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