Exchange Board approves Essential Health Benefits standard – false choice between benefits and cost

Yesterday the CT Health Insurance Exchange Board approved CT’s version of the Essential Health Benefit (EHB) package under the Affordable Care Act (ACA). As of January 1, 2014 individual and small group plans will have to cover at least the EHB services. The ACA required that the EHB include at least ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse care, prescriptions, rehab and habilitation services, lab services, preventive and wellness care including chronic disease management, and pediatric care including vision and dental care. States have several plan EHB options including large commercial plans, federal and state employee plans. After long, contentious deliberations, two exchange committees of experts and stakeholders agreed on a moderate, compromise choice based on ConnectiCare’s HMO plan that includes all state mandates. The committees recommended that compromise to the Exchange Board. While the Board eventually approved the committees’ recommendation, there was a great deal of discussion about reducing the “richness” of the plan in the interest of “affordability”. Board members noted that the recommended plan is “richer” than what is offered now in CT. They failed to note that one of the main points of reform was to improve the “value” of health insurance so it truly covers what people need. If what is available now was sufficient, we wouldn’t have needed reform. The Board wants the legislature to “revisit” legislatively mandated benefits next year, eliciting groans from lobbyist and advocate observers in the room. Unfortunately there was no meaningful discussion about the potential for ongoing payment and delivery innovations successful in many other states, to provide flexibility that improve quality, access, patient satisfaction while controlling costs. The Board includes no independent consumer advocates and several insurance industry representatives. Consequently the Board is locked in the narrow false choice between mandated benefits and affordable premiums. That very old, very simplistic dialogue only spirals downward into worse care and upward into skyrocketing costs. The Board is missing a massive opportunity to learn from innovators and truly reform CT’s health care landscape.

Join us for Consumer Conversations: the CT Health Insurance Exchange

January 1, 2014 every CT resident will be required to secure health coverage. The CT Health Insurance Exchange is being developed under the Affordable Care Act to be a fair, user-friendly marketplace for consumers and small businesses to buy decent coverage, hopefully at an affordable price. The Exchange has not heard consumer voices, does not include any independent consumer Board members, and is dominated by insurance interests. Small Business for Healthy CT and the CT Health Policy Project have invited Kevin Counihan, CEO of the exchange, to meet with consumers and small businesses to learn what consumers need and how to make the exchange a success. We will also be joined by Christine Hager, Regional Director of HHS, the federal agency funding the exchange. The meeting will be October 26th from 8:30m to 11am at the Pond House Grille in Glastonbury. To register, click here.

Resources on PCMHs and health equity

Care coordination is only one aspect of patient-centered medical homes (PCMHs) that can have a large impact in promoting health equity. PCMHs are primary care practices that create partnerships among a team of providers that serve and support consumers in improving their own health. In addition to care coordination, PCMHs track the population health needs of their patients, offer enhanced hours, and provide culturally appropriate care and services. The CT Health Foundation has published a brief, references, and a chart on the subject.

Candidate briefing book posted

The CT Health Policy Project’s 2012 candidate briefing book on CT’s health is posted. This year’s book includes briefs on thirteen timely issues including health care cost drivers, CT’s health insurance exchange and CT & national health reform. The briefing book is part of www.cthealthbook.org our resource library on health care issues and solutions facing CT.

Health Justice Town Hall

Health Justice Town Hall Meeting 2012, a statewide discussion on creating solutions for a healthy and equitable Connecticut, will be held October 23rd from 5:30 to 7:30 pm. Meetings will be held that evening in three locations – the Legislative Office Building, and two Community Health Center Inc locations -- 675 Main St., Middletown and 1 Shaws Cove, New London. More details are coming soon at www.HealthJusticeTownHall.org.

No CT hospitals make top quality list

The national experts who are responsible for accrediting US hospitals, the Joint Commission, has just released their list of 620 hospitals, Top Performers on Key Quality Measures. The 620 hospitals were recognized for providing “evidence-based clinical processes that are shown to be the best treatments for certain conditions, including heart attack, heart failure, pneumonia, surgical care, children’s asthma, inpatient psychiatric services, stroke and venous thromboembolism.” Unfortunately, no CT hospitals earned a spot on the list. Among our surrounding states, New York had 16 hospitals on the list, Massachusetts had 10, and one Rhode Island hospital met the standards.

State Employee wellness program working

Preliminary results from the new Health Enhancement Program (HEP) for state employees show decreasing use of specialists and increasing use of primary care. HEP is a wellness program that gives state employees incentives to manage chronic conditions and prevent new problems. HEP grew out of last year’s labor negotiations designed to both reduce costs and improve the quality of care – and it appears to be working. Emergency Room visits are down significantly and people with chronic conditions like heart disease, high blood pressure, high cholesterol and diabetes, are doing a better job taking their medications. The HEP results follow some very interesting FY12fiscal numbers in this presentation by the Comptroller’s Office. Once again, Medicaid dwarfs other line items in the budget at $4.7 billion. Even accounting for federal matching funds, it exceeds the next largest line item – salaries and wages. And rising Medicaid caseloads are a significant driver of the rising state budget. This is all the more reason to expand good ideas, like the HEP, to all state health spending and leverage the state’s success to improve the rest of the market.

New uninsured brief posted

Check our newest Policymaker Issue Brief for more information on the drop in uninsured CT residents last year. See where the gains came from, where residents get coverage, why it matters, and why we need to continue the important work of reform.

Census finds 94,000 more CT residents had health coverage last year

New US Census numbers found that the number of uninsured CT residents dropped to 303,000 last year from 397,000 in 2010, to 8.6% of all state residents from 11.6%. The rate of uninsurance in CT has been rising since 2005. The Affordable Care Act deserves much of the credit for the drop, especially for the estimated 23,000 young CT adults now able to stay on their parents’ policies to age 26. Employer-sponsored coverage accounted for 24,000 of the increase, but the majority was due to increases in Medicaid (43,000) and Medicare (38,000). However, it remains true that the majority (66%) of CT residents receive coverage through an employer.

Kaiser taking guesses on uninsured number

New Census figures on the number of Americans without health coverage last year are due out Wednesday morning. Experts expect the number to be up slightly as unemployment remains high. Kaiser Health News is taking guesses on their blog. The closest guess gets recognition. Any guesses for CT’s number? Go to our brief from last year to study up.

RFI for state employee Health Enhancement Program support

The Office of State Comptroller has released a Request for Information for data, support, chronic care coordination and monitoring services to support the new Health Enhancement Program. The RFI includes questions about medical management, care management, call center, physician support, data exchange, quality management, privacy & security, information technology, outcomes, and wellness support. Please share with anyone who might be interested.

CEPAC coming to CT December 6th

The New England Comparative Effectiveness Public Advisory Council (CEPAC) will hold our next meeting here in CT -- December 6th from 10am to 4pm at the Legislative Office Building. Too many new (and expensive) treatments and technologies are adopted and gain wide use before a careful analysis of their effectiveness in treating the condition and/or cost effectiveness compared to other options. CEPAC’s mission is to produce actionable information to aid regional policymakers in the medical policy decision-making process. CEPAC includes researchers, clinicians and patient advocates from all New England states who, twice a year, drill down into the research around treatment options for a condition, evaluate effectiveness and costs, and vote on whether there is sufficient evidence to recommend each treatment’s use. Both Medicare and Anthem have cited previous CEPAC votes in deciding which treatments to fund. June’s meeting in New Hampshire focused on treatments for ADHD. December’s meeting will focus on treatments for obstructive sleep apnea (OSA) in adults. Studies estimate that between 10 and 20 percent of middle-age and older adults suffer from OSA and the rate is rising as obesity rates rise. The meeting is open to the public and the public is invited to testify and/or submit written testimony.

LHP takeover of Waterbury hospitals may be off

News outlets are reporting that LHP Hospital Group, the for-profit Texas company planning to purchase both Waterbury and St. Mary’s Hospitals, has sent a letter threatening to pull out of the deal unless the three sides came to agreement by last Friday. The plan was to merge the two hospitals in a new facility. One potential area of disagreement may be delivery of abortion services and other women’s health care. The Mayor is concerned the deal will fall apart; the hospitals are saying discussions continue.

Insurance Company Shenanigans – Part 2

If you live in CT and are insured through Golden Rule, now also known as United Healthcare’s United HealthOne; you should read the State of Connecticut’s Insurance Department notice # 509542, dated 8/17/2012. Read more in today’s CT Health Exchange Watch blog by Tony Pinto.

Insurance Company Shenanigans – Part 1

In case you’re wondering why you don’t hear insurance companies complaining about Obamacare; it’s because they are big winners and don’t want to rock the boat. Read more in Tony Pinto’s blog on CT Health Exchange Watch.

Behavioral health access hearing

The CT Office of Health Care Advocate will hold a public hearing on access to mental health and substance abuse prevention, treatment and coverage to assess the need for changes to state and federal laws. The hearing will feature guest speaker Carol McDaid, Principal, Capitol Decisions, Inc. Ms. McDaid led the Parity NOW Coalition that backed the federal 2008 Mental Health Parity and Addiction Equity Act. The hearing will be October 17th at 10am in Room 2C of the Legislative Office Building. For more information and how to testify, click here.