Forum on provider consolidation and facility fees

Comptroller Kevin Lembo will be holding a public forum on facility fees and provider consolidation Wednesday December 3^rd from 2:30 to 5:30 pm in Room 2D of the Legislative Office Building. Yale-New Haven Hospital, Hartford HealthCare, Anthem, United and ProHealth Physicians will be speaking. Public comment will begin at 4 pm. The forum is part of the Comptroller’s study of the impacts of facility fees and consolidation of large groups.

Health Equity Forum

Next Tuesday, November 25^th from 6 to 8 pm, hear about Health Equity in CT at the Hartford Public Library, 500 Main St. Hear from community leaders about the Affordable Care Act – get info on saving money and avoiding hospital bills, answers to questions about enrollment and using your insurance, and voice your opinion in group discussions with providers and legislators. The forum is sponsored by NCRMHB and CT’s Asian Pacific American Affairs Commission. RSVP to info@ncrmhb.org, or 860-667-6388.

New advocacy videos from CT-N

CT-N, Connecticut’s Network, has produced ADVOCACY: Turning the Gears of Democracy -- short, easy-to-understand videos on how to advocate effectively. The four videos cover what advocacy is and why it is so important, your right to advocate, effective strategies and how to engage the media to amplify your voice. The videos are exceptional tools for both new and experienced advocates. The videos will soon be linked from the CT Health Policy Project’s Advocacy Toolbox.

Payment reform webinar slides and video posted

Yesterday Bob Berenson of the Urban Institute graciously walked dozens of webinar participants through the pros and cons of the main payment reform options – fee-for-service, capitation/population-based payment, shared savings and bundles/episodes – and the key challenges of each. Several CT plans are now considering implementing shared savings models, including Medicaid. The main takeaways, from both the webinar and the questions from CT stakeholders, were:

·                         Everyone agrees on the concept of value-based purchasing, but there is no consensus on “value” or how to measure it

·                        There is a great deal of diversity in each model

·                        No single model is perfect, enlightened systems are moving to a merged model using multiple levers to address the drawbacks in each model

·                        Medicaid is different – underpayment and other features raise the risk of underservice and reduce incentives for overtreatment

Click here for a video of the webinar and here for slides.

Medicaid update – lots of success but a concerning turf battle

Friday’s Medicaid Council meeting focused on new initiatives to rebalance care for long term supports and services. Through a impressive quilt of waivers, DSS has improved incentives for providers, expanded available services, reduced and eliminated waiting lists, and reduced costs allowing fragile people to remain in their homes avoiding costly and unwanted nursing home stays.

Last week’s meeting of the council’s care management committee highlighted continued success engaging and supporting CT practices in transforming to patient-centered medical homes. 282,232 CT Medicaid members can now access coordinated care that meets national accreditation standards at 327 individual sites across the state, up 300% since the beginning of 2012. And 51 more sites are on the glide path to PCMH recognition. DSS and CHN deserve a great deal of credit for their success in delivering quality care, sustained over years, turning around a program that has languished for decades.

Unfortunately a conflict between SIM and MAPOC has arisen over control of Medicaid policymaking; independent advocates are concerned that the program’s successes are at risk. In alignment with a letter from the Lieutenant Governor and DSS Commissioner, legislative leaders have assigned MAPOC’s Care Management Committee the task of advising the state on “all aspects of the shared savings program design and the selection of provider participants.” This mirrors the very successful model of collaboration between MAPOC’s Complex Care Committee and DSS in developing a strong model of shared savings for dual eligible members especially a consensus set of standards protecting fragile members from inappropriate underservice. Unfortunately SIM staff is insisting that a SIM committee, dominated by private insurers, retain control over development of the crucial under-service measures for the entire Medicaid program. Advocates are concerned that the committee does not include sufficient Medicaid expertise and questions the dominant role of private insurers who no longer operate our state’s Medicaid program, in large part because of inappropriate underservice. Since private insurers left Medicaid, quality of care is up, more providers are participating, and per person costs are down.

CT’s APCD chooses data contractor, concerns remain

The Hartford Business Journal is reporting that CT’s developing all-payer claims database (APCD), run by AccessHealthCT, has chosen Onpoint Health Data to run their system. APCDs have enormous potential to improve population health, track problems, evaluate solutions and maximize scarce resources. Most New England states are ahead of CT in APCD development. However, concerns have been raised about consumer privacy and security of extremely sensitive information merged across all CT’s payers into a massive single source, availability of the data to only those who need it, and ensuring uses that do not harm competition, discriminate, or reduce necessary care. Concerns have also been raised about hosting the APCD within the insurance exchange, with potential conflicts of interest in use of data and relationships with insurers. CT’s APCD has been funded by federal funds through our state exchange grant and now new SIM funding is proposed to support the database.

SIM discussion on how to cut the budget

In what was supposed to be a one-hour meeting, the SIM Steering Committee met yesterday to discuss how to cut the original $64m budget in the federal application down to $45m, as requested by CMMI. It was a poorly structured meeting that quickly led to a disorderly grab for money. Staff provided members with a proposal for what to cut and what to keep at least 24 hours before the meeting, but the proposal was not made public. Members argued for their own agencies and providers while carefully explaining why competing items were less worthy. Funding for HIT, community health workers, and state personnel were among the areas questioned. The Consumer Advisory Board agreed to cut travel to conferences for volunteer CAB members from their $1.6m budget. Less experienced members were confused about several areas including staffing and when funding parts of several positions and the use of consultants can be the most effective way to direct complex projects that cross many programs. The voting was not well planned and created deep confusion among members. I hung up after 2 hours but can’t wait to see what was decided. The regularly scheduled public Steering Committee meeting on Thursday has been cancelled.

Webinar – clearing the confusion about 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.

Healthcare tops US nonprofit employment; CT health care employs one in seven private sector workers; state health care workers average 25% higher pay

At 7.7 million workers, healthcare and social assistance employment topped other industries in US nonprofits in 2012 with more than four times as many workers as the next largest category (education), according to the Bureau of Labor Statistics. However, healthcare and social assistance wages at US nonprofits was about average among industries, averaging $47,324 that year. According to CT’s Dept. of Labor, last December in the private sector there were 209,272 health care workers in our state, over one in seven workers, with average annual wages of $57,752. Among state employees, 10,020 were employed in health care with average annual wages of $72,109.

Class slides – Implementing ObamaCare in CT

Slides and the syllabus from a Fall graduate public policy class at Trinity College are online. The course, Implementing ObamaCare in CT, is tracking how the Affordable Care Act is unfolding in our state. Class topics for the class so far include ACA 2.0/CT context, health insurance exchange, Medicaid, insurance reform, workforce/providers, public health, health equity, health care delivery reform, quality, HIT, payment reform, and new state roles. More will be added as the course continues. The class is part of Trinity’s health policy track in the Masters of Arts in Public Policy program. The course slides are part of the CT Health Policy Project’s Resources page – www.cthealthbook.org.

November CT Health Policy Webquiz: Avoidable hospitalizations in CT

Test your knowledge about avoidable hospitalizations in CT. Take the November CT Health Policy Webquiz.

CT health reform progress meter up to 29.9%

CT’s progress toward health reform moved up slightly again this month to 29.9%. Again Medicaid accounted for most of the progress including good news on per person cost stability and successful completion of an underservice monitoring plan for the health neighborhood pilot for dual eligibles. Progress was limited by the continual need to defend proven patient-centered medical home standards in the SIM process and continuing high insurance premiums. The CT health reform progress meter is part of the CT Health Reform Dashboard.