CT small businesses struggle with health benefits

A new survey by the Universal Health Care Foundation of CT found that two out of three CT small businesses can’t afford to offer health benefits to employees. A tiny fraction (6%) of small business owners who don’t offer coverage, don’t want to. Among those that offer health benefits, most have had to shift more costs onto workers. 41% say their inability to offer health benefits is limiting their growth, a majority believes that it impacts their ability to recruit and retain workers, and 28% believe this disadvantages them compared to larger companies. 60% say government should offer an alternative to private insurance. The report delves deeply into the types of coverage offered by CT small businesses and attitudes toward employee benefits. Most are unaware of federal small business tax credits for coverage. Eighty percent of CT workers are employed by small businesses.

Collaboration and transparency key to MD's insurance exchange success

Maryland is widely recognized as a leader in implementing national health reforms, particularly developing their state health insurance exchange well ahead of other states. Health insurance exchanges were created under national health reform as an understandable, fair marketplace for consumers and small businesses to understand and purchase health plans that provide value for the price; federal premium subsidies to make insurance affordable for individuals are only available in the exchanges. In a state visit this week, executive agencies, legislative branch and advocates all agreed that Maryland’s public and inclusive process was key to their success. Maryland passed enabling legislation, created their governance structure, and engaged six inclusive advisory committees last year. As one policymaker said, “It’s not possible that we missed anyone.” Through a transparent, comprehensive process with expert consultant support, those committees and the Board developed a strong set of operating policies that position the state to have a strong, effective exchange in place to help Maryland residents choose the best health plan for their needs by 2014. Using the same inclusive, transparent process, they are moving forward with decision-making and operationalizing those policies. Stakeholders credit soliciting public input often, engaging broad and diverse membership on committees, good communications, and transparent policymaking for their success. Legislation creating the Board excluded members with conflicting interests, creating an expert group with credibility, allowing the state to avoid problems Connecticut has encountered. Stakeholders also credit the decision to create a quasi-public entity with has critical to success. The new entity, outside government, provided public accountability and a fair process but also allowed faster procurement of expert consulting and facilitation services from diverse sources. To keep momentum going and recognizing the huge number of tasks, policymakers decided to make decisions in steps. Early on they finalized decisions in policy areas that achieved consensus, and put off more contentious debates for later such as whether to negotiate with plans to qualify for the exchange or approve any that meet standards. The financing model for the exchange’s administrative functions also remains to be worked out. Maryland is now deciding how to hire, train and certify navigators, to inform the public and assist consumers and small businesses in making the best purchasing decisions.

Bill to increase consumers on insurance exchange board passes House

Yesterday the House unanimously passed a much improved version of HB 5013. The amendment added another consumer and another small business representative to the Board, in addition to the one each in the original bill raised by the Insurance Committee. Also different from the committee version, the bill gives Republicans a voice in nominating the new members. (The only small business person on the current Board was appointed by Rep. Cafero, ranking Republican in the House. There are no voting consumer representatives and three from the insurance industry.) The bill also gives the State Health Care Advocate a vote. Advocates for consumers and small businesses had been calling for this version, adding enough consumer and small businesses representatives to make a difference. Unfortunately, the current Board at its last meeting already made their critical decision about hiring a CEO without a consumer vote. The Governor is now choosing the CEO from among the three names given him by the current Board.

Insurance exchange committee updates

The first meetings of the four CT health insurance exchange advisory committees were largely uneventful and had a lot in common. They were mainly led by consultants, lacked diversity, emphasized principles (already drafted by the consultants), timelines and goals. In three committees, access to outside information was limited and discouraged. In contrast, the Consumer committee appears to be developing a formal process to collect it. In every committee, the consultants emphasized the need to be cost conscious. The Qualified Health Plan committee did not address a very important policy decision, whether the exchange will be an active purchaser of health plans – negotiating on behalf of members as one large entity for better prices and to enhance quality. The Massachusetts connector is an active purchaser and has kept price increase well below the level of plans in the rest of the market. The Navigator committee spent most of its time talking about the role of brokers, agents and other stakeholders, navigator training and certification, and the need for good research on the exchange’s consumers. The latest federal regulations preclude brokers who are paid by insurance companies to sell their products from being paid as navigators inside the exchange. The Consumer committee talked about the Basic Health Program Option and making sure plans are affordable for consumers. Advocates at that meeting also pushed back at consultants’ suggestion that cost cutting had to come at the expense of outreach – using existing resources. (They acknowledged that outreach is often the first to be cut, with an expectation that nonprofits and community groups will do the work within their available resources.) At the Small Business committee the consultants announced that they expect to go out to bid for plans in that exchange later this summer.

Insurance exchange meeting update

The CT Health Insurance Exchange Board chose their three CEO candidates to send on to the Governor at last week’s meeting. The decision was made without a voting consumer representative and after another hour-long closed-door meeting. Names of the three chosen were not released; hopefully they do not have close ties to the insurance industry. A bill to add one consumer and one small business representative is making its way slowly through the General Assembly. In an interesting irony, the Board has determined that the general perception of CT stakeholders is that they have not accomplished much. Rather than consider whether the crowd is wise and improve performance, they have chosen to engage their communications consultants to fix their image with a media campaign including postcards, emails, webinars, and a website. Thankfully they have heard from CMS about the need to keep costs under some control and are looking to coordinate with state agencies, especially DSS, and with the federally funded New England IT exchange collaboration. RI, the first state to receive Level 2 exchange funding, did not receive their full request as CMS asked them to reuse available resources. CT’s exchange is reportedly also seeking to borrow a large sum from the General Fund until more federal money is granted and plan to hire nine more staff. The Board was asked to trust their leader and staff and authorize the exchange to enter into an undisclosed $3 million contract. Board member requests for information on the contract, the services to be delivered, the contractor, or the process used to choose them were denied. In good news, they will be engaging a research consultant to develop a better analysis of who likely exchange customers are, where they live, etc.

Donaghue Conference: Assessing Risk

This year’s Donaghue Conference, Evaluating Risk: How Perception Affects our Health, is Thursday, May 3rd, from 7:30am - 12:30pm at the Hartford Marriott Farmington, 15 Farm Springs Road in Farmington. Speakers will cover the factors that account for how we evaluate risk and how this influences public health communications and priorities and our own responses and actions. Speakers will also discuss how the understanding of risk and risk perception enters into practitioner/patient discussions about prevention and medical treatment decisions. Donaghue conferences are always thought provoking, fostering innovation in health and policymaking. As in years’ past the conference is free but registration is required.

Medicaid Council hears payment reform plan for duals

On Friday, the Medical Assistance Program Oversight Council heard DSS’ plans for a shared savings payment model for people eligible for both Medicaid and Medicare. The Council also heard feedback and recommendations from the Council’s model design subcommittee. The plan is to create 3 to 5 local Health Neighborhoods (HNs) in CT to provide comprehensive, patient-centered care emphasizing coordination, prevention and self-management. HNs are envisioned as local systems of care, collaboratives of providers across the spectrum including hospitals, physicians, behavioral health providers, long term care providers, home health agencies and pharmacists coordinating care on behalf of patients assigned to them. HNs would be paid in a dizzying number of ways including traditional fee-for-service, upfront payments, two levels of per-member-per-month care management payments, and a controversial proposal to share any savings with the state. DSS is also proposing to withhold some portion of one per-member-per-month payment, pool it with any savings, and return them to HNs based on performance on both quality and cost reduction. Responding to provider concerns, the Subcommittee did not agree with the withhold of care management payments which could undermine incentives to invest in care management. Responding to advocate concern that DSS’s shared savings proposal may provide incentives to deny needed care, the Subcommittee recommended an alternative -- to distribute savings to HNs in aggregate, not based on individual HN savings, for the first year and that distributions from the pool are based solely on quality standards. The Subcommittee was split on DSS’ plans to enroll consumers in HNs based on where they get care and allow them only an opportunity to opt-out. Advocates strongly urged DSS to adopt a patient-centered opt-in enrollment system, ensuring people fully understand their rights. Advocates also raised concerns about how HN lead agencies will be chosen and regulated, to ensure that resources “trickle down” to the providers actually providing and coordinating care and are not used to fill a hole in any institution’s budget, make up Medicaid underpayments, and/or losses due to care coordination. Advocates also urged DSS to require care plans for every patient, not just those identified as high risk or high utilizers of care, and require patient signatures to ensure that patients are involved and agree. Advocates also raised concerns about extra services only available to consumers who enter HNs, including chronic illness self-management education, nutrition counseling, fall prevention and medication therapy management. Advocates believe these important and cost saving services should be available to all patients. A 30-day public comment period on the proposal will begin later this month. DSS expects to submit their proposal to CMS in May.

For background, click here to learn more about Medicare’s payment reform plans to link quality and savings.

Connecticut moves up to a C+ on health reform

This month Connecticut health care thought leaders give our state a C+ on health reform, up from a C in the March survey. Connecticut again received a slightly better grade, B-/C+, for effort. Medicaid is again the bright spot, earning a B. Health Insurance Market Reform and Data-based Policymaking joined Engaging Consumers in Policymaking in earning D grades. Forty percent more respondents answered Don’t Know on one or more issue areas this month, emphasizing the need for better communication and coordination in health policymaking. Asked for suggestions to improve Connecticut’s progress toward reform, several themes emerged including engage consumers in policymaking, smarter policymaking, urgency -- move more quickly and implement a public option through the SustiNet plan. For more on how CT is progressing toward reform, visit the CT Health Reform Dashboard.

HIT privacy bill watered significantly down

Last week the Public Health Committee made significant changes to SB 368, originally designed to protect consumers’ private health information. The bill would have required 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. The alternative opt-out policy, supported by HITE CT, puts every consumers’ information into the system unless they exercise an option through an as-yet-undefined, but deeply underfunded process. Advocates testified in favor but large physician organizations and AARP opposed the bill. The substitute language adopted by the committee adds to HITE CT’s annual report information on how they will inform patients about how their medical information will be used and shared.

April web quiz – Alzheimer’s disease in CT

Test your knowledge of Alzheimer’s disease in CT. Take the April CT Health Policy Webquiz.

No increase in state employee health plan costs

The State Comptroller announced Thursday that premiums for the state employees’ medical, pharmacy and dental plans will not increase next fiscal year. Nationally employer health costs are expected to increase by five to six percent. The Comptroller credits the patient-centered medical home and Health Enhancement Program initiatives, lower emergency room visit rates, greater use of primary care, and pharmacy initiatives.