SIM plan comments focus on protecting consumers

CT’s SIM draft plan to reform health care for at least 80% of state residents in five years is out for public comment. SIM is the state’s newest plan to radically reform health care delivery and payment across the entire state. Concerns raised in the CT Health Policy Project’s comments include potential incentives in the proposed payment system to stint on necessary, appropriate care. Advocates have urged the committee not to reward stinting -- to include monitoring for inappropriate under-treatment and deny shared savings payments that are generated by denying needed care. The comments also outline concerns about the process, including the exclusion of critical stakeholders from decision-making, about the danger of reversing hard-won improvements in CT’s Medicaid program, and highlight leading examples of responsible reform from CT and other states.

This is the first opportunity for the public to comment on the SIM plan that is to be finalized by the end of next month. Early next year the state intends to apply for a follow up federal grant of about $50 million to implement the plan.

CT hospital ER waits longer than US average

Average waits at CT hospital emergency departments vary from 82 minutes at Hartford Hospital to 14 minutes at Windom Hospital, according to a new analysis by the CT Health I-Team. CT’s average wait time is 30 minutes; the national average is 28 minutes. While CT hospitals are implementing quality improvements, experts expect wait times to increase with ACA coverage expansions starting in January, especially in Medicaid. From 2011 to 2012 ER visits in CT rose by 55,000.

Health exchange enrollment still low and older

12,648 people have signed up for coverage through Access Health CT, our state health insurance exchange in the first month according to new enrollment numbers. About half (41%) have qualified for Medicaid. The other half (56%) enrolled in private insurance plans; more than half of those are choosing a silver plan. 62% have enrolled in an Anthem plan, 35% in ConnectiCare and only 2.4% in a HealthyCT offering. But the most interesting finding is that enrollees tend to be older, especially those enrolling in private insurance coverage. This is concerning because younger, healthier members are critical to sustaining an affordable pool. Enrollment in the Charter Oak Plan, set to close next month, never reached 15,000 because it attracted an older, less healthy membership, causing premiums to surge, pricing out healthier members, ending in a death spiral.

9,000 CT policies canceled due to ACA standards

CT Insurance Commissioner Leonardi stated in an interview yesterday that 9,000 policies were cancelled recently because they were not grandfathered under the Affordable Care Act. Plans that were in place in March 23, 2010 (when the Act passed) and haven’t changed benefits or consumer costs in significant ways but don’t meet some new ACA standards for coverage may be grandfathered – or allowed to continue in place. Plans that are newer or did change significantly but don’t meet new standards cannot be grandfathered – 9,000 of them in CT. 27,000 CT policies in total were cancelled recently, most for reasons other than new ACA standards. Plan cancellations are not new and happen every year. The state is still considering what can be done to help people with cancelled coverage and whether a special legislative session is needed.

Advocates’ letter expands on SIM concerns about payment model risks

A new letter signed by 21 CT consumer advocates to the SIM committee provides more clarity on previous concerns and raises others that have surfaced in the SIM draft plan. SIM is the state’s newest plan to radically reform health care delivery and payment across the entire state. Previous concerns, raised in our August letter to SIM leaders, included potential incentives in the proposed payment system to stint on necessary care for patients’ health and healing. Advocates have urged the committee not to reward stinting -- to include monitoring for inappropriate under-treatment and deny shared savings payments that are generated by denying needed care. SIM leaders say they are studying the concept and will approach the SIM steering committee about the idea. The letter repeats concerns that independent consumer advocates have not been represented on the committee. Also included in the August letter and only partially addressed to date has been a lack of transparency in SIM committee and workgroup deliberations, also without independent consumer advocacy representation. A new concern in this latest letter, revealed in the latest SIM draft, includes the potential for downside risk in Medicaid – requiring providers to share losses on patients that end up costing more than analytic models estimate they should have. Advocates are very concerned that downside risk, or any disproportionate incentives to reduce care under any payment model is troubling in any population, but could especially jeopardize the recent hard-won progress in improving care and provider participation in Medicaid. The SIM draft plan was released Nov. 1^st and is open for public comment until Nov. 26^th or the end of the month.

Medicaid Council update

Friday’s Medicaid Oversight Council meeting focused on the success of the Intensive Care Management Program. The program provides the most fragile Medicaid consumers with team-based, patient-centered care starting with a comprehensive assessment of what consumers need, both health and other supports, strengths and barriers. The team supports the consumer in setting their own goals and helps develop a individualized care plan to meet those goals. The program, developed and run by Community Health Network, served 3,500 people from January through September of this year. The large majority came into the program through predictive modeling of plan data and ED or hospital discharge planning, however members can be referred by caregivers, CHN staff, providers, agencies, screenings, or themselves. Most ICM consumers have multiple chronic conditions, with cardiac, gastrointestinal and behavioral health conditions most common. Early results find that the program has reduced inpatient admissions by 43% and ED use by 6%. Over 90% of members are satisfied with the services and would recommend it to others.

The Council also heard about DPH’s successful WIC program that provides over 54,000 CT low income children and mothers with healthy food and nutritional support to encourage long term healthy eating habits.  

SIM slides outline project and consumer risks

Slides created for a presentation to consumer advocates provides background on the state SIM project, its goals, the administration’s proposal, and risks to consumers and taxpayers are online. SIM is the administration’s plan to radically transform health care – how it is delivered and how it is paid for – for at least 80% of state residents – to cover Medicare, Medicaid, private insurance, self-insured plans, employer coverage, small businesses, the new exchange – everyone.

November CT Health Policy Webquiz: CT’s public health needs

Test your knowledge of CT’s public health needs. Take the November CT Health Policy Webquiz.

CT Health Reform Progress Meter moves up to 27.7%

CT policymakers have completed 27.7% of the tasks necessary for health reform, up 4% from last month. Most tasks on the Progress Meter list are due on Jan.1^st of next year. Medicaid accounted for the forward progress in November’s Health Reform Dashboard. Once again, deep concerns about payment reform in the SIM process and the insurance exchange’s premium increases are holding Connecticut back.