Consumers raise concerns with CT insurance exchange

Consumers and small businesses had a rare opportunity to share their concerns with CT’s health insurance exchange Friday. A standing room only crowd met with the exchange’s CEO, Kevin Counihan at a restaurant in Glastonbury. Christie Hager, HHS Regional Director, also attended. Comments focused on the lack of consumer and small business input to the exchange, inappropriate influence of insurance interests, and the exchange staff’s decision not to negotiate with insurers to get the best value for customers. Through negotiation, MA’s exchange has been able to keep the rate of premium increases to half what it is outside their exchange. However prices in Utah’s exchange, which does not negotiate with insurers as CT’s exchange is planning, are actually higher than prices outside the exchange. CT’s exchange is being set up by the state, with millions in federal grants, to help consumers get decent, affordable coverage and is expected to purchase on behalf of one in ten state residents. As of Jan. 1, 2014, everyone in CT will be required to have coverage. Residents who qualify for federal affordability subsidies will have to buy their insurance through the exchange. Check back at the CT Health Policy Project’s site soon for a brief on the benefits for CT consumers, promoting value and affordability, through negotiation on CT’s exchange.

CT health reform update

The CT Health Policy Project has posted a summary of updates and context on CT’s progress toward health reform.

PCMH workforce conference offers lessons for CT

Yesterday’s conference on patient-centered medical homes and workforce brought speakers from other RI, MA and Pittsburg together with CT programs to share best practices and lessons learned. Take aways included baking training into all activities and for every member of the team. It is also critical to begin training well before NCQA recognition. And training is not over with recognition; CHC, Inc. retrains all team members every year. The speakers emphasized that the patient-centered vision is the responsibility of everyone – including clinician, administrators, IT staff and receptionists. Teams are not one-size fits all; they have to fit into their community. Sustainable funding in a multi-payer initiative was cited by several states as critical, from the beginning. It is critical to use data – process and population health – to target interventions. Kyle Crawford from the Pittsburgh Regional Health Initiative noted that we have to create a “better relationship with our data.” Other lessons included the importance of behavioral health integration and engaged, committed leadership both at the practice level and among policymakers.

Additions to candidate briefing book

New briefs have been added to our CT Health Policy Project briefing book for Connecticut candidates. New briefs include wellness programs, patient-centered medical homes in CT, comparative effectiveness research, and CT’s health care workforce. The candidate briefing book is part of cthealthbook.org, our site for CT health care system resources. Check often for more updates.

CT exchange staff won’t negotiate with insurers on behalf of consumers

Staff of the CT Health Insurance Exchange have “opted to utilize an ‘any qualified plan’ approach” for determining which plans can be offered in the exchange. Proposed qualifications are minimal and generally only what is required by the Affordable Care Act. This decision is counter to the CT exchange’s own research. According to the market consultants, “One of the most attractive aspects of the Exchange is that the big insurance companies compete for their business. The feature evoked references to Lending Tree’s slogan ‘When banks compete you win.’” Utah’s health insurance exchange has pursued an “any qualified plan” approach, similar to CT’s staff proposal, and has attracted little enrollment with no evidence of cost control. Massachusetts’s Connector, on the other hand, operates with an active purchasing approach – negotiating with insurers to get the best price and quality for consumers. Annual premium increases for plans in Massachusetts’s exchange have been half the increase of plans outside the exchange. Starting in 2014, every CT resident will be required to secure health coverage. Over 150,000 state residents will have to buy it in the exchange to get federal affordability subsidies. According to the staff memo, the decision not to negotiate on behalf of consumers has been made and they are only taking comment on how to implement that policy. The memo was delivered Monday to the Qualified Health Plan Committee that no longer includes a consumer representative due to the unfortunate loss of Jennifer Jaff.

Medicaid Council update

Lots of good news at Friday’s MAPOC meeting. DSS has significantly improved their redetermination process in response to huge backlogs that prompted a legal aid lawsuit. The dual eligible Health Neighborhood proposal’s behavioral health component has been improved by shifting from the controversial, administratively complex and fragmented co-lead proposal to a partnership. This is what it always should be – partnerships across health care silos into an integrated neighborhood. People don’t come in silos, only the health system does, and further codifying that in policy is a very bad idea. The state is still currently pursuing a limited health home option only for people with serious mental illness. Health homes are an ACA provision reimbursing states 90% of care coordination costs for people with chronic conditions but only for two years. At the meeting, agency staff noted that CMS has issued guidance that states will retain the ability to access the 90% match for other populations in the future, but speakers noted the uncertainty of future federal funding due to sequestration and the imminent fiscal cliff. The state was urged to move swiftly to ensure that every eligible person be covered by the option as soon as possible.

PCMH workforce conference Oct. 23rd

Patient centered medical homes offer exciting potential to both improve the quality of care and control costs. But this transformation of care delivery will require new skills and roles in CT’s health care workforce. A conference to explore these issues and CT’s readiness for delivery reform will be held October 23rd from 8am to 3pm at Wilde Auditorium at the University of Hartford. Speakers include academic experts, working professionals and consumer advocates from CT and other states. The conference is sponsored by the Universal Health Care Foundation of CT together with the Allied Health Workforce Policy Board and the University of Hartford Center for Public Health and Education Policy. To register, click here.

State innovation application posted

The state’s application to CMS for a $3 million State Innovation Models Grant is now online. If awarded, the grant would fund health care planning activities including hiring staff at state agencies and consultants. The project will work to align incentives among stakeholders to reform delivery and payment systems. The initiatives include coordinating data across payers, supporting providers in practice transformation, and expanding primary care capacity. The role of consumers and the Cabinet is unclear. The project was developed by state agencies; the activities would be coordinated by the Office of Health Care Reform and Innovation.

CT still earns a C+ on reform

Once again, CT health care thoughtleaders give our state a C+ on health reform. From the beginning of the CT Health Thoughtleaders Survey in February, CT has varied between C and C+. CT has always received a B for effort. In good news, grades for the CT Health Insurance Exchange improved since June with fewer D’s and some A’s in this survey. Unfortunately, grades for Engaging Consumers in Policymaking and Data-based Policymaking have fallen. The former was the most common recommendation from thoughtleaders to improve progress toward reform. The overwhelming response was to engage consumers in policymaking – increase consumer voices, greater public engagement in the process, and engage advocates. Other suggestions included smarter policymaking (data, best practices), improve communications and transparency, convene stakeholders to build trust, and guard against conflicting financial and special interests. New questions in this survey found that almost all thoughtleaders are somewhat or very engaged in the process of reform, however all but four cite barriers to engagement. Understanding how critical stakeholder engagement will be to success, policymakers should work to improve effective, meaningful access to the process. A disturbing number of respondents have not been asked, or have tried but found few ways to participate. The Thoughtleader Survey is part of the CT Health Policy Project’s Health Reform Dashboard project at www.cthealthreform.org.

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.

Aetna announces layoffs, blames ACA, puzzling

Aetna has announced they will soon be laying off 80 CT workers, 160 nationwide. The company cited competitive pressures from the Affordable Care Act (ACA) in their decision, which is puzzling. The ACA legally requires Americans to buy their product, which should substantially improve their bottom line. Significant lobbying from the insurance industry into the law ensured that we would not have a competing public option to help reduce costs. It is also interesting that Aetna laid off more employees (100 in CT, 625 in the US) a month before the ACA passed. The economic downturn has hit CT hard, and the 80 innovation, technology, and customer service workers will be joining a growing number of unemployed CT residents. The laid off employees will receive nine weeks of pay and some are eligible for a severance package.

Fascinating UConn medication management conference

UConn’s School of Pharmacy invited some stellar speakers to yesterday’s 2012 Hewitt Symposium on Medication Management. Medication management is an important new tool to both lower health care costs and improve care. The tool pairs patients with complex conditions and many medications with a pharmacist to ensure they are taking the right medications, eliminate conflicts, address side effects, prevent errors, and help them adhere to the care plan. Speakers came from successful programs in Boston, Pittsburg, Minneapolis, North Carolina, Iowa, and Connecticut. A CT Medicaid program, highlighted in Health Affairs, saved $1,123 per patient per year in medication costs and $472 in medical care – saving $2.50 for every dollar spent on the program. Another CT program serving Cambodian refugees saved even more -- $3,032.44 per patient per year – returning $5.60 for every dollar of program spending. The speakers shared important lessons learned. Opportunities to both save money and improve care are rare -- every CT payer should be looking at medication management.

Midwifery conference

Mary Breckinridge, one of the foremothers of nurse-midwifery in the United States, famously said, “Our goal is to see ourselves surpassed.” Nearly a century later, there is still much room for improvement in maternity care. As new tools and resources become available, what will it take to transform maternity care, and how can midwives and other maternity care professionals be part of that transformation? Join us for the ACNM Region 1 Annual Meeting: Quality Improvement in Maternity Care. Network with providers from across New England, earn CEUs, and get inspired to improve quality and patient safety. Saturday, November 10 8:30am – 3pm New Haven Lawn Club 193 Whitney Avenue, New Haven

October webquiz – pre-exisiting conditions

Test your knowledge of CT residents with pre-exisiting conditions. Take the October CT Health Policy Webquiz.