Out-of-the-box ideas to solve problems

A clip from Crowd Control, a new National Geographic channel show, puts innovative thinking to work solving problems. This clip highlights a novel idea to trick New Yorkers into taking the stairs instead of an escalator. Notice that no one knows they are exercising or doing “the right thing” – they are just having fun. This clip addresses the problem of stopping people from illegally parking in disabled spaces. Crowd Control is the latest project of Daniel Pink, author of Drive – one of my favorite books.

Update: Conference cancelled -- Trinity College conference on The Contraception Mandate – religious, legal and health implications

November 12^th Trinity College will host a day-long conference on The Contraception Mandate – Religious Liberty & Health Care. Marc D. Stern, General Counsel for the American Jewish Committee and Member of the Bar of the U.S. Supreme Court, will be the keynote speaker. After lunch, three breakout sessions on related topics—Religiously Affiliated Organizations and Health Care, Legal Issues Pertaining to Women's Health Care, and Connecticut Regulations and the Contraceptive Mandate—will be held. The conference is free, but registration is required for lunch.

New comparison finds 2014 CT insurance premiums are higher than most states

A study by Health Pocket averaging unsubsidized insurance premiums both on and off the exchange found that for 23 year olds, CT’s average premiums this year were the 11^th highest among states, 12% higher than the US average. For 30 year olds, CT also ranks 11^th highest with premiums 13% higher than the US average, and 8^th highest for 63 year olds at 16% higher than the US average. Between 2013 and 2014 monthly premiums, averaged on and off exchanges rose for both men and women and all ages studied, but increases were not the same. American men age 30 experienced 78.2% average increases, but premiums for American men age 63 rose only 22.7% on average. The ACA limited the difference in premiums charged by age effective this year. The difference in premiums between CT residents age 23 and age 63 changed from 300% in 2013 to 195% this year. Federal subsidies, available only to insurance purchased in the exchange, limit monthly insurance premiums for people with qualifying incomes.

Webinar -- learn the basics of confusing/scary payment model options for CT

Join Bob Berenson, MD of the Urban Institute for a CTHPP webinar November 18^th at 1pm as he explains health care payment reform options. Dr. Berenson has long health policy experience, both inside and outside government. He served as Director of Medicare Payment Policy at CMS. His work focuses on quality measurement/improvement and Medicare shared savings. In the webinar Dr. Berenson will focus particularly on shared savings models as CT is considering for both the Medicaid/Medicare health neighborhood pilots and the much more ambitious SIM plan. Click here to register for the Nov. 18^th webinar.

National Medicaid Managed Care conference hears CT best practices

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CID 2014 managed care report card online

The CT Insurance Dept. has released their annual consumer report card on health insurers.  In its 9^th year, the report card compares managed care plans offered in CT across 15 categories of performance including number of providers by county, controlling high blood pressure, cancer screening rates, prenatal care, and drug spending. An incredible resource, the report also includes enrollment numbers by plan, NCQA quality ratings, worksheets for consumers to compare plans on important features, and very useful customer service contact info.

SIM decision to use national PCMH standards affirmed – again

At last night’s SIM Practice Transformation committee meeting, consumer advocates were able to halt erosion of national standards for patient-centered medical homes (PCMHs). Following research and best practices and resisting misinformation, in June the committee voted to use nationally recognized NCQA standards for PCMHs in SIM. NCQA-recognized PCMHs are the foundation of CT Medicaid’s remarkable success in lowering costs, improving quality and engaging new providers in the program. Unfortunately, there have been more recent efforts in the committee to erode that decision. Last night’s meeting was frustrating to watch as much policymaking was based on misleading anecdotes, random conversations, and lack of understanding of health policies – thankfully advocates did their homework and cited published research to make their case. Eventually SIM staff reaffirmed that NCQA standards will be the “framework” and “backbone” for PCMH standard setting in SIM. It is important to note that Massachusetts has reportedly reversed their decision to create state-specific PCMH standards.

The committee also heard from AmeriCares Free Clinics that provide coordinated, high quality care to thousands of uninsured low-income state residents left out of ACA expansions. AmeriCares would like to earn PCMH status to further improve the quality of their care, despite the fact that they do not bill to payers and will not be rewarded financially. AmeriCares asked to be included in the SIM glide path providing technical assistance to earning PCMH status, despite the fact that they do not bill to Medicaid. Staff agreed to keep open the possibility for free clinics to apply for the funding, but priority will still go to the large Medicaid shared savings networks.

Webinar -- Provider Payment Reform Options: Aspiration Meets Reality

Join Bob Berenson, MD of the Urban Institute for a CTHPP webinar November 18^th at 1pm as he explains health care payment reform options. Dr. Berenson has long health policy experience, both inside and outside government. He served as Director of Medicare Payment Policy at CMS. His work focuses on quality measurement/improvement and Medicare shared savings. In the webinar Dr. Berenson will focus particularly on shared savings models as CT is considering for both the Medicaid/Medicare health neighborhood pilots and the much more ambitious SIM plan. Click here to register for the Nov. 18^th webinar.

Medicaid quality up, costs stable since switch to ASO

We got lots of good news at today’s Medicaid Council meeting. New financial reports show that since October of 2013 HUSKY enrollment has grown 20% but spending has grown only 13.6%. Per person spending on HUSKY Part D, which includes the former SAGA members and the newly eligible childless adults from the ACA, has actually decreased slightly. We expected pent-up demand for services to increase that number for a short time; this may indicate that it is a healthier population that has enrolled. Another report, a précis, summarizes the considerable innovations in the program since the shift from capitated managed care plans to an ASO model, including exciting new data. The program now benefits from predictive modeling and tracking of health measures that can help providers deliver the right care to the right person at the right time. We also heard about improvement in the ConnectCT enrollment system – average wait time on the phone to talk with a benefit center is down from 78 minutes in August to 66 minutes last month. DSS talked about plans to bring that down further. We also heard about the behavioral health program’s efforts to improve access to care.

October CT Health Policy Webquiz: NCQA rankings of CT health plans

Test your knowledge about the latest NCQA quality rankings of CT health plans . Take the http://cthealthpolicy.org/quiz/oct2014.htm.

Candidates for Governor on health care

To help with your decision Nov. 4^th, the CT Mirror has done a great job of describing Malloy record and Foley’s positions on health care if elected.

CT has second highest rate of 2013 hospital Medicare readmission penalties

CT was behind only NJ last year in the percent of hospitals receiving Medicare readmission penalties and the average penalty for CT hospitals more than doubled from 2012. Medicare fines hospitals for patients who return unplanned to the hospital for treatment within 30 days of discharge compared to an expected readmission rate, adjusted for severity of illness, age, and other conditions. According to experts, more than half of readmission spending could have been avoided. The highest penalty for a CT hospital went to St. Vincent’s which has been above average since the quality improvement program began three years ago. New Milford Hospital has received no penalty in any of the last three years. No CT hospital received the maximum penalty in 2013. Hospitals have responded to the program by replacing cursory paper discharge plans with meaningful connections to care in the community. This year the program expanded the maximum penalty and the number of conditions they evaluate. Twelve CT hospitals experienced significant increases in penalties this year.

Webinar -- Provider Payment Reform Options: Aspiration Meets Reality

Join Bob Berenson, MD of the Urban Institute for a CTHPP webinar November 18^th at 1pm as he explains health care payment reform options. Dr. Berenson has long health policy experience, both inside and outside government. He served as Director of Medicare Payment Policy at CMS. His work focuses on quality measurement/improvement and Medicare shared savings. In the webinar Dr. Berenson will focus particularly on shared savings models as CT is considering for both the Medicaid/Medicare health neighborhood pilots and the much more ambitious SIM plan. Click here to register for the Nov. 18^th webinar.

CT health reform progress meter up to 28.8%

CT’s progress toward health reform moved up slightly to 28.8% this month, from 28.4% last month. Medicaid accounted for most of the progress including addressing audit issues that serve as a barrier to provider participation and the health neighborhood pilot for dual eligibles that is carefully protecting consumers from underservice in a collaborative and constructive process. Progress was limited by inadequate outreach resources for the upcoming AccessHealthCT open enrollment season and SIM’s decision to use admittedly inappropriate Medicare ACO quality standards for everyone simply to better position the state to receive the SIM grant amounting to about $6 million/year for five years . The CT health reform progress meter is part of the CT Health Reform Dashboard.

Fascinating discussion -- US Senate panel considering regulatory barriers to ACOs

The first meeting of a panel convened by Sen. Angus King (ME) to consider federal regulatory barriers to provider risk payment models was held in Dirksen Senate Office Building this morning. The panel was moderated by Michael Chernew of the Health Care Markets and Regulation Lab at Harvard Medical School, which is guiding the process with Sen. King’s policy staff. I was joined on the panel by Carrie Arsenault of Beacon Health in Brewer ME, one of the brave remaining 19 Pioneer ACOs of the original 32, Eric Bieber of University Hospitals in Cleveland OH, and Janet Niles of Ochsner Health System in New Orleans. The discussion was thought-provoking and a little provocative at times. After hearing all the challenges, I left wondering why any group would consider becoming an ACO. Only one in four Medicare ACOs earned savings payments last year, despite spending $2 million each on average to support the model. It was clear that all the panelists are primarily motivated by improving the quality of care they provide; financial interests are far less important. Concerns included regulatory paperwork burdens, even if you get a commonsense waiver, the difficulty of reaching the savings threshold, attribution, and the need for a glide path for organizations wishing to develop ACO models responsibly. Downside risk is a very heavy lift for these organizations; reportedly many Medicare ACOs will leave the program if they are required to accept downside risk, as the Pioneer ACOs are this year. We heard a lot about the importance of engaging consumers in improving their health. In my remarks, I focused on consumers’ perspectives and concerns – that shifting risk onto providers holds great promise to build value and reduce overtreatment, but great risk in that it significantly changes incentives in the patient-provider relationship. Every regulation was a good idea and served a purpose at the time it was proposed. Undoing those standards should be done carefully. I talked about the importance of monitoring for underservice and how CT’s health neighborhood pilots for dual eligibles is building such a monitoring system. There was no argument that incentives in Medicaid are different than other programs – when providers are underpaid, the incentives to overtreat are less, but undertreatment is more of a concern. I talked about anti-competitive concerns of consolidating providers, overlap and conflict with state regulatory roles, and the importance of paying for quality, independent of and in addition to shared savings. Relying only on shared savings to improve quality is not realistic – if we want it, we have to pay for it.

It was a fascinating conversation. I can’t wait for the next meeting.