April CT Health Reform Dashboard -- 10.8% progress to date

This month again CT is making progress toward health reform. This month we are 10.8% of the way toward health reform. Unfortunately we are only up from 10.7% last month. At this rate, it will take 48 years to fully implement reform. Track CT’s progress on the CT Health Reform Dashboard at www.cthealthreform.org

Exchange advisory committees begin work

Last week the four CT Health Insurance Exchange advisory committees held their first meeting jointly. The meeting included a very good presentation on the basics of the exchange and a list of the decision points for each committee. The next advisory committee meetings, all public and all tentatively in Room 310 of the Capitol, will be:

Consumer Experience and Outreach
April 10th 9 to 11am

Brokers, Agents and Navigators
April 10th 12:30 to 2:30pm

Health Plan Benefits and Qualifications
April 11th 9 to 11am

Small Business Health Plan Options Program (SHOP)
TBD

Experience to inform health insurance exchange outreach

CT has a long and varied history of outreach programs; some worked very well and some were less successful. There is a great deal of experience available to the CT Health Insurance Exchange and their consultants to design a robust program that meets the needs of individuals and small businesses likely to enroll. As individuals will be required under federal law to purchase coverage, and 140,000 state residents will have to buy it on the exchange to access subsidies, it is vital that we learn from experience and not repeat mistakes. We’ve collected some of that experience in a new brief. We offer this experience to the Exchange to help ensure a viable, trusted Exchange is developed that makes serving its customers their first priority.

HIT privacy bill heard in Public Health Committee

An important bill, SB 368, had a public hearing Friday in the Public Health Committee. The bill would require HITE CT, our state’s developing health information exchange, to get patient consent before sharing any medical records on the exchange. Termed opt-in, this privacy policy has been adopted by all our surrounding states and is working successfully to facilitate patient-centered care. In those states, more than nine out of ten patients agree to share their information. Vermont recently switched from an opt-out policy to opt-in. ,. HITE-CT’s Board members adopted a controversial opt-out privacy policy in a contentious vote. The opt-out policy, where all information is shared by default unless the patient exercises an as-yet-undeveloped process to decline, would require every provider to “segment” or tag all information in every file that relates to ten sensitive conditions, such as HIV and behavioral health, and accept liability for getting that right. HITE CT’s own evaluation study recently found public opinion in CT supporting opt-in over opt-out. The Public Health committee heard from consumers, advocates and providers who support the patient-centered opt-in policy.

Insurance Exchange meeting allows limited public comment

Partially responding to widespread calls to respect consumer voices, the CT Health Insurance Exchange Board allowed 12 minutes of public comment at the beginning of today’s meeting. Speakers were limited to two minutes each – there was only time for five. They heard from a struggling consumer, a small business owner, advocates and a representative of the faith community that, while we are grateful for this effort, the process needs to be far more open. Several Board members seemed moved by the testimony and understood that they are missing important perspectives critical if the exchange is going to work. The Board is currently hiring senior staff, developing a budget, beginning to develop a mission statement and guiding principles, and choosing an administrator for the exchange, all without voting consumer input. Mintz and Hoke, the advertising agency hired for consumer input, was criticized by speakers and Board members for soliciting limited input and not reaching out to CT’s well-organized consumer advocacy networks. Their scope is limited to message-testing for the eventual exchange products, not listening to customers about how those products should be designed to meet the demands of the market. They emphasized mass media, which has not historically been successful in outreach in CT, social media and texting. While texting and social media are commonly used between young invincibles in personal communications, it is unclear whether they are effective vehicles to sell health insurance. They are still researching other states’ consumer research efforts and populations eligible for the exchange; unfortunately, it is unclear if there is time for a learning curve. The speaker helping the Board with governance put consumers at the end of the chain of stakeholders (never mentioned small businesses) and equated consumers with providers and health plans in importance. It was clear that Board members have not seen consulting contracts, RFPs or other solicitations before they are finalized. The administrative RFP will be “fast tracked” concerning many consumers and small businesses. Mike Devine, the only small business owner on the Board, asked whether KPMG, hired for business operations, had investigated overlap with other agencies in CT, and other states. There is likely a great deal of overlap with other states, particularly the New England collaborative, and federal and very well-resourced privately funded programs that are developing innovative enrollment, operations and outreach programs. After an hour and a half of public meeting, the Board went into secret executive session for an hour and twenty minutes. After which they reconvened for less than a minute to adjourn, without voting or reporting on what was discussed in executive session.
Ellen Andrews

Dual eligible payment reform update

Advocates have raised concerns about DSS’ plans to re-engineer CT’s Medicaid pilot program for dual eligibles, people eligible for both Medicare and Medicaid. Last year HHS granted CT $1 million to plan this initiative. DSS intends to assign consumers to “health neighborhoods” – contractual networks of providers to cover the care continuum that will coordinate care, prevent problems and help patients manage their own health. Providers in the neighborhood may include hospitals, home health agencies, primary care and specialty providers, nursing homes, behavioral health providers, hospice, and pharmacists. Patients can access care outside the neighborhood. While DSS has abandoned plans to create ACO-like, risk-bearing entities, they intend to share savings with the neighborhood. Under shared savings, DSS will determine what each neighborhood’s patients would have cost the state without the extra services; we have no details on how they will make that determination. If patients in a neighborhood’s panel cost less than expected, DSS intends to share some portion of those savings with the neighborhood, as long as they meet certain quality standards (that have yet to be decided). Half the savings will be shared with the federal government who is paying half the costs of care. While this gives providers a financial reward for reducing inappropriate care, it may also reward denials of needed care and/or cherry picking patients into the program that they are likely to make money on. As patients are unlikely to know the subtle differences between various federal and state programs, they are most likely to ask their provider (in the neighborhood) which program is best for them. DSS is also considering whether to allow patients to choose if they want to participate (opt-in) or if DSS will just auto-assign them and possibly allow them to opt-out. Advocates support an opt-in, patient-centered approach and are proposing that DSS pool savings across neighborhoods and apportion them based only on quality measures. If there are no savings, providers receive no incentives. In addition to incentives to deny care and cherry pick, DSS’ proposal could end up costing the state more if the program does not save money overall but one or more neighborhoods show savings. Those neighborhoods would qualify for rewards from the program. Those reward payments would not be matched by the feds. Advocates also raised concerns about the fate of safety net providers within the neighborhoods. They could be placed in the position of investing in care coordination and prevention, and being at the mercy of larger institutional providers to get reimbursed. This same problem occurred under capitated HMOs in HUSKY. Another problem with the plan is that DSS expects the neighborhood to invest in care coordination and other services upfront relying on possible rewards much later. It is unclear how many providers in CT have the resources to make such upfront investments. Many are concerned that it will take years before there are any savings and that costs may increase in the short term to pay for enhanced primary and preventive care. Planning groups are being asked to make these decisions without any data. The entire system requires a great deal of trust in DSS. The full committee considering the program design is meeting Friday at 9:30 in Room 1A of the LOB.

CT gets a C for health reform

In a new survey, Connecticut health care thought leaders give our state a C on health reform. The state received no A’s. Connecticut received a slightly better grade, C+, for effort. Connecticut’s Medicaid efforts are a bright spot, earning a B. The worst grade was for Engaging Consumers in Policymaking, averaging a D rating. A significant number of responders answered Don’t Know on one or more issue areas, echoing calls for better communication and coordination in health policymaking. Asked for suggestions to improve Connecticut’s progress toward reform, several themes emerged including engaging consumers in policymaking, limiting the influence of special interests, expanding the health care workforce, and improving policy coordination, focus and leadership. Click here for more detail on the survey. The survey is part of the CT Health Reform Dashboard, tracking our state’s progress toward health reform.

DSS medication clients’ information released in error

In supporting information regarding a bill, DSS sent OPM information on up to 8,500 clients who receive medications from DSS. The information, with client numbers but no names or Social Security numbers, was then sent to legislators, legislative staff, and organizations involved in administering medications to DSS clients. The client numbers should not have been shared with OPM and DSS is investigating whether this constitutes a breach of HIPAA; currently it is labeled an unauthorized disclosure of information. DSS and OPM issued a statement about the error and are working with the Attorney General’s office. They have notified recipients of the information and are working with them to discard the data. The bill in question would allow unlicensed home health aides, under a nursing supervisor, to administer medications to people in state home health programs. This latest release of sensitive patient information highlights the need for strong privacy and security protections for medical records. For a list of breaches of sensitive information reported to the federal government affecting over 500 people, click here.

CT Health Reform Dashboard -- 10.7% progress to date

The good news is that CT is making progress. This month we are 10.7% of the way toward health reform. The bad news is that we are up from 10.4% last month. Track CT’s progress on the CT Health Reform Dashboard at www.cthealthreform.org

March web quiz – CT health risk factors

Test your knowledge of CT’s health risk factors. Take the March CT Health Policy Webquiz.

Free dental clinic announces 2012 date

The CT Mission of Mercy will be holding their annual free dental clinic for uninsured state residents later this month March 23 and 24 at the O’Neil Center, Western CT State University, West Side Campus, 43 Lake Avenue Ext., Danbury. At last year’s clinic 1,683 volunteers provided $1.2 million of free care to 1,852 people from 186 towns.