not work under the direct supervision of a physician may not qualify for the ACA increase in rates to Medicare levels, to become effective Jan. 1, 2013. We were also given information on January 1st increases in Charter Oak and unsubsidized HUSKY B premiums. Charter Oak rates are increasing 32% for all -- to $589/month for people who enrolled after June 2010. HUSKY B rates are increasing 16% from $270.36 to $314/month for families who do not receive subsidies (over 300% FPL). We will receive new enrollment numbers next month to know how many people these rates affect.

We also heard from Commissioner Bremby about strong measures his office has taken about problems in processing applications and voter registrations at the Hartford DSS office. He described plans to upgrade enrollment and other systems as well as enhanced monitoring that will help ensure this never happens again.

HUSKY B saves $4 million in switch from HMOs

As advocates predicted, it appears the shift from capitated managed care to self-insurance saved the HUSKY Part B program $4 million in lower medical costs in the first six months. (The numbers are still tentative, as there may be some outstanding claims from the first half of the year, but they are not expected to be large). January 1st of this year the state moved the entire HUSKY program out of capitated HMOs and into a self-funded model with care coordination. At this week’s PCMH committee of the Medicaid Council, DSS reported that spending in the HUSKY B program was down significantly after the switch. The switch was only effective for six months of the latest fiscal year (FY12) but even so, medical service spending was down by $4 million over the previous year. HUSKY B spending in FY 11 was $35 million. If the $4 million savings continues for the rest of 2012, savings would be 23%. Enrollment varied by only 2% between the years. HUSKY Part A savings from the switch were not available as that spending is included in the much larger Medicaid line item.

HHS approves CT insurance exchange plan

Along with six other states, CT’s health insurance exchange received approval yesterday from the federal agency providing funding. CT was among the first six states to apply to HHS for approval – 14 states have applied to date. No state’s application has been denied. CT’s exchange has been criticized for their plan to accept any willing plan and refusing to negotiate with insurers to control costs and reduce consumer premiums. CT’s exchange also voted not to conduct a secret shopper survey to monitor whether people who purchase their insurance plans can find a provider. The exchange has also been criticized for having no independent consumer Board members, having Board members with close ties to the insurance industry and for members with insurance company investments.

NY ex-con shoplifts to get prison health care

Frank Morocco, a Buffalo area ex-convict, intentionally got himself arrested for shoplifting two weeks ago. He stole $23 worth of miscellaneous items, making sure he was seen by store employees and other customers. He stated that he was desperate and saw no other way to get treatment for his cancer. He suffers from a rare form of leukemia for which he received great care while in prison. But since his release last December he has been unable to afford private insurance and his employer does not offer benefits. With assistance from his probation officer he applied for Medicaid and disability coverage, but was denied. He has incurred $5,000 in medical debt in the last year. The Buffalo Times article notes other cases of ex-convicts getting arrested for health care.

CEPAC meeting in CT – effective sleep apnea treatment

Yesterday’s New England Comparative Effectiveness Public Advisory Council (CEPAC) meeting centered on sleep apnea. Too many new (and expensive) treatments and technologies are adopted and gain wide use without a careful analysis of their effectiveness in treating the condition and/or cost effectiveness compared to other options. CEPAC’s mission is to produce actionable information to aid regional policymakers in the medical policy decision-making process. CEPAC includes researchers, clinicians and patient advocates from across the New England states who, twice a year, drill down into the research around treatment options for a condition, evaluate effectiveness and costs, and vote on whether there is sufficient evidence to recommend each treatment’s use. About 10 to 20% of middle-age and older adults suffer from sleep apnea, with regular bouts of difficulty breathing through the night. And rates of the condition are rising, driven in part by rising obesity rates. Studies have found that sleep apnea patients have higher rates of health care use, including more and longer hospital stays, and higher health care costs before diagnosis than after. Sleep apnea has been linked to lower productivity among workers, higher motor vehicle crash rates, and cardiovascular disease. After long discussion of the research and impact in the real world, the group voted on effective treatments (home sleep studies) and treatments (urging more research on weight loss support). Studies like these are critical to the double goal of both improving the quality of care and controlling costs. We have to find more opportunities like this if we are going to fix our broken health care system.

December webquiz – CT spending on medical assistance programs

Test your knowledge of DSS spending on medical assistance programs, most notably Medicaid. Take the December CT Health Policy Project webquiz.

Medicaid outreach recommendations

Small grants, engaging an army of trusted community messengers, ubiquitous marketing, and robust monitoring will be critical to enrolling the estimated 130,000 newly eligible CT Medicaid members in January 2014, according to a report by the CT Health Policy Project. Best opportunities for outreach include providers, current HUSKY members, faith-based communities, connecting with employers and other state programs, targeting life transitions, improving application and enrollment processes, and thanking outreach partners. It will require strong, concerted efforts to overcome the program’s stigma and other barriers to enrollment. The report draws on the experience of community organizers, consumer advocates who worked on HUSKY outreach, providers that care for CT’s uninsured patients, and lessons from other states. While aimed at Medicaid, many of the report’s findings also apply to the new CT Health Insurance Exchange.

Exchange Board and staff water down already watered-down affordability and access provisions

In a surprise to advisory committee co-chairs, CT Health Insurance Exchange staff submitted four alternative policy proposals at today’s Board meeting – they were adopted virtually intact by the Board. The staff alternatives were contrary to the recommendations adopted Tuesday by the Consumer and Qualified Health Plan Advisory Committees, with Exchange staff at every meeting. One staff change increased the number of options insurers can offer (in response to insurance industry comments); research shows that consumers prefer and make better choices with a limited number of well-vetted options. Another eliminated a secret shopper survey to ensure that the plan’s provider panels are accurate; in a Mercer study of HUSKY plans, shoppers were only able to get appointments with one in four providers on those HMO panels. Staff stated that accountability in secret shopper surveys seem “too adversarial” with insurers. Another proposal reduced the number of essential community providers that plans have to include in their networks, such as community health centers. The last one eliminated even the guidance that the Exchange will develop a plan of some undefined type to eventually, someday move along a continuum toward an active purchasing model. Active purchasing now saves MA exchange consumers millions in premiums by fostering competition and negotiating rates with insurers.

Staff reviewed comments to the draft health plan solicitation. Ten of the 22 comments mentioned were from insurers – half were accepted in the staff proposals, two were not, and three others were not relevant. Five comments came from NCQA, two from unknown sources, four from this consumer advocate (none were reflected in proposals) and one from a provider (was reflected in joint committee proposal).

The Exchange staff also announced they have hired Pappas Macdonnell, a Westport marketing firm with experience in selling corporate insurance and financial products. When asked if they have any experience in marketing to low-income, uninsured populations, one representative noted that he has worked on Democratic political campaigns.

In other news, they have settled on a new name for the Exchange – Access Health. They also have submitted an application for $2.6 million in federal funding for application assisters. They expect to award about 300 grants of about $6,000 each to community organizations to publicize the exchange, help people figure out what assistance they are eligible for, and help them enroll. They have hired three new Exchange staff this month.

Governor’s initial budget cuts

Yesterday the administration announced an initial list of $170 million in cuts to address the growing state budget deficit. The cuts include AIDS services, breast & cervical cancer detection and treatment, home care, Healthy Start, and DSH payments to hospitals. The cuts also include $1.5 million from HUSKY B, but expenses were down significantly in that program last year. As predicted, the switch from capitated HMOs to the ASO model may be responsible for those savings.

Joint exchange committees voting down active purchasing, cost control

While the votes are reportedly still coming in, it appears that the Consumer and QHP Insurance Exchange committees have voted against active purchasing. With active purchasing, other state exchanges are using the power of numbers, as large employers do, to negotiate better premiums, lower costs and better coverage for their members. MA has saved millions for consumers in their state with active purchasing. While the committees’ language includes a symbolic nod to possible future negotiation, it is far weaker than current state law. Reportedly, through a procedural maneuver, Exchange staff and committee co-chairs agreed to link all the proposals in one vote. Providers on the committees were picked off by adding back requirements that their organizations be included in network standards. Reportedly consumers lost votes we would have had if active purchasing had had a fair vote. All meetings this week and negotiations over language were conducted in secret. A critical negotiation session happened by conference call, but the public was not allowed to listen in. (The public was told to come to the LOB, from 6 to 7pm Monday to hear the call. However the building closes at 5:30.) This secrecy would not be allowed if the Exchange was part of state government – there are laws about that. But as a quasi-public entity, they can make their own rules. It is ironic as 50% of the Board members are public officials (71% if you count spouses and retirees), and all their millions in funding come from taxpayers. Exchange staff also incorrectly argued that they had to have this issue decided in time to release the health plan solicitation next month. However, state RFPs rarely release specifics on how they will score bids with the RFP release. Why would you? Now the HMOs know that as they prepare their premium bids, that the sky is the limit.

Official vote tally from Exchange staff: Note -- a vote to reject was a vote FOR active purchasing Below lists the results of the votes cast by the Consumer Experience and Outreach and Health Plans Benefits and Qualifications Exchange Advisory Committees with concern to the certification of Qualified Health Plans within the Exchange. Results:
Twenty (20) – Approve Two (2) – Reject Approve
-- Sheldon Toubman Vicki Veltri
Gerard O’Sullivan Anne Melissa Dowling Deb Polun
Marcia Petrillo
Steve Frayne
J. Erlingheuser
Mark Espinosa
Gloria Powell Margherita Giuliano Tanya Barrett
Bonnie Roswig
Mary Fox
Alta Lash
Arlene Murphy
Sarah Frankel
Cee Cee Woods
Dr. Robert McLean Dr. Robert Scalettar Reject
-- Kevin Galvin Deirdre Hardrick

Just 6 days to comment on exchange health plan solicitation

Stakeholders had only six days to comment on the 40 page health plan solicitation from the CT Health Insurance Exchange – and it’s already over. Stakeholders in CA and MD had months to comment, with multiple drafts, meetings and opportunities to craft better proposals. The CT Health Policy Project’s initial comments centered on active purchasing, network adequacy, and the proposed “iterative process”. MA’s Connector has used active purchasing to save consumers millions in premiums – CT should do the same. When consumers are required to purchase coverage in the exchange, they must be able to get an appointment with a provider. HUSKY secret shoppers were only able to get appointments with 1 in 4 providers on the health plan lists. Using the standards from HUSKY contracts, thoroughly vetted in CT, and intensely monitoring compliance is key. The exchange’s proposal to initially implement a weak exchange and implement some standards later will sound eerily familiar to CT advocates – with a very poor history. Other comments include better cost sharing structures, standardize rating options so differences are meaningful, wellness programs that aren’t a screen for cherry-picking, constructive connections to the Medicaid program, accreditation standards, quality improvement plans (at least have one), and CID rate reviews as a floor. Perhaps the most troubling thing about the proposal is how much is taken on faith in attestations from insurers. Will anyone be monitoring to see if the promises are real?

Exchange advisory committees reject “any-willing insurer”

Today in a joint meeting of the Health Plan Benefits/Qualifications and Consumer Experience/Outreach committees of the CT Health Insurance Exchange voted against the staff recommendation “that the Exchange not deny any carrier QHP certification on the basis of its approved rates”. The only votes for the staff’s any willing insurer proposal were from Aetna and CT Insurance Dept. representatives. The committees asked staff to come back with a new proposal that includes rate negotiation.

Who is coming into LIA?

Today’s CT Mirror asks the question – who are the 37,000 new enrollees in the Low Income Adult Program? LIA was created just over a year ago as an option under the Affordable Care Act. CT shifted our fully-state-funded SAGA program into Medicaid, getting a 50% federal match, and re-named it LIA. When the program switched, the SAGA $1,000 asset limit on eligibility was lifted. As more people have signed up for the program than intended (fuzzy policy estimates are hardly new) and costs are higher than expected, the state has asked the feds for permission to re-impose an asset limit of $10,000 for eligibility. The administration has suggested that many new LIA members are able to pay for insurance, but are choosing coverage in a public program. The article notes that we really don’t know who is enrolling, because the state doesn’t ask about assets in applications and no one has surveyed the population. But the reporter spoke to providers who say that’s not what they are seeing in the real world. The article also includes interviews with two new enrollees that do not fit the administration’s picture. Make sure and read down to both stories – important lessons about people working hard doing everything they should and are unlucky enough to have health problems – exactly who safety net programs are built for. In a down economy, it shouldn’t be surprising that numbers are up.

CT Insurance Exchange holding public events

In response to concerns about the lack of public input, CT’s Health Insurance Exchange will be holding seven “Healthy Chat” events in the next month. Similar to Consumer Conversations last month but sponsored by the exchange this time, they will be reporting on their activities but will also be taking questions. We will be asking why they aren’t willing to negotiate with insurers to keep premiums affordable. The events will all be 5:30 to 7:00pm with registration at 5:00. The events will be in Hartford on November 27th, Waterbury on November 29th, New London on December 4th, New Haven on December 6th, New Britain on December 11th, Stamford on December 13th, ending with Bridgeport on December18th. For more details, click here.

Where are the consumers on the consumer committee?

Kevin Galvin of Small Business for Healthy CT reflects on the recent CT Health Insurance Exchange’s Consumer Committee meeting. A lack of consumers on the consumer committee explains a lot.

November webquiz – substance use rates in CT

Test your knowledge of substance abuse in CT. Take the November CT Health Policy Webquiz.

Why CT’s health insurance exchange needs to negotiate

CT’s health insurance exchange is not planning to negotiate with insurers to improve value and control costs for consumers. As of January 2014, consumers will be mandated to secure coverage. Consumers eligible for affordability assistance must purchase in the still developing exchange to get the subsidies. Massachusetts’s exchange (the Connector) negotiates, termed active purchasing, with insurers saving consumers $16 to $20 million annually. In contrast, Utah’s exchange does not negotiate with insurers but includes any qualified insurer, as the CT exchange is planning, and premiums are HIGHER inside the exchange than in the outside market. There is some disagreement about whether the Board and the Qualified Health Plan Committee have already made the decision. No public comment was solicited on the issue and the decision memo was posted a day after the QHP committee meeting. For more on the issue, go our Policymaker Brief.

Consumer questions to CT insurance exchange

Some initial questions from consumers for the exchange were collected for last Friday’s Consumer Conversations. Among the 43 early questions -- Will you standardize benefit limits, exclusions, and substitutions to the Essential Health Benefit package? and How will you monitor that there are enough of the right kinds of doctors, and other providers taking new patients in each plan close to where people live?

CT health reform progress up to 16.7%

CT inched up only 0.3% in progress toward health reform last month. We have completed 16.7% of the tasks needed to be ready for January 1, 2014 when individuals will be legally required to secure health coverage. Highlights remain Medicaid and patient-centered medical homes. Unfortunately, problem areas continue to be the insurance exchange and insurance review. Last month, CT health care thoughtleaders gave CT a C+ grade for reform progress. For more, visit the CT Health Reform Dashboard at www.cthealthreform.org.

Consumers raise concerns with CT insurance exchange

Consumers and small businesses had a rare opportunity to share their concerns with CT’s health insurance exchange Friday. A standing room only crowd met with the exchange’s CEO, Kevin Counihan at a restaurant in Glastonbury. Christie Hager, HHS Regional Director, also attended. Comments focused on the lack of consumer and small business input to the exchange, inappropriate influence of insurance interests, and the exchange staff’s decision not to negotiate with insurers to get the best value for customers. Through negotiation, MA’s exchange has been able to keep the rate of premium increases to half what it is outside their exchange. However prices in Utah’s exchange, which does not negotiate with insurers as CT’s exchange is planning, are actually higher than prices outside the exchange. CT’s exchange is being set up by the state, with millions in federal grants, to help consumers get decent, affordable coverage and is expected to purchase on behalf of one in ten state residents. As of Jan. 1, 2014, everyone in CT will be required to have coverage. Residents who qualify for federal affordability subsidies will have to buy their insurance through the exchange. Check back at the CT Health Policy Project’s site soon for a brief on the benefits for CT consumers, promoting value and affordability, through negotiation on CT’s exchange.

CT health reform update

The CT Health Policy Project has posted a summary of updates and context on CT’s progress toward health reform.

PCMH workforce conference offers lessons for CT

Yesterday’s conference on patient-centered medical homes and workforce brought speakers from other RI, MA and Pittsburg together with CT programs to share best practices and lessons learned. Take aways included baking training into all activities and for every member of the team. It is also critical to begin training well before NCQA recognition. And training is not over with recognition; CHC, Inc. retrains all team members every year. The speakers emphasized that the patient-centered vision is the responsibility of everyone – including clinician, administrators, IT staff and receptionists. Teams are not one-size fits all; they have to fit into their community. Sustainable funding in a multi-payer initiative was cited by several states as critical, from the beginning. It is critical to use data – process and population health – to target interventions. Kyle Crawford from the Pittsburgh Regional Health Initiative noted that we have to create a “better relationship with our data.” Other lessons included the importance of behavioral health integration and engaged, committed leadership both at the practice level and among policymakers.

Additions to candidate briefing book

New briefs have been added to our CT Health Policy Project briefing book for Connecticut candidates. New briefs include wellness programs, patient-centered medical homes in CT, comparative effectiveness research, and CT’s health care workforce. The candidate briefing book is part of cthealthbook.org, our site for CT health care system resources. Check often for more updates.

CT exchange staff won’t negotiate with insurers on behalf of consumers

Staff of the CT Health Insurance Exchange have “opted to utilize an ‘any qualified plan’ approach” for determining which plans can be offered in the exchange. Proposed qualifications are minimal and generally only what is required by the Affordable Care Act. This decision is counter to the CT exchange’s own research. According to the market consultants, “One of the most attractive aspects of the Exchange is that the big insurance companies compete for their business. The feature evoked references to Lending Tree’s slogan ‘When banks compete you win.’” Utah’s health insurance exchange has pursued an “any qualified plan” approach, similar to CT’s staff proposal, and has attracted little enrollment with no evidence of cost control. Massachusetts’s Connector, on the other hand, operates with an active purchasing approach – negotiating with insurers to get the best price and quality for consumers. Annual premium increases for plans in Massachusetts’s exchange have been half the increase of plans outside the exchange. Starting in 2014, every CT resident will be required to secure health coverage. Over 150,000 state residents will have to buy it in the exchange to get federal affordability subsidies. According to the staff memo, the decision not to negotiate on behalf of consumers has been made and they are only taking comment on how to implement that policy. The memo was delivered Monday to the Qualified Health Plan Committee that no longer includes a consumer representative due to the unfortunate loss of Jennifer Jaff.

Medicaid Council update

Lots of good news at Friday’s MAPOC meeting. DSS has significantly improved their redetermination process in response to huge backlogs that prompted a legal aid lawsuit. The dual eligible Health Neighborhood proposal’s behavioral health component has been improved by shifting from the controversial, administratively complex and fragmented co-lead proposal to a partnership. This is what it always should be – partnerships across health care silos into an integrated neighborhood. People don’t come in silos, only the health system does, and further codifying that in policy is a very bad idea. The state is still currently pursuing a limited health home option only for people with serious mental illness. Health homes are an ACA provision reimbursing states 90% of care coordination costs for people with chronic conditions but only for two years. At the meeting, agency staff noted that CMS has issued guidance that states will retain the ability to access the 90% match for other populations in the future, but speakers noted the uncertainty of future federal funding due to sequestration and the imminent fiscal cliff. The state was urged to move swiftly to ensure that every eligible person be covered by the option as soon as possible.

PCMH workforce conference Oct. 23rd

Patient centered medical homes offer exciting potential to both improve the quality of care and control costs. But this transformation of care delivery will require new skills and roles in CT’s health care workforce. A conference to explore these issues and CT’s readiness for delivery reform will be held October 23rd from 8am to 3pm at Wilde Auditorium at the University of Hartford. Speakers include academic experts, working professionals and consumer advocates from CT and other states. The conference is sponsored by the Universal Health Care Foundation of CT together with the Allied Health Workforce Policy Board and the University of Hartford Center for Public Health and Education Policy. To register, click here.

State innovation application posted

The state’s application to CMS for a $3 million State Innovation Models Grant is now online. If awarded, the grant would fund health care planning activities including hiring staff at state agencies and consultants. The project will work to align incentives among stakeholders to reform delivery and payment systems. The initiatives include coordinating data across payers, supporting providers in practice transformation, and expanding primary care capacity. The role of consumers and the Cabinet is unclear. The project was developed by state agencies; the activities would be coordinated by the Office of Health Care Reform and Innovation.

CT still earns a C+ on reform

Once again, CT health care thoughtleaders give our state a C+ on health reform. From the beginning of the CT Health Thoughtleaders Survey in February, CT has varied between C and C+. CT has always received a B for effort. In good news, grades for the CT Health Insurance Exchange improved since June with fewer D’s and some A’s in this survey. Unfortunately, grades for Engaging Consumers in Policymaking and Data-based Policymaking have fallen. The former was the most common recommendation from thoughtleaders to improve progress toward reform. The overwhelming response was to engage consumers in policymaking – increase consumer voices, greater public engagement in the process, and engage advocates. Other suggestions included smarter policymaking (data, best practices), improve communications and transparency, convene stakeholders to build trust, and guard against conflicting financial and special interests. New questions in this survey found that almost all thoughtleaders are somewhat or very engaged in the process of reform, however all but four cite barriers to engagement. Understanding how critical stakeholder engagement will be to success, policymakers should work to improve effective, meaningful access to the process. A disturbing number of respondents have not been asked, or have tried but found few ways to participate. The Thoughtleader Survey is part of the CT Health Policy Project’s Health Reform Dashboard project at www.cthealthreform.org.

Join us for Consumer Conversations: the CT Health Insurance Exchange

January 1, 2014 every CT resident will be required to secure health coverage. The CT Health Insurance Exchange is being developed under the Affordable Care Act to be a fair, user-friendly marketplace for consumers and small businesses to buy decent coverage, hopefully at an affordable price. The Exchange has not heard consumer voices, does not include any independent consumer Board members, and is dominated by insurance interests. Small Business for Healthy CT and the CT Health Policy Project have invited Kevin Counihan, CEO of the exchange, to meet with consumers and small businesses to learn what consumers need and how to make the exchange a success. We will also be joined by Christine Hager, Regional Director of HHS, the federal agency funding the exchange. The meeting will be October 26th from 8:30m to 11am at the Pond House Grille in Glastonbury. To register, click here.

Aetna announces layoffs, blames ACA, puzzling

Aetna has announced they will soon be laying off 80 CT workers, 160 nationwide. The company cited competitive pressures from the Affordable Care Act (ACA) in their decision, which is puzzling. The ACA legally requires Americans to buy their product, which should substantially improve their bottom line. Significant lobbying from the insurance industry into the law ensured that we would not have a competing public option to help reduce costs. It is also interesting that Aetna laid off more employees (100 in CT, 625 in the US) a month before the ACA passed. The economic downturn has hit CT hard, and the 80 innovation, technology, and customer service workers will be joining a growing number of unemployed CT residents. The laid off employees will receive nine weeks of pay and some are eligible for a severance package.

Fascinating UConn medication management conference

UConn’s School of Pharmacy invited some stellar speakers to yesterday’s 2012 Hewitt Symposium on Medication Management. Medication management is an important new tool to both lower health care costs and improve care. The tool pairs patients with complex conditions and many medications with a pharmacist to ensure they are taking the right medications, eliminate conflicts, address side effects, prevent errors, and help them adhere to the care plan. Speakers came from successful programs in Boston, Pittsburg, Minneapolis, North Carolina, Iowa, and Connecticut. A CT Medicaid program, highlighted in Health Affairs, saved $1,123 per patient per year in medication costs and $472 in medical care – saving $2.50 for every dollar spent on the program. Another CT program serving Cambodian refugees saved even more -- $3,032.44 per patient per year – returning $5.60 for every dollar of program spending. The speakers shared important lessons learned. Opportunities to both save money and improve care are rare -- every CT payer should be looking at medication management.

Midwifery conference

Mary Breckinridge, one of the foremothers of nurse-midwifery in the United States, famously said, “Our goal is to see ourselves surpassed.” Nearly a century later, there is still much room for improvement in maternity care. As new tools and resources become available, what will it take to transform maternity care, and how can midwives and other maternity care professionals be part of that transformation? Join us for the ACNM Region 1 Annual Meeting: Quality Improvement in Maternity Care. Network with providers from across New England, earn CEUs, and get inspired to improve quality and patient safety. Saturday, November 10 8:30am – 3pm New Haven Lawn Club 193 Whitney Avenue, New Haven

October webquiz – pre-exisiting conditions

Test your knowledge of CT residents with pre-exisiting conditions. Take the October CT Health Policy Webquiz.

Exchange Board approves Essential Health Benefits standard – false choice between benefits and cost

Yesterday the CT Health Insurance Exchange Board approved CT’s version of the Essential Health Benefit (EHB) package under the Affordable Care Act (ACA). As of January 1, 2014 individual and small group plans will have to cover at least the EHB services. The ACA required that the EHB include at least ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse care, prescriptions, rehab and habilitation services, lab services, preventive and wellness care including chronic disease management, and pediatric care including vision and dental care. States have several plan EHB options including large commercial plans, federal and state employee plans. After long, contentious deliberations, two exchange committees of experts and stakeholders agreed on a moderate, compromise choice based on ConnectiCare’s HMO plan that includes all state mandates. The committees recommended that compromise to the Exchange Board. While the Board eventually approved the committees’ recommendation, there was a great deal of discussion about reducing the “richness” of the plan in the interest of “affordability”. Board members noted that the recommended plan is “richer” than what is offered now in CT. They failed to note that one of the main points of reform was to improve the “value” of health insurance so it truly covers what people need. If what is available now was sufficient, we wouldn’t have needed reform. The Board wants the legislature to “revisit” legislatively mandated benefits next year, eliciting groans from lobbyist and advocate observers in the room. Unfortunately there was no meaningful discussion about the potential for ongoing payment and delivery innovations successful in many other states, to provide flexibility that improve quality, access, patient satisfaction while controlling costs. The Board includes no independent consumer advocates and several insurance industry representatives. Consequently the Board is locked in the narrow false choice between mandated benefits and affordable premiums. That very old, very simplistic dialogue only spirals downward into worse care and upward into skyrocketing costs. The Board is missing a massive opportunity to learn from innovators and truly reform CT’s health care landscape.

Join us for Consumer Conversations: the CT Health Insurance Exchange

January 1, 2014 every CT resident will be required to secure health coverage. The CT Health Insurance Exchange is being developed under the Affordable Care Act to be a fair, user-friendly marketplace for consumers and small businesses to buy decent coverage, hopefully at an affordable price. The Exchange has not heard consumer voices, does not include any independent consumer Board members, and is dominated by insurance interests. Small Business for Healthy CT and the CT Health Policy Project have invited Kevin Counihan, CEO of the exchange, to meet with consumers and small businesses to learn what consumers need and how to make the exchange a success. We will also be joined by Christine Hager, Regional Director of HHS, the federal agency funding the exchange. The meeting will be October 26th from 8:30m to 11am at the Pond House Grille in Glastonbury. To register, click here.

Resources on PCMHs and health equity

Care coordination is only one aspect of patient-centered medical homes (PCMHs) that can have a large impact in promoting health equity. PCMHs are primary care practices that create partnerships among a team of providers that serve and support consumers in improving their own health. In addition to care coordination, PCMHs track the population health needs of their patients, offer enhanced hours, and provide culturally appropriate care and services. The CT Health Foundation has published a brief, references, and a chart on the subject.

Candidate briefing book posted

The CT Health Policy Project’s 2012 candidate briefing book on CT’s health is posted. This year’s book includes briefs on thirteen timely issues including health care cost drivers, CT’s health insurance exchange and CT & national health reform. The briefing book is part of www.cthealthbook.org our resource library on health care issues and solutions facing CT.

Health Justice Town Hall

Health Justice Town Hall Meeting 2012, a statewide discussion on creating solutions for a healthy and equitable Connecticut, will be held October 23rd from 5:30 to 7:30 pm. Meetings will be held that evening in three locations – the Legislative Office Building, and two Community Health Center Inc locations -- 675 Main St., Middletown and 1 Shaws Cove, New London. More details are coming soon at www.HealthJusticeTownHall.org.

No CT hospitals make top quality list

The national experts who are responsible for accrediting US hospitals, the Joint Commission, has just released their list of 620 hospitals, Top Performers on Key Quality Measures. The 620 hospitals were recognized for providing “evidence-based clinical processes that are shown to be the best treatments for certain conditions, including heart attack, heart failure, pneumonia, surgical care, children’s asthma, inpatient psychiatric services, stroke and venous thromboembolism.” Unfortunately, no CT hospitals earned a spot on the list. Among our surrounding states, New York had 16 hospitals on the list, Massachusetts had 10, and one Rhode Island hospital met the standards.

State Employee wellness program working

Preliminary results from the new Health Enhancement Program (HEP) for state employees show decreasing use of specialists and increasing use of primary care. HEP is a wellness program that gives state employees incentives to manage chronic conditions and prevent new problems. HEP grew out of last year’s labor negotiations designed to both reduce costs and improve the quality of care – and it appears to be working. Emergency Room visits are down significantly and people with chronic conditions like heart disease, high blood pressure, high cholesterol and diabetes, are doing a better job taking their medications. The HEP results follow some very interesting FY12fiscal numbers in this presentation by the Comptroller’s Office. Once again, Medicaid dwarfs other line items in the budget at $4.7 billion. Even accounting for federal matching funds, it exceeds the next largest line item – salaries and wages. And rising Medicaid caseloads are a significant driver of the rising state budget. This is all the more reason to expand good ideas, like the HEP, to all state health spending and leverage the state’s success to improve the rest of the market.

New uninsured brief posted

Check our newest Policymaker Issue Brief for more information on the drop in uninsured CT residents last year. See where the gains came from, where residents get coverage, why it matters, and why we need to continue the important work of reform.

Census finds 94,000 more CT residents had health coverage last year

New US Census numbers found that the number of uninsured CT residents dropped to 303,000 last year from 397,000 in 2010, to 8.6% of all state residents from 11.6%. The rate of uninsurance in CT has been rising since 2005. The Affordable Care Act deserves much of the credit for the drop, especially for the estimated 23,000 young CT adults now able to stay on their parents’ policies to age 26. Employer-sponsored coverage accounted for 24,000 of the increase, but the majority was due to increases in Medicaid (43,000) and Medicare (38,000). However, it remains true that the majority (66%) of CT residents receive coverage through an employer.

Kaiser taking guesses on uninsured number

New Census figures on the number of Americans without health coverage last year are due out Wednesday morning. Experts expect the number to be up slightly as unemployment remains high. Kaiser Health News is taking guesses on their blog. The closest guess gets recognition. Any guesses for CT’s number? Go to our brief from last year to study up.

RFI for state employee Health Enhancement Program support

The Office of State Comptroller has released a Request for Information for data, support, chronic care coordination and monitoring services to support the new Health Enhancement Program. The RFI includes questions about medical management, care management, call center, physician support, data exchange, quality management, privacy & security, information technology, outcomes, and wellness support. Please share with anyone who might be interested.

CEPAC coming to CT December 6th

The New England Comparative Effectiveness Public Advisory Council (CEPAC) will hold our next meeting here in CT -- December 6th from 10am to 4pm at the Legislative Office Building. Too many new (and expensive) treatments and technologies are adopted and gain wide use before a careful analysis of their effectiveness in treating the condition and/or cost effectiveness compared to other options. CEPAC’s mission is to produce actionable information to aid regional policymakers in the medical policy decision-making process. CEPAC includes researchers, clinicians and patient advocates from all New England states who, twice a year, drill down into the research around treatment options for a condition, evaluate effectiveness and costs, and vote on whether there is sufficient evidence to recommend each treatment’s use. Both Medicare and Anthem have cited previous CEPAC votes in deciding which treatments to fund. June’s meeting in New Hampshire focused on treatments for ADHD. December’s meeting will focus on treatments for obstructive sleep apnea (OSA) in adults. Studies estimate that between 10 and 20 percent of middle-age and older adults suffer from OSA and the rate is rising as obesity rates rise. The meeting is open to the public and the public is invited to testify and/or submit written testimony.

LHP takeover of Waterbury hospitals may be off

News outlets are reporting that LHP Hospital Group, the for-profit Texas company planning to purchase both Waterbury and St. Mary’s Hospitals, has sent a letter threatening to pull out of the deal unless the three sides came to agreement by last Friday. The plan was to merge the two hospitals in a new facility. One potential area of disagreement may be delivery of abortion services and other women’s health care. The Mayor is concerned the deal will fall apart; the hospitals are saying discussions continue.

Insurance Company Shenanigans – Part 2

If you live in CT and are insured through Golden Rule, now also known as United Healthcare’s United HealthOne; you should read the State of Connecticut’s Insurance Department notice # 509542, dated 8/17/2012. Read more in today’s CT Health Exchange Watch blog by Tony Pinto.

Insurance Company Shenanigans – Part 1

In case you’re wondering why you don’t hear insurance companies complaining about Obamacare; it’s because they are big winners and don’t want to rock the boat. Read more in Tony Pinto’s blog on CT Health Exchange Watch.

Behavioral health access hearing

The CT Office of Health Care Advocate will hold a public hearing on access to mental health and substance abuse prevention, treatment and coverage to assess the need for changes to state and federal laws. The hearing will feature guest speaker Carol McDaid, Principal, Capitol Decisions, Inc. Ms. McDaid led the Parity NOW Coalition that backed the federal 2008 Mental Health Parity and Addiction Equity Act. The hearing will be October 17th at 10am in Room 2C of the Legislative Office Building. For more information and how to testify, click here.

742,000 CT residents with pre-existing conditions’ access to coverage will be protected under ACA

New estimates from Families USA finds that 742,000 non-elderly CT residents have been diagnosed with serious conditions often linked to individual coverage denials. Beginning in 2014 under the Affordable Care Act, no Connecticut resident can be denied coverage, charged a higher premium, or sold a policy that excludes coverage of important health services simply because of a pre-existing condition. The rates of pre-existing conditions in CT vary little by county, but adults ages 55 to 64 are 2.5 times more likely than younger adults ages 18 to 24. More than half of CT residents with pre-existing conditions have incomes over 400% of the federal poverty level and over three quarters are white.

CT health reform progress up to 15.2%

CT made impressive progress toward health reform in August. We moved from 13.7% of the way to 15.2% this month. Highlights include negotiation of a compromise Essential Health Benefit Package and CMS grant funding to the insurance exchange. The grant is very exciting – the state plans to use most of the funding for a new, comprehensive IT system. If we do this right, this could solve a lot of our systemic problems. Unfortunately we fell behind in limiting monopoly providers by approving the Yale-New Haven – St. Raphael’s merger raising serious concerns about access to care for New Haven area un and underinsured consumers, and about costs for all of us. But we are stepping up progress – it’s been a good month.

HHS approves CT application for more insurance exchange funding

Today Health and Human Services, the federal agency tasked with approving and funding state insurance exchanges under the Affordable Care Act, announced that CT’s Level II insurance exchange application has been approved for $107 million, along with new grants for seven other states. A large part of CT’s grant is meant to fund development of an IT system to coordinate “eligibility, enrollment, and information exchange among individuals, employers, insurance carriers, and state and federal government agencies”. This function is sorely needed, long overdue, and hopefully CT’s Health Insurance Exchange will do a good job of designing and procuring this system. Advocates have been critical of many decisions made by the insurance-dominated exchange Board, which includes no independent consumer representatives.

Update on patient-centered medical homes in CT

A recent CT Health Foundation blog highlights progress toward building patient-centered medical homes in our state. The post outlines initiatives by DSS, the CT State Medical Society, ProHealth, Qualidigm, the Community Health Centers Association of CT, CHC Inc., and Community Health Network. CT now has 730 NCQA certified PCMHs and that number is growing.

Great student journalism articles

CT Health I-Team’s summer journalism boot camp students produced some great work this year. Articles this summer include CT suicide rate hits 20 year high, mental health issues for delinquent girls, and exercise equipment and basketball injuries are up. C-HIT runs summer workshops for high school students interested in investigative journalism, in partnership with Quinnipiac University and the University of Connecticut.

CT health care spending growth roughly tracks our GDP

Is health care spending skyrocketing? Yes and no. It is true that total health spending in CT averaged 7.9% annual increases from 1980 to 2009, higher than the 6% growth rate for our overall state economy (Gross State Product, GDP). However when overall economic growth slows, health care spending growth does as well, according to data from the Centers for Medicare and Medicaid Services.

Last chance: Seeking nominations for CT thought leaders

We are refreshing our invitation list for the CT Health Thoughtleader Survey. The survey has been cited by policymakers as a tool in evaluating our state’s progress toward reform. It is part of our CT Health Reform Dashboard. To keep the list robust and ensure a broad reach, we are seeking nominations for the survey. Who do you rely on for information on health reform in CT? Help us improve the tools for our state’s health policymakers and give us your nominations.

CT 42nd among states in adult obesity rates

CT is doing better than 41 other states in adult obesity rates for last year, according to new CDC numbers. We are tied with Nevada and New York. However even at that level, one in four CT adults (24.5%) is obese, and that rate is up from 18% a decade earlier. A recent IOM report provides comprehensive recommendations to reverse the trend including integrate physical activity every day in every way, market what matters for a healthy life, make healthy foods and beverages available everywhere, activate employers and health care professionals, and strengthen schools as the heart of health.

Four CT hospitals earn highest Medicare readmission penalty

Starting in October, Medicare will begin reducing reimbursements to Griffin Hospital, St. Raphael’s, Masonic Home and Hospital, and Midstate Medical Center by 1% because of high patient readmission rates. Eight CT hospitals - Hartford, Hebrew Home and Hospital, Manchester, Middlesex, Rockville, Sharon, Backus and Windham hospitals - will have no deductions to their Medicare payments due to better readmission rates. The other nineteen CT hospitals will receive varying readmission penalties. Overall CT hospitals ranked 12th highest among states in readmission penalties; no Idaho hospitals received any penalties. There was no significant difference between the highest and lowest performing CT hospitals on levels of uncompensated care or overall margins. Among the four hospitals serving the largest number of CT Medicare patients, Hartford Hospital received no penalty, St. Francis a small penalty (about half the state average), Yale New-Haven a substantial penalty (2.5 times the state average), and St. Raphael’s received the maximum penalty of 1%. St. Raphael’s also relies on Medicare for half of total revenue, more than any other CT hospital. Next year the maximum penalty doubles to 2%, and rises to 3% the year after. Penalties are based on the percent of heart attack, heart failure and pneumonia patients who return to the hospital for any reason within a month. The initiative is part of health reform’s shift away from paying for volume to paying for the quality of care. Soon hospital Medicare reimbursements will also be adjusted based on adherence to basic standards of care and patient experiences of care.

Updated CT Health Policy 101

Our CT Health Basics primer/training module for the CT Health Policy Project is updated. Check www.cthealthbook.org regularly for other resource updates.

How will 137,000 CT residents get their MLR rebate money?

Today’s CT Post highlights some of the confusion about the insurance rebates mandated by the Affordable Care Act from health plans that didn’t spend at least 80% of premiums on health care and quality. This month 137,452 state residents should get refunds averaging $168 but how they get the money varies. If consumers bought an individual policy the possibilities are a check from their insurer, a discount on their premiums, or a lump sum reimbursement to their account. Employers are not allowed to keep the money for workers who purchased coverage through them. It must be used to benefit the covered workers, but they are still working out how to do that.

Comptroller’s Virtual Roundtable – getting men into the doctor’s office

Comptroller Kevin Lembo explores the reluctance of men to access preventive care in his latest Virtual Roundtable. The question posed -- If you’re a man reluctant to go to the doctor, what would finally convince you to go? If there’s a man in your life reluctant to go to the doctor, have you successfully convinced him to go? If so, how? Join the conversation.

Health cost moderation predated recession; holds hope for future

A new study in the New England Journal of Medicine finds that recent “curve bending” reductions in health spending growth started before the recession. Economists had suggested that the recent moderations in health costs were simply a result of the overall economic downturn and would skyrocket again as the economy picks up. But better adjusted numbers show that US health cost inflation started declining in 2003, well before the 2008/09 recession. While it decreased significantly during the recession and rebounded as expected when the recession ended, both overall and more recent cost trends are down. The 2010/11 increase in health costs post-recession was driven mainly by a large increase in hospital spending, dwarfing even the 2006 addition of prescription coverage to Medicare. Physician payment growth has been low throughout the decade, below general inflation at several points. Beyond implications for measuring true health cost trends, this finding suggests that the health care system has productively addressed skyrocketing costs, through structural changes such as generics, patent expirations, fewer blockbuster treatments, payment and delivery reforms. In the future, health care inflation may track general inflation more closely, relieving pressure on the economy, government programs, businesses and households.

CT Health Reform by the Numbers

At least 60% of CT’s newly insured under national health reform will be coming into our Medicaid program, according to expert estimates. 40,000 to 60,000 of those are currently eligible but not enrolled. Nationally Medicaid is expected to make up only one third of new coverage. Even with reform, up to 197,000 CT residents will still lack coverage. Almost half of CT residents buying coverage in the new CT Health Insurance Exchange will not get premium subsidies – they will pay the full cost of coverage, including the exchanges’s administrative costs. For more, go to CT Health Reform by the Numbers.

August web quiz – CT local health system performance

Test your knowledge about CT local health system performance. Take the August CT Health Policy Webquiz.

48% of CT Medicaid highest prescribing physicians get drug company perks

According to the CT Health I-Team, the highest prescribing doctors in CT for many medications receive large payments for speaking fees and travel from the companies that manufacture those same medications. Forty of the 108 physicians in CT’s Medicaid program with the highest psychotropic and pain medication prescribing rates get perks from the companies that make those same drugs. The analysis, covering 2008 to 2011, was triggered by a request from US Sen. Grassley to state Medicaid programs. This year marks a record in federal penalties against drug makers for improper marketing and other infractions. In September of next year drug companies will have to report all payments to providers under the Affordable Care Act, but advocates are skeptical that transparency will end the link between prescribing and marketing.

August CT Health Reform Dashboard – 13.7% progress

This month CT is again making progress toward health reform. We are now 13.7% of the way toward health reform. Unfortunately we are up only slightly from last month’s 13.2% performance. At this rate, it will take over fourteen years to fully implement reform, but January 1, 2014 is only a year and a half away. Track CT’s progress on the CT Health Reform Dashboard at www.cthealthreform.org

Seeking nominations for CT thought leaders

We are refreshing our invitation list for the CT Health Thoughtleader Survey. The survey has been cited by policymakers as a tool in evaluating our state’s progress toward reform. It is part of our CT Health Reform Dashboard. To keep the list robust and ensure a broad reach, we are seeking nominations for the survey. Who do you rely on for information on health reform in CT? Help us improve the tools for our state’s health policymakers and give us your nominations.

CT Health Intern Academy

Last week’s CT Health Intern Academy offered dozens of interns, job changers and volunteers basics and skills to navigate CT’s health care landscape. The day-long conference featured talks by Kevin Lembo (State Comptroller), Pat Baker (CT Health Foundation), Johnny Scafidi (Dwight Hall at Yale), Vicki Veltri (State Healthcare Advocate), Amy Gagliardi (CHC, Inc.), Kevin Galvin (Small Business for a Healthy CT), James Stirling (Stirling Benefits), John Clark (Comptroller’s Office), Jeff Shaw (House staff), Lynne Ide (Universal Health Care Foundation), Rev. Bonita Grubbs (Christian Community Action), Heang Tan (HealthJusticeCT), Patty McQueen (Communication Strategies), Angela Carter (New Haven Register), Hillary Waldman (former Hartford Courant health reporter), and Ellen Andrews (CTHPP). The Academy was co-sponsored by the CT Health Policy Project and Dwight Hall at Yale. For pictures, slides, speaker bio.s, resource list, glossary, and speaker answers to questions posed by student interns, go to www.cthealthintern.org.

Health Insurance Exchange Board recommends standards for benefit package

Last week, the CT Health Insurance Exchange Board voted on their recommendation for the benchmark essential health benefit (EHB) package that must be offered in 2014 by all individual and small group plans, both inside and outside the Exchange, under national health reform. Federal regulators granted states the ability to define the EHB package, within guidelines. The plan is modeled on ConnectiCare’s HMO package, with additions including coverage for prescription drugs and pediatric vision and dental care. The plan includes all state mandated benefits. Abortion coverage is included but must be paid with non-federal funds. The choice of ConnectiCare’s package was a compromise reached in two Exchange Advisory Committees in a contentious process. The plan represents the middle choice in generosity of benefits and price among the federal options. Thankfully, the Exchange Board honored the process of the two committees; advocates had been concerned that the insurance-dominated Board, that includes no independent consumer representatives, would choose a less generous option. The recommendation is now open to public comment for 30 days.

OHA saves CT consumers $2.4 million in last quarter, 99% of state employees HEP-compliant, and HUSKY/Charter Oak member forums scheduled

The Office of Health Care Advocate reported today saving consumers $2.4 million from April through last month. OHA provides assistance and support to CT consumers struggling with insurance. 85% of OHA consumer cases result in overturning insurer denials of coverage.

The Office of State Comptroller announced Tuesday that over 99% of the 53,000 state employees participating in the new Health Enhancement Program are compliant with preventive screening requirements. HEP is designed to reduce ER visits and complications of chronic illness through prevention. Early reports suggest lower ER use and reductions in other costly care. Bucking the national trend, the CT state employee plan saw no increase in cost this year.

The HUSKY and Charter Oak plans will be holding Community Meetings next month around the state to hear from members and answer questions. HUSKY and Charter Oak cover over 400,000 CT residents. The meetings will be in New Haven, Waterbury, New London, Norwich, Danbury and Bridgeport. For details, click here.

Kaiser: 10 things you didn’t know were in the ACA

Postpartum depression, privacy for nursing mothers and assisted suicide are all addressed in the ACA. Go to today’s Kaiser Health News to find seven more issues you probably missed in reading all 906 pages.

Why recessions are good for our health

Honest, more people die during economic expansions than recessions. Economists aren’t sure why but they have theories, according to a paper by the National Bureau of Economic Research. More working hours during good times may mean we don’t exercise as much and eat less healthy food. In recessions traffic and pollution are lower, possibly improving health outcomes. Another theory holds that work is stressful and consequently harms our health (but unemployment is pretty stressful too, so I’m not sure about that one). Alternatively, in good economic times it is harder to fill many health care jobs, which may compromise the quality of health care. Interesting speculation.

Exchange Navigator Committee moves into recommendations

Yesterday the CT Health Insurance Exchange Brokers, Agents, and Navigators Committee started the hard work of developing a structure and defining roles for the Navigator Program. Navigators will educate and help enroll potential individual and small business exchange, and Medicaid enrollees. Under the ACA and federal regulations, navigators must have demonstrated ability to reach those three audiences, meet licensure and conflict of interest standards (yet to be determined), and meet certification standards set by the Exchange (also yet to be determined). Staff draft recommendations include two tiers of navigators. Tier 1 Educators will focus on raising awareness of the Exchange and Medicaid options, distribute impartial information about options and enrollment, and ensure cultural competence. They would be paid on a grant/lump sum basis. Tier 2 Enrollers will focus on collecting the information needed to determine eligibility for appropriate programs, assisting in enrollment, and follow up. The committee is still discussing how to compensate Tier 2 navigators. Organizations, not individuals, will be designated as navigators and can apply for Tier 1, Tier 2 or both functions, but individuals acting as navigators will have to receive the appropriate training and certifications. The committee is still discussing how to certify SHOP navigators. The committee also discussed providing training/information opportunities for stakeholder organizations and individuals who are not interested in certifying, or being paid, as navigators but want to help in outreach and public education.

The committee also reviewed new data from Thompson Reuters commissioned for the exchange on CT’s uninsured, Medicaid and likely exchange-eligible populations to help target outreach and education efforts. Initial analysis found that current uninsured and Medicaid populations live in the same communities, and a small number of urban zip codes, particularly in Hartford and New Haven, account for a significant part of both populations. Researchers estimate that there are currently 66,000 adults and 18,000 children in CT eligible for the current Medicaid program but not enrolled. They also estimate that 205,000 adults and 11,000 children will be eligible for subsidies in the exchange. There is a lot of information on citizenship, race/ethnicity, income levels, and the proportion having difficulty speaking English.

CT gets a Medicare Accountable Care Organization

Today CMS announced 89 new approved Medicare shared savings Accountable Care Organization applicants, including MPS ACO Physicians in CT. Prior to today, CT had no approved Medicare ACOs. Other CT organizations have reportedly recently submitted ACO applications. The Medicare ACO program, created in the Affordable Care Act, is designed to improve access and coordination of care for Medicare fee-for-service members while reducing fragmentation and controlling costs. MPS will share with CMS in any savings earned by coordinating care. To share in savings, ACOs must reach quality benchmarks including patient experience of care standards.

CT Health Intern conference July 24th

Breaking into Health: Tapping into Skills and Experience, is designed for anyone interested in breaking into CT’s health landscape to gain valuable skills from health professionals working in the real world of health care and policy. The free conference will be July 24th from 10am to 4pm at the Divinity School at Yale, is co-sponsored by the CT Health Policy Project and Dwight Hall at Yale. Speakers include Comptroller Kevin Lembo as well as reporters, business people, state agency staff, foundations, health care providers, advocates, and budget analysts. Parking and lunch are free but registration is limited. For more information and to register, go to www.cthealthintern.org.

The ACA and what it means for CT consumers

While we are all celebrating the Supreme Court upholding the Affordable Care Act, consumers want to know what it means in the real world. The CT Health I-Team has a great piece answering just that question.

So now what? A guide for consumers

Now that the Supreme Court has ruled, and we’ve taken a day to celebrate, it’s time to get back to work. Kaiser has a very good explanation of what the ruling means for consumers in the real world.

Supreme Court upholds Affordable Care Act

Today the US Supreme Court affirmed almost all of the 2010 national health reform Affordable Care Act. This is a wonderful outcome for Connecticut – for the 200,000 who will now get coverage, for the $1.5 billion/year to our state to make coverage affordable for low income residents, for 26 year-olds who can stay on their parents’ policies, for the state budget which stands to gain $250 million/year, for women who won’t be charged more than men for insurance, for anyone with a pre-exisiting condition, for seniors on Medicare who will see their donut hole close, and for all of us who will benefit by controlling skyrocketing health costs.

Awaiting the Supreme Court: What Could it Mean for CT?

Policymakers and politicians, in CT and across the country, are eagerly awaiting/dreading tomorrow’s Supreme Court ruling on the Affordable Care Act. We’ve outlined a few possible scenarios and the potential impact on CT. All scenarios have an upside, and there is a way through for every possibility. No matter the decision, we are much farther along than before the ACA. Everyone is affected by rising costs, growing un/underinsurance, and lagging quality of care. And more importantly, after the ACA debates, virtually everyone understands that. A lot of important reforms happening now in CT are independent of the ACA and will likely continue. We can continue our momentum for reform. The status quo is no longer acceptable to anyone.

Courant editorial critical of Senate failure to add consumers to exchange board

Yesterday’s Hartford Courant editorial voiced disappointment that the legislature and administration could not agree to add consumer and small business voices to the CT Health Insurance Exchange Board this session. The editorial notes that a bill adding a significant number of both voices passed the House but stalled in the Senate. The editorial notes both the need for the expertise of consumers and the perception that the lack of balance will taint the Board’s work with suspicion.

June web quiz – trends in CT adults’ access to care

Test your knowledge about trends in CT adults’ access to health care. Take the June CT Health Policy Webquiz.

Thoughtleaders give CT reform a C+, again

CT thoughtleaders gave our state a C+ grade in health reform again this month in the CT Health Reform Thoughtleaders Survey. CT’s reform efforts have not varied much over the last four months, earning a C or C+ in each Thoughtleader Survey. CT also earned a C+ for effort this month, as in the past. This month patient-centered medical homes were the highest rated at a B. Engaging Consumers in Policymaking continued to lag other areas, earning only a D grade. Themes among thoughtleader suggestions to improve progress include engaging consumers and small businesses in policymaking, and fostering collaboration, cooperation and respect. The Thoughtleader Survey is part of the CT Health Policy Project’s Health Reform Dashboard project at www.cthealthreform.org

Entertaining, imaginary Socratic dialogue on the individual mandate

I know we are all spending way too much time thinking about the impending ACA Supreme Court decision, but for a lighter perspective read a column in yesterday’s National Law Journal. A mythical professor harasses a passer by about the individual mandate, hippos, broccoli and seat belts.

RWJ provides support for HEP evaluation

The State Comptroller announced today that the Robert Wood Johnson Foundation has agreed to fund an evaluation of CT’s new state employee Health Enhancement Program. The two year study will be conducted by the University of Michigan’s Center for Value-Based Insurance Design. It is hoped the study will identify more opportunities to build value and provide savings.

Only State Health Care Advocate gets a vote on the health insurance exchange

Budget implementer legislation passed late yesterday included only a provision to give the State Health Care Advocate a vote on the CT Health Insurance Exchange Board. The bill did not add any independent consumer or small business members. While the Health Care Advocate is a respected and valued member, she serves at the pleasure of the Governor. Consumers will still have no independent voice on a board dominated by insurance interests and charged with deciding what health insurance options will be available on the Exchange. Furthermore, without real consumer membership, the Exchange Board does not comply with federal regulations. Despite legislation passed last year prohibiting any Board member affiliated with the insurance industry, three current members have only insurance experience. The vote is particularly disappointing in light of the unanimous and bipartisan approval by the House in the regular legislative session of a bill that would have added two new consumer members, as well as two small business representatives. It is hard to understand why the inclusion of consumers and small business members continues to be such a problem given the broad support among rank and file lawmakers. Ellen Andrews

What is at stake for CT in Supreme Court decision?

A great Health Affairs blog by Sonya Schwartz, of the National Academy for State Health Policy, outlines the likely impact on active states, like CT, of various Supreme Court ACA scenarios. She uses a Richter Scale of impact from 2.0 if the entire ACA is upheld to 8.0 if the entire law is invalidated. It is one of the more readable, but substantive, analyses I’ve seen.

Medicaid Council meeting update

Friday’s Medicaid Assistance Program Oversight Council meeting was very productive and mainly positive. The main area of discussion was DSS’ implementation of new asset limits required by budget negotiations (bad news) and new spend down tracking processes (good news). This August the enrollment brokers (Xerox, formerly ACS) will handle tracking and evaluation of medical bills as well as information and support for people “spending down” to Medicaid eligibility. This has been a significant barrier to coverage for up to 17,000 people at any time. The new process will move time-consuming documentation to ACS and to electronic formats, providing welcome relief for both frustrated consumers and overwhelmed DSS workers. In bad news, as an outgrowth of negotiated budget cuts, DSS is applying to CMS for a waiver to the LIA program (formerly SAGA) to institute a $10,000 asset test (exempting a home and one car), permission to count parental income and assets for applicants under age 26 who live with parents or are claimed as dependents, and to establish a 90 day limit on nursing home coverage. Spending down to LIA coverage will not be necessary in January 2014 under national health reform. DSS expects that many or most of those with assets will be able to transition to Charter Oak coverage for the interim, which their assets should cover. DSS will also assist anyone needing more than 90 days of nursing home care to apply for disability or other Medicaid coverage. In other news, DSS responded to comments on their dual eligible application and “reserved” the requirement for a behavioral health co-lead in each neighborhood to allow further study and agreed to include incentives in all three years of the pilot for health neighborhoods that improve performance and outcomes, less than if they also achieve savings, but something. DSS also outlined ConnectCT, their plans to improve application, web, customer service and document management/workflow processes. Long overdue and very exciting; hoping for more meetings like this.

HHS awards HealthyCT $75.8 million loan to develop new statewide nonprofit insurer

Today HHS announced approval of HealthyCT’s CO-OP application to develop a new non-profit insurance company for CT consumers. The federal $75.8 million loan is meant to cover start up costs and reserve funds for the new insurer. The CO-OP opportunity (Consumer Operated and Oriented Plan)was created in the national health reform Affordable Care Act, to foster more competitive markets and develop non-profit, consumer-driven insurance options. The HealthyCT model and application focus on improving the quality, coordination and continuity of care for the citizens of Connecticut, primarily in the individual and small group markets. HealthyCT plans to offer high-quality, coordinated medical care with strong physician-patient relationships at its foundation and encourage the use of patient-centered medical homes. HealthyCT was sponsored by two CT physician organizations – the CT State Medical Society and the CSMS IPA, but will be open to providers willing to work with HealthyCT and meet established criteria. As a non-profit health insurer, any surplus funds will go back into the plan to help keep premiums stable and improve the quality of care.

Twelve CT hospitals rate just a “C” on patient safety

Over 400 people die every day in a US hospital due to a preventable error, according to the Hospital Safety Score website. The site gives twelve CT hospitals a “C” or average rating on patient safety including Waterbury, Stamford, Bridgeport, Charlotte Hungerford, New Milford, St. Mary’s, Milford, Yale-New Haven, Backus, Manchester Memorial, and John Dempsey Hospitals. Just one more, thirteen, earned a “B” rating – Day Kimball, Sharon, Lawrence & Memorial, Johnson Memorial, MidState, Middlesex, Windham, Hartford, Bristol, Griffin, Danbury, Norwalk, and the Hospital of Central CT. Only four received “A”s – St. Raphael’s, St. Francis, Greenwich, and St. Vincent’s Hospitals. The scores are based on 26 nationally recognized measures of hospital safety including pressure ulcers, falls and trauma, hand hygiene, and medication reconciliation. The website, sponsored by the Leapfrog Group, a national leader in improving the value and safety of American health care, serves as a tool for consumers choosing a hospital and guarding their health as an inpatient.

CT hospital info scarce on new rating site

The Leapfrog Group, a national leader in improving the quality and value of health care, has released a new web tool comparing hospitals on patient safety performance. Unfortunately, only two CT hospitals responded to the Leapfrog survey – Sharon and Backus Hospitals. Both did very well in two areas including managing serious errors; both needed work in other areas. But we commend their willingness to measure and improve quality, and to trust the public with the information. Non-responding CT hospitals included Bridgeport, Danbury, Greenwich, Griffin, Midstate, Milford, New Milford, Norwalk, St. Mary’s, St. Raphael’s, St. Vincent’s, Stamford, Charlotte Hungerford, Waterbury, and Yale New Haven.

AG will not block YNHH-St. Raph’s purchase

The CT Attorney General’s office has concluded their analysis of anti-trust implications of Yale-New Haven Hospital’s proposal to purchase The Hospital of St. Raphael and will not seek to block the sale. The sale would leave New Haven with only one hospital raising concerns about higher prices for services, less care and higher medical debt for uninsured and underinsured patients, lower access to care for all patients, and less responsiveness to community needs. The AG’s office coordinated their investigation with the Federal Trade Commission, which must also approve the sale. Responding to a request from the AG’s office, YNHH has agreed to “maintain current levels of charitable healthcare and financial assistance and provide the same level of service and assistance to patients receiving care on the St. Raphael’s campus.”

CEPAC meeting focuses on ADHD treatments

The spring CEPAC meeting last Friday at the University of New Hampshire was a deep dive into research comparing treatments for Attention Deficit Hyperactivity Disorder (ADHD). 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. Diagnoses of ADHD have risen significantly in recent years affecting at least 5 million US children between the ages of 4 and 17. Boys are more likely to be diagnosed and children from lower income families are nearly twice as likely to be diagnosed. The condition has been linked to worse outcomes in social functioning, academic performance, adolescent substance abuse, and delinquent behavior. It is estimated that ADHD costs the US economy over $30 billion/year. Treatments include stimulant and non-stimulant medications, and behavioral training including parent behavior training, school-based interventions, and other forms of therapy. There are not enough rigorous clinical trials comparing each intervention to placebo, partly for ethical reasons that few are willing to relegate some families to no intervention at all. Given that, by the end of the there was a consensus among CEPAC members that Parent Behavior Training (PBT) is the preferred approach for preschoolers, resorting to medications only if PBT is not available or doesn’t work, in concordance with the professional societies. There was some question about adequate access to PBT in some areas of New England. For school-age children, there was consensus that medications work. I was surprised that side effects and long term impacts are not as common as generally thought, but still significant and many children discontinue drugs because of them. The next meeting will be in December and may be in CT.

CT Health Reform Dashboard – CT up to 13.8%

CT has jumped ahead in progress in health reform to 13.8% of the tasks completed, according to the June CT Health Reform Dashboard. This is up from 12.1% last month. While we are closing in on the major January 1, 2014 deadline for many reforms, much remains to be done. At this rate, it will take 4.2 years to achieve reform – down from 5.6 years last month. The dashboard can be found at www.cthealthreform.org.