HITE CT considering scaling back to secure messaging, easing privacy concerns

CT’s quasi-public entity charged with building a health information exchange for the state is considering scaling back from an overly ambitious agenda to focus on more feasible goals. At HITE-CT’s May meeting, the Board discussed focusing on secure messaging for now. As secure messaging essentially replaces the current FAXes of health information shared between individual providers engaged in a patient’s care, it does not carry the same concerns about privacy and security as the original plan. The discussion was prompted by questions raised by DSS and the federal Office of National Coordinator. HITE CT is currently funded through a federal ONC grant and is interested in securing Medicaid funds to continue operation. The scaled back agenda may include a provider directory (important to hospitals), public health reporting (important to DPH), and/or continuation of the current pilot preparations.

Comments on dual eligible proposal center on behavioral health co-lead

Comments at Friday’s Complex Care Committee meeting focused on the late addition of requiring a behavioral health co-lead to DSS’s proposal to manage care for CT’s dual eligible. The pilot proposal would create five health neighborhoods, a collection of local providers across the care continuum, working as a team to coordinate care for about 5,000 people eligible for both Medicare and Medicaid. DSS and several multi-stakeholder committees have been working on the proposal for about a year. Until a few weeks ago, the plan was for the neighborhood to be administratively headed by a single local lead organization that would assemble the providers in the neighborhood, have content expertise in patient-centered care, etc., financial solvency, and would submit the application to DSS. However, very recently, DSS and DMHAS added a requirement that there be two co-leads – one medical and one for behavioral health. The concern was that 38% of dual eligible have serious mental illness and that their needs might not be addressed in a neighborhood headed by a medical lead. Both advocates and providers voiced concerns about the new proposal. The largest concerns include the lateness of the addition and inadequate time to integrate it into the larger, very complex plan. The law of unintended consequences is strong. Other concerns include reducing the number of applicants and available choices for the state and for consumers, anti-competitiveness, troubling involvement of state agencies in the competition and shared savings, a multitude of operational and financial questions, and that this may open the door to other co-leads. Many feel that it is not necessary, or even helpful, to designate a behavioral health co-lead to ensure that the 38% of patients with serious mental illness get the care they need and that medical and behavioral health are integrated. Creating co-leads undermines the foundational concept of a neighborhood of care. Despite the still-open comment period and concerns voiced from the beginning, DSS responded at Friday’s meeting that they intend to submit the application with the behavioral health co-lead. They only solicited comment on how to do it. It is unfortunate that this last-minute surprise addition has undermined what has been a collaborative process largely resulting in a consensus proposal. While there is much agreement on the rest of the proposal, other areas of concern include how savings will be shared across and between neighborhoods, how improved quality will be rewarded, how voluntary enrollment will be, care plans for every neighborhood consumer, conflicts of interest in co-leads also providing services, the need for robust evaluation and monitoring, and fairness in available services. The opportunity for public comments closed Friday. DSS plans to submit the plan to CMS very soon.

CT Health Insurance Exchange unknown in CT

The most important job of the CT Health Insurance Exchange is educating the public and gaining their trust. Read Kevin Galvin’s blog post at www.ctexchangewatch.org to see just how big that challenge is.

Insurance Exchange Board meeting notes

The CT Health Insurance Exchange Board met last week – not much happened. Small business owner, Kevin Galvin, and a consumer who has struggled with health care and insurance access gave very moving public comment to start the meeting. There were lots of updates but no actual substantive information. The committee reports were interesting – somewhat different than reports from advocates who attended them. There was an acknowledgement from the SHOP committee that they need to engage small business owners on the committee; they are going to work on that. They also recognize that the measure of their success should be whether more CT small businesses offer benefits rather than enrollment in the SHOP exchange. MA found that while small business enrollment in their Connector has lagged, more small businesses are finding affordable, decent coverage options and offering benefits to their employees. The SHOP exchange could serve as a competitive catalyst to improve offerings in the entire market. There was discussion about having CBIA run the SHOP exchange as well. The Qualified Health Plan Committee is struggling with defining the essential health benefit package and whether to include all the state mandates. There was discussion about the health benefits offered to employees of the exchange; Board members felt strongly that, as soon as the exchange is operational, employees should get their health benefits there, as will members of Congress. Mintz & Hoke continues their efforts to solicit the best ways to sell the exchange to consumers and small business. They are not collecting input for the exchange to use in designing their system but were asked for the feedback they have gotten so far. Their answers were 1) consumers are confused and uncertain, 2) benefit choices must be kept simple, choosing insurance is intimidating, and 3) they are targeting two populations – families (with mainly women making health decisions) and young invincibles. Upon questioning, they agreed with Vicki Veltri’s experience, matching ours, that the most salient fact about consumers is that they are very distrustful of both insurance and of government. The Exchange crosses both issue areas.

CT drops back to a C on health reform

This month Connecticut health care thought leaders gave our state a C on health reform, erasing the C+ bump in last month’s survey. Connecticut also earned a C for effort. Patient-centered medical homes join Medicaid as the bright spots, earning a B and C+, respectively. Medicaid is the only area that received any A grades from thoughtleaders. Educating the Public earned the worst grade – a C/D, closely followed by Public Education and Health Insurance Market Reform. Suggestions to improve Connecticut’s progress echoed last month’s themes -- engaging consumers and small businesses in policymaking, smarter policymaking, urgency, and a call for collaboration. For more, go to the CT Health Reform Dashboard at www.cthealthreform.org.

Fascinating presentation at Health Care Cabinet

Today’s Cabinet meeting featured a presentation by Capitol District Physicians Health Plan, an Albany-based, nonprofit, physician-led health plan, that is succeeding in the triple goals of reducing costs, improving quality of care and addressing population health. Their CEO, a cardiologist, and VP of Underwriting described the innovations that led to their success including patient-centered medical homes, partial capitation for primary care providers (including risk adjustment and increased fees in the calculations), wellness programs, investments in technology, and worksite population health programs. They have integrated care management, data analysis and population health into the practices they support with additional staff at the practice site. The keys to their success seem to be significant sophistication in health policy/data, physician leadership and the connection with employers. CT could learn a lot from them. Hopefully future Cabinet meetings will include more presentations like this one.

Medicare/Medicaid dual eligible reform plan update

On Friday, the Medicaid Council passed the recommendations of the Complex Care Subcommittee on DSS’s application for an integrated care demonstration program for people eligible for both Medicaid and Medicare. The committee recommended that the Council endorse DSS’ application with the condition that providers be rewarded based on performance on quality measures; the amount they receive may be reduced if they do not also produce savings for their enrollees by an amount or percentage to be determined. The rewards are in addition DSS opposed the recommendation arguing that rewarding only providers who both generate savings and reach performance standards is the best way to ensure the program generates savings. The recommendation passed unanimously with two abstentions. Public comments on the application are being accepted until May 24th.

Exchange fix bill dies in Senate

The bill to bring the CT Health Insurance Exchange into compliance with federal regulations died on the Senate calendar last night as the session ended. The bill would have added two consumer and two small business representatives to the Board’s membership and given the State Health Care Advocate a vote. Currently there are no voting members representing consumers and three Board members have insurance industry backgrounds. The bill passed two committees and passed the House unanimously but was never called in the Senate. The administration has defended their appointments and the composition of the current Board. Board members are appointed by the Governor and legislative leadership. Thankfully one current member, appointed by House Republicans, is a small business owner.

CT Health Reform Dashboard – CT up to 12.1%

CT has jumped ahead in progress in health reform to 12.1% of the tasks completed, according to the May CT Health Reform Dashboard. This is up from 10.8% 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 5.6 years to achieve reform. The dashboard can be found at www.cthealthreform.org.

Risk is all about perception, and that shapes health decisions

Making good decisions, about our health and everything else, revolves around perceptions of risk, according to speakers at yesterday’s annual Donaghue Foundation conference. David Ropeik, author of How Risky Is It Really? Why Our Fears Don’t Always Match the Facts, and Brian Zikmund-Fisher, Professor of Health Behavior and Health Education at the University of Michigan, delivered a great deal of evidence that our perceptions of risk are not necessarily tied to the realities. How risk is communicated can be as important as the numbers. Thankfully, the science of how to convey risk information in a useful and meaningful way is constantly improving. Fascinating conference, yet again, leaving us with lots to think about and use in our work.

May web quiz – Medicaid eligible CT residents under national reform

Test your knowledge about the CT residents who will become eligible for Medicaid in 2014 under national health reform. Take the May CT Health Policy Webquiz.