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.