Consumer advocates provide constructive input to SIM

Today a letter was sent to state SIM planners from 24 CT consumer advocates representing 21 organizations proposing an alternative to the state’s proposed SIM plan. The SIM project, funded with a $3m federal grant, is developing payment and care delivery models for at least 80% of state residents – 3 million people or more and $30 billion in CT health spending. Advocates are concerned that the decision-making groups lacked consumer input, and that the process was largely conducted out of public view over a short few months in the summer. The plan includes a controversial plan to shift financial risk onto providers. The state now intends to apply for up to $60m in federal funding to implement the model. In the letter, advocates affirmed our support for the concept – to improve quality and access to care, while controlling costs. But advocates also urged policymakers to build a meaningful, feasible quality monitoring system for CT, in an inclusive process engaging all stakeholders, including consumers and advocates. It is critical that this quality system be working and in place, before any provider risk incentives attach. Advocates are optimistic that this alternative will serve the goals of the SIM project but will also protect consumers from savings generated by withholding appropriate care as opposed to the intended reductions in unnecessary care and duplication of services.

Quinnipiac med students start classes today

The first class of students at the new Quinnipiac University medical school started classes today. Training for the sixty students will emphasize team-based care with the goal of encouraging them to practice primary care.

Book Club: Naked Statistics

A new addition to the CT Health Policy Project Book Club – Naked Statistics: Stripping the Dread from the Data – makes statistics relevant, accessible and entertaining. “Statistics is like a high-caliber weapon: helpful when used correctly and potentially disastrous in the wrong hands.” If you want to understand health policy, you need to get comfortable with statistics. And this is the book to help you.

Waterbury Hospital for-profit takeover community forum tonight

A community forum on Vanguard/Tenet’s planned takeover of Waterbury Hospital will be tonight at 7pm at St. John’s Episcopal Church, 16 Church St. in Waterbury. Community and labor organizations are concerned about the for-profit, out of state company buying the nonprofit hospital.

SIM and Cabinet meeting update

Yesterday’s Health Care Cabinet meeting wasn’t very enlightening. The SIM report on consumer outreach was pretty much as expected. Consultants reported on focus groups with HUSKY and uninsured consumers and described plans for an online survey. Not surprisingly, they found lots of complaints about challenges accessing health care, stigma and poor treatment. They did not report talking about payment models or systems change with consumer groups and it is not mentioned in their online survey. They are planning five new taskforces and the current payment group will continue meeting. There was no discussion of adding consumers or advocates to the groups.  They intend to have a draft SIM plan ready by Labor Day.

In other news, we have heard from advocates in other states about their SIM processes. Most have large, public, diverse stakeholder meetings that include consumers and advocates. Maryland’s SIM planning is amazing. They started Local Health Improvement Coalitions in 2011 with diverse membership – consumers, advocates, community organizations, schools, public health, legislators, plus all the CT SIM stakeholder groups – and are using their APCD, advanced analytics and performance monitoring to identify hot spots and other problems, uniting the entire health system to create local solutions. They intend to use the SIM grant to build on the local quality coalition capacity. Payment reform is a much smaller part of their plan; quality is clearly the priority.

Colorado also has an exciting SIM process. They have a strong APCD and are also using the data to target quality and access interventions.  They have a large, diverse, public stakeholder group, including advocates and consumers, that meets monthly. They have a strong stakeholder and public input process, including inviting written public comment on the final plan. They even hired a consumer organization to write the patient-centered care part of the plan.

For-profit Vanguard and Yale-New Haven set to takeover ECHN

Eastern CT Health Network, including Rockville and Manchester Hospitals and their networks, has entered an agreement with for-profit Tennessee-based Vanguard Health Systems and Yale-New Haven Health Systems. Under the agreement Vanguard will takeover outpatient facilities at both hospitals and Yale will provide clinical support. Vanguard is also seeking to acquire Waterbury Hospital and more recently announced they will be purchased by Tenet Healthcare Corp. Advocates have raised concerns about Tenet’s history of federal actions and penalties.

Exchange premiums up from this year, lots of variation

Our analysis of the recently announced 2014 Access Health CT standard plan premiums finds that for five typical CT households covered by the two health insurers with premium history – Anthem and ConnectiCare – in all but one case, families will experience significant premium increases from this year.  Premiums will rise between 30 and 163%. The one premium decrease is $8.02/month for a family of three and that family could save even more by switching insurers. The examples were chosen by the exchange’s actuaries to model for their last Board meeting. Monthly premiums on the exchange will vary significantly – from $125.35 for a child living in Hartford County in a bronze ConnectiCare plan to $1,144.80 for a Fairfield County 64-year-old in a gold Anthem plan. The largest premium variation is by age, and to a lesser degree by generosity of plan (bronze, silver, gold). Variation between insurers and counties is much lower. However Fairfield County is the most expensive for each insurers’ plans. Unfortunately Fairfield County has the highest number and rate of uninsurance in the state.

CT moves up to 13th worst in hospital Medicare readmission penalties

Twenty four CT hospitals will face Medicare penalties because of readmission rates averaging 0.43% of Medicare revenues. In an important move to link payment to quality of care, Medicare began last year providing individual hospitals with penalties and rewards based on the number of discharged patients who are readmitted within a month. While CT is 13^th worst among states both in the percent of hospitals penalized and in the average penalty, that is up from the very bottom last year. 

Aetna leaves CT insurance exchange

Aetna has withdrawn their application to participate in Access Health CT, our state’s health insurance exchange. Aetna’s proposal was the least costly individual premium option for 14 of the 15 examples given at the last Board meeting. Unfortunately this reduces the affordability of options in the exchange and leaves only three plans each in CT’s individual and small business exchanges. Aetna intends to continue to offer individual coverage in CT outside the exchange. Last week ConnectiCare withdrew from CT’s small business exchange but maintained their proposal in the individual exchange.

August CT Health Policy Webquiz: CT health insurance base premiums

Test your knowledge of base health insurance premiums in Connecticut for this year. Take the August CT Health Policy Webquiz.

CT Health Reform Progress Meter moves up to 23.1%

CT policymakers have completed 23.1% of the tasks necessary for health reform, making up for last month’s drop. Most tasks on the Progress Meter list are due on Jan.1^st of next year. Medicaid accounted for the forward progress in August’s Health Reform Dashboard. Deep concerns about payment reform in the SIM process and the insurance exchange’s premium increases are holding Connecticut back.