New SIM summary online – consumer concerns remain

The administration’s federal SIM application for $64 million is finished. As the plan and application developed, consumer advocates sent five letters signed by dozens of independent advocates voicing concerns including weak consumer protections, incentives to deny necessary appropriate care, the need for nationally recognized standards, and the lack of independent voices in the process. Some of our concerns were incorporated, but many remain. An update on the application is online, including where the money would go if awarded, the fate of consumer interests, and what still needs to be done. 

New to Book Club: Fixing Health Care Inside & Out

Our latest addition to the CT Health Policy Project Book Club offers very concrete guidance for practices and policymakers working to improve quality and access to care, while holding the line on skyrocketing health care costs. From the Harvard Business Review, Fixing Health Care Inside & Out is a great compendium of health care innovations that focus on improving quality and ensuring that precious, scarce resources are maximized. Helpful lessons that work from the real world include overcoming turf battles in building teams, organizing around consumers’ needs rather than medical specialties, effectively using peer pressure to improve performance, and ensuring that shiny new (expensive) technologies are used appropriately. Authors also describe how the structure of the current system (fee-for-service and beyond) can sabotage great new, simple, efficient ideas.

Join a tweet chat on CT’s SIM plan Wednesday

A community of CT social media health advocates hold regular tweetchats with the hashtag #hcsmct. A tweetchat is a public Twitter conversation, generally with a regular schedule, connecting people with common interests. Including the hashtag #hcsmct in tweets during the chat allows visitors to follow and participate in the discussion. Join us this Wednesday, Aug. 27^th at 3pm to discuss CT’s SIM plans for health care innovation. @cthealthnotes will be moderating – my first time, so be patient.

CT state employee plan premiums 25% more than US average

According to a new report, CT state employee plan premiums averaged $1,199 per employee last year, the 9^th highest rate among states. State employees with single coverage paid 11% of premium on average, compared to 25% of all CT employee plans. Families averaged 15% of premiums for state employees compared to 32.7% for all CT families. The average actuarial value of CT state employee coverage was 98%, higher than any other state or the highest 90% platinum level for health insurance exchange coverage.

SIM administrators seeking planning consultants should avoid prior mistakes

State SIM administrators are soliciting bids for a new set of consultants to guide the implementation process. Given the problems with the SIM final plan development process, advocates offer these recommendations. This time:

• ·      Use an transparent, objective process that is open to all qualified applicants
• ·      Avoid any perceptions of political and other conflicts
• ·      Require a familiarity with CT’s health system and history, or at least a willingness to learn
• ·      Require strong, broad research skills
• ·      Require the consultants to be open to and respectful of all stakeholder ideas and perspectives
• ·      Prohibit biases toward pre-conceived payment or other theoretical models that conflict with CT realities
• ·      Select for strong listening skills, both to committee members and the much larger wisdom of the stakeholders crowd, avoid perception that all the answers reside in any small committee
• ·      Select for a record of respectfully engaging that wisdom and incorporating it into implementation to engage everyone in making SIM work
• ·      Select for consensus-building skills over rhetoric

Advocates look forward to contributing to SIM’s implementation and ensuring a success that benefits every state resident.

CMS stopped reimbursing CT for new Medicaid eligibles in January

CT News Junkie reported today that CMS halted reimbursements for the newly eligible Medicaid members as of January 1^st. The first quarter payment the state missed was $249 million, but the second quarter amount could be more as enrollment grew under the ACA expansion starting January 1^st. According to DSS’s financial reports, the state’s expected federal MLIA amount for May alone is $126 million. This follows smaller but related issues reported in June concerning Medicaid reimbursement for DMHAS services. The state expects to have the problem resolved by the end of the year but concerns have been raised about the state’s cash levels to ensure payments to providers and other state spending.  

Fact checking CT’s uninsured numbers since the ACA

An article in today’s CT Mirror focuses on a question bouncing around CT health policy circles – what impact has ObamaCare had on coverage in our state? The answer – we don’t know. Current estimates by Access Health CT have caveats. Highly recommended reading --  especially click on the graphic.

2014 Candidate Health Care Briefing Book online

The CT Health Policy Project has posted our latest Health Care Briefing Book for candidates. The site includes eighteen short briefs on timely topics in Connecticut’s health care landscape. Topics include health care cost drivers, Access Health CT -- Connecticut’s health insurance exchange, SIM -- CT’s new plan for health care reform, and CT’s Medicaid program – progress and challenges.

August CT Health Policy Webquiz: ACA insurance rebates in CT

Test your knowledge about ACA insurance rebates to CT residents. Take the August CT Health Policy Webquiz.

Half of exchange enrollees were uninsured

A survey released yesterday conducted by AccessHealthCT found that 53% of people who signed up for coverage through the exchange this year were previously uninsured. The question asked if anyone in the enrollees’ household had insurance in the past year. Interestingly the percent of households previously uninsured differed little for those who enrolled in Medicaid (55%) vs. insurance (52%). The survey suggests that the exchange moved just over 40,000 uninsured CT residents into private insurance this year. AccessHealthCT’s survey methodology is not available at this writing.

A national Gallup survey released Tuesday found that CT’s uninsured rate dropped from 12.3% last year to 7.4% this year. Gallup found that states, like CT, that both expanded Medicaid and implemented a state-based exchange experienced the largest gains in coverage – possibly due to larger shares of federal outreach funding. Among those states, CT ranked seventh in overall coverage gains.

CSG/ERC Hopkins tour highlights patient safety, care coordination and cancer innovations

Yesterday’s off-site trip to Johns Hopkins from the CSG/ERC annual meeting was impressive. We heard about out of the box thinking by a clinical scientist that led to a breakthrough in treating lung cancer – that very low, but longer term doses of chemotherapy drugs worked better than full doses in shrinking tumors and helped make future traditional chemotherapy far more effective. Traditional funders do not generally support out of the box ideas, preferring to stick with safe projects, but missing important innovations.

We also heard about an important ICU innovation that is re-engineering how multiple machines communicate with an EMR to save providers’ time, reduce measurement errors, and improve patient safety. Most machines in the ICU (in health care in general) do not communicate – they are made by different venders with no incentive to make them work together. One speaker compared this to Boeing who employ hundreds of independent venders to make parts that Boeing assembles into planes, but not requiring that the company that makes the landing gear ensure that the system can communicate with the dashboards the pilots see so they can know if the wheels are up or down. Hopkins has re-engineered their ICUs so that devices communicate hourly with the EMR and a dashboard lets providers know if care is appropriate. The system also includes a patient/family portal allowing them to see the quality of care, and to enter information important to them, including their goals for care.

The final speaker described Hopkins’ CMMI Innovation Award program which is identifying high utilizers of care in East Baltimore, a very low income, high health need community, and creating health neighborhoods on steroids to coordinate care, address social needs, and keep people healthy.

Moving video and panel on the opiod addiction epidemic, with policy options to address the problem

This morning’s standing-room-only panel at CSG/ERC's annual meeting in Baltimore on the epidemic of opiod addiction combined emotion with constructive options for policymakers. We first watched part of The Hungry Heart, a movie about the rising toll of addiction on rural communities and heard from a former addict and a physician from the movie. The stories of wrecked lives were heartbreaking. We then heard from CEPAC experts who described their recent report on the effectiveness of various treatment options, (medication vs. inpatient) and the need to expand treatment capacity. They estimate that every dollar spent on opiod addiction treatment generates $2 in savings – medical costs, corrections, and social costs. CEPAC estimates that there are about 130,000 opiod addicts in New England alone, but only 30% are receiving treatment. If we could get half the untreated population into effective treatment, the region could save 700 lives and $3 billion. They included concrete recommendations for policymakers that could improve access and lower barriers to effective treatment and highlighted successful programs from the region.

CSG/ERC panel on Medicaid innovations

Today’s health committee meeting at the CSG/ERC annual meeting in Baltimore featured updates from NY and CT about what is working in state Medicaid programs, and an update from CMMI on what’s next for the State Innovation Model program. Sen. Terry Gerratana moderated the panel that included Asm. Richard Gottfried (NY), Olivia Puckett (MAPOC) and Clare Wrobel (CMMI).  Asm. Gottfried described NY’s Medicaid program that covers 5 million people and spends over $50 billion each year. 92% of children and adults and 43% of seniors and people with disabilities were in a managed care plan last year. Now NY is planning to expand managed care further with delivery system reforms and a fund to protect safety net providers. Olivia Puckett described CT’s Medicaid innovations including the successful person-centered medical home, Intensive Care Management, OB Pay for Performance, and dental health programs. Clare Wrobel described the SIM grant goals to help states use their levers and engage across payers and programs to improve population health, transform health care delivery and expand value-based payment models. She described the work of the six current test grant states – VT, AR, ME, MA, OR, and MN. She also described some themes from the Model Design and Pre-Test State SIM plans and CMS’s process for awarding Test Grants in the next round. All speakers echoed Clare’s last take-away message – it’s a long journey; this is just the beginning.

CA’s exchange keeps coverage affordable through negotiation

Premiums on California’s exchange will rise only 4.2% next year, due in large part to active purchasing. Overall health spending is expected to rise 6.2% next year. Through active purchasing, CA’s exchange negotiates premiums with insurers to get the best deal for consumers. Connecticut’s exchange does not negotiate premiums on behalf of consumers. CT’s insurance department has pushed back on double digit requested increases by insurers on the exchange, but the exchange itself does not address rates or affordability. Premiums on CT’s exchange this year are the 4^th highest in the nation and the highest among state-based exchanges.