NCQA patient-centered medical home webinar video posted

A recording of today’s webinar with NCQA about patient-centered medical home recognition is posted online. Experts from NCQA described their process and standards for patient-centered medical homes and the benefits to Connecticut. The slides are posted online as well.

SIM FAQs updated

We’ve updated the Frequently Asked Questions about CT’s SIM plan. SIM is the state’s newest plan to radically reform health care delivery and payment across the entire state. Advocates have raised concerns that the plan doesn’t do enough to protect consumers from stinting on care resulting from payment reform, could reverse recent progress in CT’s Medicaid program, lowers effective medical home national standards now commonly used in our state, and will undermine critical public health functions. The final plan was developed without input from critical stakeholders, including consumers. The updated FAQs include a description of the final plan, the process so far, implementation plans going forward and links to more on advocates’ concerns.

News: Independent CT hospitals discussing tiered networks, Pre-ACA CID routinely approved very high rates for Aetna

The Hartford Business Journal is reporting that some smaller, independent CT hospitals are in discussions with each other and with insurers about options that improve their efficiency and make coverage more affordable. The hospitals are talking with insurers about value-based insurance designs or tiered networks where consumers who choose to access care at lower priced facilities benefit with lower cost sharing, making care even more affordable. Lower costs are often not found in large networks and facilities. The talks are in part a response to large, for-profit hospital networks forming across the state. An agreement that may include physician practices among six to ten small hospitals could happen within a few months.

The CT Mirror is reporting that before the Affordable Care Act’s insurance reforms Aetna benefited from years of higher than usual margins, about 55% medical loss ratios compared to 70 to 80% for other CT insurers during the same years. The ACA requires medical loss ratios of at least 80%. There is no evidence that the CT Insurance Dept. ever rejected a rate increase request from Aetna before the ACA changed the rules. This year Aetna asked for and was approved for an 8.75% increase in individual policies.

Webinar: The value of NCQA recognition of patient-centered medical homes

Join us for a webinar with National Committee for Quality Assurance experts Thursday, May 29^th at 1pm to learn about their patient-centered medical home recognition standards updated for 2014. NCQA has the most widely adopted standards, with a growing list of 1,009 certified PCMHs in Connecticut. There is substantial evidence linking nationally recognized PCMHs with the triple aim of improving patient experience of care, improving health outcomes, and controlling costs. One in three CT Medicaid consumers is now served in a nationally certified PCMH and enjoying better quality of care, improved access and lowered costs since the adoption of PCMHs in the program. NCQA has invested over $9 million in continual improvements to their standards and employs dozens of staff to oversee the recognition process. Learn more about NCQA’s national resources that Connecticut can draw on to provide value to our state. Click here to register for the webinar.

CTNJ op-ed: Privacy and trust concerns at CT’s APCD

Advocates are raising concerns about the privacy of sensitive medical records at Access Health Analytics, our state’s all-payer claims database (APCD). At the CT Health Policy Projects we have been great supporters of an APCD for CT knowing that, if done well, it could be a powerful tool to give consumers information about the cost and quality of care. It can also assist policymakers in smarter health care planning – directing resources exactly where needed and following up by evaluating if they worked as planned. So we were very disappointed by Access Health Analytics’s decision not to give CT residents the option to control where our health information goes -- not only because it denies basic rights but it also undermines the integrity and support for the APCD.

Rhode Island made a different, very patient-centered decision for their database that started this month. They included an opt-out provision, trusting consumers to trust them. And by all accounts it is working well. After hearing about strong security and privacy protections, many Rhode Island callers decide not to opt-out. State officials expect at least 98.5% of residents’ records to be in the system.

Access Health Analytics was asked to consider including an opt-out provision like Rhode Island’s in our state’s APCD but refused. Fortunately this does not have to be the end of the process. The decision is not in law (state law is silent on the issue) but was voted by an appointed advisory committee in obscure meetings in response to an Access Health Analytics staff recommendation. And there is time to fix this – the APCD is still in development, no changes have to be made to do it right. Access Health Analytics need to trust CT consumers if they expect us to trust them.

Exchange tweaks for 2015 offerings – weak on affordability, expanded networks, HSAs

Changes for next year’s CT health insurance exchange plan offerings are small and unlikely to change premiums much. Cost sharing for the most affordable plans will be rising, with consumers paying more for services. Studies find that even modest increases in cost sharing lead consumers to reduce both necessary and unnecessary care, and can drive up far more expensive care such as hospitalizations. The problem is especially serious for people with chronic conditions, exactly the people we want to access health care. Unfortunately even shifting more costs onto consumers will do little to make coverage affordable. Premium reductions from the increased cost sharing limits are expected to be less than estimates for rising prices next year.  In good news, the exchange will hold insurers to set higher standards for plan networks next year, including ensuring geographic access to providers that are taking new patients. For more detail, check the April 30^th exchange board materials.

New to the CT Health Policy Book Club – Reinventing American Health Care

I received the newest addition to the CTHPP Book Club -- Reinventing American Health Care: How the Affordable Care Act Will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System -- when the author, Ezekiel Emanuel, came to an ICER board dinner in Boston this spring. He spent the evening talking and strategizing with a small group of prominent health care stakeholders and leaders who all care deeply about comparative effectiveness research and other ways to build a smarter health care system. Reading the book felt as if he was bringing the country into that fascinating conversation. As one of the primary architects of the ACA, he is naturally a big believer in the potential of the law to transform our broken health care system. But he is not blind to the challenges and problems – both in the law and in implementation. The book is an accessible overview, explaining both the bill and the problems in the US health system within the context of history and current politics. But he goes further than other ACA authors in candidly describing the problems of implementation, internal and external, future challenges, health care megatrends, and very specific predictions about the future of health care in America.

CHC quality conference: Reimagining primary care

Yesterday’s ninth annual Weitzman Institute conference on improving the quality of care did not disappoint. National and CHC, Inc. speakers touched on workforce and technology innovations to build primary care capacity and improve quality of care, engaging youth in coverage expansions, connecting medicine to community services to stop the expensive treadmill of treating preventable health problems, and the future of primary care. One of the many excellent topics include a talk by Nwando Olayiwola MD, former CHC physician and co-author of a new Millbank review of the effectiveness of patient-centered medical homes. According to the study, nationally recognized PCMHs are associated with significantly reduced ED visits, lower hospital admissions and readmissions, increased patient experience of care, and lower costs. CHC panelists following her talk reported impressive results for their PCMHs in CT, certified by both NCQA and JCAHO. Dr. Olayiwola reported that 80% of PCMHs nationally are certified by NCQA. For more on PCMH certification, join us for our webinar May 29^th with NCQA.

Cabinet meeting – exchange and SIM updates

Most of today’s Cabinet meeting was spent on SIM’s decision to create a CT-specific medical home standard rather than using well-vetted, evidence based national standards. (May 29^th we are hosting a webinar with NCQA to learn more about the NCQA system that has certified 1,009 PCMH providers in CT already. Register here.) Questions were raised about paying for value/quality and how that fit with lowering standards to reach “late adopter” practices. SIM intends to place an emphasis on incentives for practices to engage in a process of transformation rather than reach a set of standards. Concerns were raised about eroding consumer protections and not ensuring value for rising health spending. Concerns were also raised about wasting grant dollars to re-create national standards that are associated with better health outcomes. Other states add state-specific requirements on top of national PCMH standards, such as CLAS standards for culturally appropriate care. Emphasizing outcomes over process could raise incentives for adverse selection, avoiding exactly the patients who stand to benefit most from coordinated care.

Other concerns included ensuring that, to avoid past SIM problems, consultants assigned to workgroups should not steer decision-making but should be there to support the workgroups of CT stakeholders. Groups should also solicit a lot of outside input, accessing the wisdom of CT’s health policy community. A list of possible future policy briefs was shared. SIM agreed to accept suggestions for others.

The health insurance exchange update included an emphasis on training and education to retain current members. Plans to improve the SHOP exchange include a focus on adapting products and lowering prices. There was a great deal of discussion of high prices but little tangible action toward lowering them. This year the exchange will not be engaging consultants to review rates or enhance affordability.

Webinar: The value of NCQA recognition of patient-centered medical homes

Join us for a webinar with National Committee for Quality Assurance experts Thursday, May 29^th at 1pm to learn about their patient-centered medical home recognition standards updated for 2014. NCQA has the most widely adopted standards, with a growing list of 1,009 certified PCMHs in Connecticut. There is substantial evidence linking nationally recognized PCMHs with the triple aim of improving patient experience of care, improving health outcomes, and controlling costs. One in three CT Medicaid consumers is now served in a nationally certified PCMH and enjoying better quality of care, improved access and lowered costs since the adoption of PCMHs in the program. NCQA has invested over $9 million in continual improvements to their standards and employs dozens of staff to oversee the recognition process. Learn more about NCQA’s national resources that Connecticut can draw on to provide value to our state. Click here to register for the webinar.

Hospital conversion bill passed, but outcome not clear

In the last hours of the session the General Assembly passed legislation regarding for-profit hospital conversions and hospitals’ ability to merge with physician practices. The legislation was proposed in response to Tenet’s plans to partner with Yale-New Haven, Waterbury, Manchester, Rockville, and Bristol hospitals. The deal required the ability of for-profits to purchase physician practices. Labor groups have been wary of the proposal, concerned about protecting consumer and worker rights. The final language changes current law to make it easier for hospitals to convert to for-profit status, but increases state oversight. The bill includes important consumer protections, for example hospitals must notify patients’ community physician within 24 hours of admission. The bill was negotiated with heavy input from both sides, but Tenet and YNHH issued a statement critical of the bill stating that if enacted it could jeopardize the deal. This may be very good news for controlling health spending in CT as evidence mounts that hospitals’ purchase of private practices increases overall costs.

Website moving, be patient

Our CT Health Policy Project website is moving to a new home and will be temporarily offline. We expect to be back up with the information you are craving in 12 to 24 hours depending on how long the DNS propagation takes. I am told I have to be patient.

MA health reform saved lives

A new study finds that health reform and expanded coverage in MA saved lives. Comparing MA counties with matched counties in other states, researchers found a drop in mortality, especially from causes amenable to health care (i.e. not due to accidents). A completely illegitimate, back-of-the-envelope, they’ll-take-my-degree-away calculation (is that enough disclaimers?) finds that 351 MA residents each year are saved due to reform. The impact on mortality was greatest in low-income, previously high-uninsured communities, as expected if coverage is the cause. The authors also found gains in access to care and overall health status. Living in CT and a reader of this blog you might think this conclusion is obvious, but there are doubters. Previous research on the subject was mixed but as described here the study design in this analysis is much stronger.

State Employee health plan update

Today’s meeting of the Health Care Cost Containment Committee was short but interesting. The HCCC, the best kept secret in state government, is a joint labor-management committee under the Comptroller’s Office that makes decisions about the $1.2 billion/year program that covers 208,378 state employees, retirees and dependents. Consultants noted that costs in the program rose 3.4% over the last year, lower than the rest of the market at 6 to 6.5%. It was reported (they ran out of copies of the financial report) that there is an unexpected $14 million surplus in the program this year. However that will be gone next year and leave a large gap due to a large number of expected retirees. It was reported that between 1,600 and 1,800 Corrections employees eligible for retirement have signed up for retirement counseling – that is between half and all of the eligible workers.  It was reported that typically 28% of eligible workers elect to retire when eligible. After a short meeting, the public was dismissed and, according to observers, the “interesting, real meeting starts.” The committee agenda also includes no opportunities for public comment and is not held in an easily accessible public venue. The lack of transparency is reminiscent of CT’s SIM planning process.

CT hospitals safety rankings lower than surrounding states

New rankings of hospital safety by the Leapfrog Group outline sharp differences between CT’s hospitals. St. Francis and Backus earned an A grade. However Charlotte Hungerford received a D and Windham received an F. CT hospitals underperformed compared to surrounding states. MA and RI have no hospitals with D or F grades. 70% of MA hospitals earned an A as did 19% in NY and 33% in RI – compared to only 8% of CT hospitals. Every day over 200 Americans die in a hospital due to a medical error. CT’s overall performance is mixed compared to other states, and nationally hospitals are making some progress in reducing infections, but more work needs to be done.

May Health Reform Dashboard, Webquiz online

Test your knowledge about health risk factors in Connecticut adults. Take the May CT Health Policy Webquiz.

May’s Health Reform Dashboard and Progress Meter show the state moving backward. While CT improved in data transparency, we lost ground in the APCD’s decision to reject patient-centered policies and deny sensible privacy rights to state residents (more on this important issue is coming). The administration’s SIM decision to reject nationally recognized medical home standards also hurt progress toward reform.