CT health reform progress dips to 28%

CT lost ground in progress toward health reform according to the August CT Health Reform Dashboard. The state moved backward to 28% completion mainly due to the new SIM/Medicaid plan that has drawn concerns from many stakeholders, less transparent policymaking, and concerns that a federal grant is driving health policy choices. Progress on patient-centered medical homes was mixed with improvement by reaffirming national standards, balanced by re-direction of glide path funding to support Medicaid shared savings.

New SIM under service survey -- please help protect consumers

The SIM Equity and Access Committee is working to develop a monitoring system for inappropriate underservice as CT’s health system moves toward shared savings payment models. Underservice can be denial of appropriate care, limiting expensive treatment options, limiting access to certain providers, avoidance of consumers that may not generate savings, or cost shifting to consumers. Limits may be complete denial of treatment, offering only some treatment options, or limiting the scope/duration/frequency of treatment. While inappropriate underservice occurs now, especially in the Medicaid program, it is possible that shared savings incentives will encourage the problem. To protect consumers, the SIM plan includes a principle denying shared savings payments that were generated by systemic, inappropriate underservice.

Development of a robust monitoring system for undertreatment is crucial to protecting consumers as Connecticut reforms our health care payment systems. The Equity and Access Committee is seeking input for our task. To collect input, the CT Health Policy Project has developed a short survey to help us collect measures of likely underservice to share with the rest of the committee. Please take a few minutes to complete the survey. Even if you participated in our last survey, please also fill out this one. If you have any questions, contact Ellen Andrews at andrews@cthealthpolicy.org.

Public forum tonight about St. Mary’s Hospital purchase and for-profit conversion

At 5pm tonight there will be a public forum at St. Mary’s Hospital’s Conference Center Auditorium about plans to sell the hospital to Tenet Healthcare Corp. Tenet is a for-profit hospital chain based in Dallas with hospitals and clinics in 16 states. Tenet plans to purchase five CT hospitals, including nearby Waterbury Hospital, and create a strong financial relationship with Yale-New Haven. Advocates and labor representatives have raised serious concerns about for-profit health care in CT and about Tenet specifically. The state passed legislation this year making it easier for non-profit hospitals to convert to for-profit status.

Value over Volume 2.0 – twenty three tools for state policymakers to improve quality and control costs

Health care costs consume nearly a quarter of state budgets, and that share is rising at a rate that policymakers agree is unsustainable. Evidence shows that our runaway spending is not driving improved quality, and that lasting reform will require a shift from a volume-based system to one based on value.  The good news is that states are on the cutting edge of a transformation in how we pay for health care, with potentially far-reaching impacts at home and in the broader market.  

These innovations are documented in Value Over Volume 2.0, a new report from the CSG/ERC Health Policy Committee, which provides twenty three new tools to help policymakers build on their progress. The tools are concrete policy options being used successfully by states and other payers to control rising health costs while enhancing the effectiveness of care.

“This is a must-read for anyone working in health care policy today. Each topic discussed is a road map to where we need to go after federal reform,” said Connecticut State Senator Terry Gerratana, co-chair of the legislature’s Public Health Committee, and co-chair of CSG/ERC’s Health Policy Committee.

As the leading payers and regulators of health care, states have unique levers to reform health payment for both state spending and the larger market. Value Over Volume 2.0 follows up on CSG/ERC research released four years ago introducing state policymakers to payment reforms.

$3 million in ACA insurance rebates coming to CT residents

69,186 CT residents will soon receive $3 million in rebates from insurers that spent less than 80% (individual coverage) or 85% (large groups) of premiums on medical or quality improvement services last year. The rebates result from Medical Loss Ratio provisions in the ACA. CT’s total is down from $5.6 million in total refunds for 2012. National totals are down as well suggesting that insurers are doing a better job of pricing their products and reducing excessive administrative costs and profits. CT individual market refunds average only $14 compared to the national average of $85 but CT large group customers will do better with average refunds of $183 compared to $73 nationally. No small group consumers in CT will receive refunds in this round. The refunds could come as a check in the mail, a reimbursement to the account that paid the premium, a reduction in future premiums or through the employer but in a way that benefits the consumer.

SIM application online

CT’s SIM application has been submitted and is online. An analysis will be coming soon.

New to Book Club – Think Like a Freak

The newest addition to the CT Health Policy Project Book Club, Think Like a Freak, offers tools to unlock creativity in problem solving, using new perspectives to solve intractable challenges – and health care has a lot of those. Freakonomics and SuperFreakomomics, earlier CT Health Policy Project Book Club selections, gave us interesting examples of how a different perspective on a problem can give us better answers. The examples were fascinating, which is great if they hit the issues you work on, but we can’t wait for the authors to solve all our problems. Their new book helps the reader find that new perspective and “think like a freak”. Lessons include think like a child, focus on incentives, and learn to appreciate quitting. They also spend a good amount of time working through the barriers to thinking like a freak including no time, the comfort of running with the herd, and blindness to biases.

June CT Health Policy Webquiz: CT health system performance

Test your knowledge about Connecticut’s health system performance. Take the July CT Health Policy Webquiz.

CMS announces new assistance for states to improve health system, many SIM alternatives

Today CMS unveiled the Innovation Accelerator Program providing states with over 50 tools, programs and technical assistance to improve Medicaid programs – both delivery and payment reforms. SIM is only one of the dozens of tools listed. The tools include numerous alternatives to CT’s risky SIM proposal to achieve every one of the goals outlined in the CT SIM final plan.

SIM moving ahead with risky Medicaid plan despite 25 advocates’ objections

At yesterday’s meeting, the SIM steering committee chose to move ahead with plans to radically change the Medicaid program – to include shared savings and an 1115 waiver. The new plan, rushed out in only a few weeks, reverses earlier assurances to advocates that the state would go slowly into shared savings payment incentives, recognizing that people in the program are at higher risk of underservice.  New features unveiled at yesterday’s meeting include that the eventual plan is to move 600,000 Medicaid members into shared savings over the next six years, only beginning with 200,000 or more Jan. 1, 2016. We also had our first look at the proposed SIM budget, which includes only a small sum for monitoring underservice, less than for focus groups and other consumer education or program evaluation. The budget was developed by collecting requests from the “owners” of SIM – state agencies. However state officials assert that the grant is not motivated by bringing federal funding to the state. Twenty five independent consumer advocates, who do not stand to benefit from the decision either way, signed a letter opposing the new Medicaid plan, concerned about serious harms to Medicaid clients who struggle now to access care, and jeopardizing recent hard-fought progress in the program. But committee members were not persuaded,  believing the potential benefits outweigh the risks.

Medicaid Council voices concerns about new SIM proposal

In a special meeting yesterday, the majority of Medicaid Council members voiced concerns about the rushed, new SIM proposal for Medicaid. Legislators compared the new proposal to the failed HUSKY HMO proposal 20 years ago and made it clear that they are concerned about “going back down that road”. Concerns included the application’s aggressive pace of reform with several speakers asking DSS to slow down and revert to the original SIM plan that staged reforms with time for evaluation and improvements in between, building on lessons learned. Speakers were concerned that the move to shared savings would undermine the successful PCMH program that is improving care, engaging more providers and controlling costs. In fact, CT Medicaid spending is under control, projected to drop even, over the next several years. Strong concerns were raised about the dangers of an 1115 waiver, even if intended for a purpose everyone could support, could later be used to deny care to people as has happened in the past when the state budget runs into deficit. Advocates pointed out that there are other, less risky ways to accomplish the goals outlined for the 1115 waiver. Speakers were concerned about the priority focus on cost savings over improving quality. Concerns were raised that shared savings is relatively new across the US, and that it has not been universally successful. There were strong concerns about exacerbating underservice, which happens frequently now in the program under fee-for-service, without new incentives to deny care. SIM proponents acknowledged that the new proposal was precipitated by securing a federal grant but believe that the potential benefits outweigh the risks. Representatives from ProHealth and CT’s community health centers, both of which would potentially benefit from the proposal, spoke in favor of the proposal.

Questions for SIM about radical new Medicaid proposal

Questions sent yesterday for today’s meeting about SIM’s risky, new Medicaid proposal have been posted. One asks why a dangerous 1115 waiver is necessary? Did SIM planners explore other, less dangerous options? 1115 waivers necessarily include a cap on federal reimbursement (to meet the federal budget neutrality requirement) endangering the state budget and potential future Medicaid cuts if health costs continue to rise. The two stated reasons for a waiver – covering community health worker preventive services, and providing air conditioners for people with asthma – are not compelling. As of Jan. 1^st federal rules changed to allow Medicaid payment for CHW services and the extra state cost of air conditioners for 75% of Medicaid adults with asthma is minimal. Advocates have many concerns about the skeletal proposal rushed out to win a federal grant. The MAPOC will hear from SIM proponents about their plan this morning at 9:30 in Room 2C of the LOB.