2014 – CT Health Care Year in Review

A lot happened in health care in CT this year -- a lot of promising projects but some opportunities lost as well, leaving lots of uncertainty for 2015. It’s never boring.

     Thankfully, health care costs held stable   CT seems to be following the US trend of slowing health costs. Spending per person in Medicaid held stable, even for new eligibles. And, thanks to the ACA, CT’s share of Medicaid costs actually dropped this year. Premiums in the exchange are largely unchanged for next year, but we started out fourth highest in US.

    More people have coverage  The final uninsured rate is months away, but all signs indicate it should be down. Medicaid enrollment grew significantly; the large majority of those new members were likely uninsured previously. AccessHealthCT enrolled thousands, but it’s unclear how many were uninsured. Affordability of coverage in CT remains a serious challenge.

      Stunning Medicaid turnaround Since the exit of commercial insurers and financial risk the program, quality of care now rivals commercial plans, 32% more providers participate, and per person costs are stable in CT’s largest health plan.

      CT is trying health reform again, with mixed reviews so far  SIM, the administration’s latest reform attempt, won a modest federal grant but early interest among stakeholders is waning and serious concerns have been raised by consumers. CT’s Medicare ACOs have had a shaky start, with only one of eleven earning shared savings payments. However, Medicaid’s health neighborhood plan to coordinate care and align incentives to support quality is moving ahead with good support. The lesson -- thoughtful, open collaboration works.

      New public health strategic plan We are lucky that CT is the fourth healthiest state and DPH has guided development of a thoughtful, realistic strategic plan to address rising public health challenges.             
      CT hospitals staying (mostly) nonprofit Early in 2014, it seemed inevitable that for-profit Tenet would be buying four CT hospitals, but that deal now appears dead.

    Lots of questions remain for CT health care in 2015.

·            Will payment reform sputter out, or more likely, continue it’s fragmented, piecemeal route? Will we know?

·            What does the future hold for CT’s hospitals? Will mergers and consolidation with other providers continue?

·            Can Medicaid continue the quality and access improvements while containing costs? Will plans for shared savings and returns to financial risk unravel the progress?

·          Will CT finally get health IT right? Will patient privacy be protected?

·          Will Congress reauthorize CHIP (HUSKY B in CT) so 14,000 children can keep their coverage?

·          Will the state adopt any measures to make health insurance, especially in the exchange, more affordable?

New England comparative effectiveness report on controversies in diabetes management options

A new analysis comparing treatments for Type 2 Diabetes found significant opportunities to expand use of high value options– those that are both clinically effective and cost effective. NPH insulin (intermediate-acting human insulin) is equally effective as newer insulin analogs at lowering blood glucose levels, but at one-third the cost.  The prevalence and costs of diabetes are rising, costing $245 billion in 2012 and expected to reach $500 billion by 2025. The report results from an exhaustive review of the evidence by economic and clinical experts at ICER which informed voting by CEPAC, a committee of New England consumers and providers, on which treatments are worth the cost. The report includes estimates of how much could be saved across New England by expanding high value options. Policymaker and consumer action guides distilled from the report will be available next month.

CT Health Notes newsletter – a view through CT health care history

To keep up on the latest in CT’s health care landscape, sign up for our (mostly) every-other-week newsletter, CT Health Notes. You can also search our archives that go back fifteen years. For a reminder of how far CT has come, our first CT Health Notes edition from January 2001 included an invitation to our first conference – Alternatives to Medicaid Managed Care – What is PCCM Anyway?

CT News Junkie Op-ED – learning from mistakes in HIT

A new opinion piece in CT News Junkie focuses on the need for CT to develop a functional health information system, that respects consumers’ privacy, is crucial to patient safety, improving quality, controlling costs and thoughtful reform. The merciful demise this year of HITE-CT, a quasi-public entity charged by the state with doing just that, offers some lessons.

SIM update

CMMI announced Tuesday that Connecticut was among eleven states whose SIM application was approved. CT expects to receive $45 million over four years to support reform.

The SIM Health IT Council will hold its first meeting today at 1pm at the LOB. Commissioner Bremby of DSS,  which has been given responsibility for developing an Health IT plan for the state, presented on the state’s plans at the last SIM steering committee meeting. The ambitious but thoughtful plan includes infrastructure, risk profiling, a consent registry, and other critical pieces to create a functional system for CT.

The SIM workforce council has been placed on hold. Only one of the three original workforce proposals was included in the final SIM applications. UConn will no longer be leading that effort.

The Chartis Group has been chosen as consultants to support the work of the Equity & Access Committee to develop a system of underservice monitoring. The Committee will meet with the consultants for the first time tonight at 6pm in Rocky Hill.

Medicaid update

The Medicaid Council workgroup developing quality measures to use in reforming Medicaid’s payment system has held a couple of meetings – one very constructive, the first not so much. The first meeting was hastily called, dominated by SIM representatives, and contentious. However, the comforting bottom line from that meeting was that DSS will make the final decisions about how payment reform is structured for Medicaid. The second meeting was more friendly and productive, with better representation by Medicaid stakeholders and committee members who’ve worked over the years to improve the program. At the second meeting we worked through an impressive list of quality measures already being used by the program including typical quality measures, consumer and provider satisfaction surveys, and provider profiling. The committee explored what is now being measured, how that data is used, and is soliciting additions to fill gaps.

In Friday’s Medicaid Council meeting we watched a new You Tube video from DSS highlighting the program’s recent progress in improving access to quality care and controlling costs. The video is part of the department’s efforts to better communicate policy decisions and accomplishments. We also heard more about the extensive array of available Long Term Supports and Services that allow fragile people to live in their communities while saving the program money. We also heard an update on the enrollment dashboard and consultants the department is hiring to help improve processes.

CT fourth healthiest state

In this year’s report, America’s Health Rankings finds CT residents are healthier than residents of all but three other states, up from 7^th in the last two years. Our strengths include a very low smoking rate, low teen birth rate, and a high rate of dental visits. Our challenges are a very troubling high rate of avoidable hospitalizations, high rate of binge drinking, disparities based on educational attainment, and insufficient sleep.

Consumer Advisory Board considers ethics policies

In today’s meeting, the Consumer Advisory Board (CAB) discussed proposed ethics standards to ensure that anyone who makes decisions about funding from SIM not benefit from that funding. According to Connecticut’s Public Officials and State Employees Guide to the Code of Ethics, a substantial conflict of interest exists when “a public official, his or her spouse, a dependent child, or a business with which he or she is associated will derive a direct monetary gain or suffer a direct monetary loss by virtue of his or her official activity.” The guide further states “A public official or state employee must abstain from taking official action on the matter that presents a substantial conflict for them, his or her immediate family, or any associated business.” Under the SIM proposal approved by the SIM Steering Committee, the CAB proposes to fund community organizations and other potential contractors. The proposed language for adoption by the CAB requires transparent and open procurement processes, members, their families or businesses they are associated with are prohibited from bidding on or accepting funds that are directed by or on behalf of the CAB or SIM, and a revolving door provision that extends the provision for one year after the member’s appointment ends. Members expressed support for the concept and avoiding even a perception of conflicted interests. Some suggested following generally weaker non-profit Board standards that often only require that the member with the conflict recuse himself or herself from voting on the application of their business or organization. This allows situations, as happened at the AccessHealthCT Board, where a member argued and voted for weak standards and opposed active purchasing, resigned from the Board, and subsequently went to work for an insurer that intends to participate in the exchange under the weak standards and without facing negotiation with the state to keep rates affordable. The CAB asked for more clarification on whether they are required to follow the Code of Ethics. But at least one member offered that the CAB should adopt the ethics code standards anyway and err on the side of caution.