CTNJ Op-Ed: Health Neighborhood cuts misguided

An Op-Ed in today’s CT News Junkie focuses on the Governor’s proposal to cut funding for innovative health neighborhood pilots to serve state residents eligible for both Medicare and Medicaid. This program will improve the quality of care for Medicaid’s most costly aged and disabled members, providing significant savings to the state’s budget. The program builds on what has been learned from Medicaid’s impressive success at improving the value of care for HUSKY members. After two years of extensive planning and collaboration, the project is very close to implementation. The Governor’s proposal acknowledges that the project “could generate long-term savings by promoting practice transformation, facilitating person-centered team-based care, and creating a payment structure that aligns financial incentives to promote value”. If this promising innovation is halted, how long can CT tolerate low-value, high-cost health care for our most fragile residents?

Deficit grows, Medicaid revenues below expectations – Let’s hope for good news from April tax receipts

Legislative and administrative deficit estimates for this year vary by $52.8 million, about 0.3% of the total General Fund. However that small difference may be enough to trigger another deficit mitigation plan of cuts by the Governor. However any plan for cuts wouldn’t come until May, and the legislative session ends June 3^rd – it is possible that any cuts for this year would be rolled into the next biennial budget. However all this may be unnecessary if receipts of taxes on April 15^th are good. So basically, no one knows what is going to happen.

An important note – while Medicaid receipts are below estimates largely due to a difference with the federal government on reimbursements, that difference is a one-time issue affecting only this fiscal year. Per person costs in the program have been stable, saving the state $210 million this year.

Guest blog: It's Not Patients’ Fault!

No, really, it's not our fault. According to a study published last month by JAMA Oncol, it is a myth that escalating health costs are driven by patients “demanding” tests and treatments. It simply is not happening. Rather, it would appear that responsibility for factors ranging from poor communication, to “defensive medicine”, to deliberate overpricing of various tests, procedures and medications, to manipulation and gouging by “big pharma” and outrageously high medical malpractice premiums that providers must cope with, must be passed on somehow. And like cancer treatment itself, it's cumulative. But in spite of all that, no, no indeed, it is not the patient's fault!

The JAMA Oncol investigation reports that in a study of over 5,000 patients with various cancers, including some of the most severe, less than one in ten (8.7%) asked for a particular treatment or intervention, and providers complied with most of these (83%), finding them clinically appropriate. Of the few that were found to be inappropriate, only seven (0.14%) were indulged. This is not a significant driver of costs. If this is true in oncology, where the patient stress level is very high and demands for anything and everything would be expected, it’s even less likely for less severe conditions.

Point two; it's not the Internet's fault either. Despite reports from some providers that the ease with which patients can obtain information about their condition and treatment options, is driving demand for excessive and expensive tests, procedures, etc. But this is another myth. And this myth is very confusing to patients, as we are constantly encouraged to bring lists of our concerns with us to appointments. We are told to come to appointments prepared to make the most of the short time we have with our providers. We are told that an informed patient “chooses wisely” and questions the need for extra tests and treatments but we are then blamed for doing our diligence, our lack of understanding what we are asking for and about, and for driving up the costs of care.

The fact is, that no matter how informed, misinformed, demanding or compliant a patient may be, we are still in your CARE. Unless we have a medical degree ourselves (and in the appropriate specialty, no less), we are always in a subordinate and vulnerable position. So you need to explain things and take our concerns seriously, not interpret them as threats. We want to be treated as individuals who deserve to have a respectful relationship with the person who helps us get healthy. Creating a collaborative relationship with patients will lower healthcare costs, not inflate them.

Gaye Hyre

Integrating behavioral health into primary care focus of next CEPAC meeting

The next CEPAC meeting will review the latest research on best practices to effectively integrate behavioral health into primary care practice. Up to 70% of physician visits include a behavioral health component. Patients with chronic conditions are more likely to experience mental illness as well and costs for these patients can be two to three times higher. Successful integration of behavioral health into primary care practice holds great promise to improve health outcomes, maximize capacity, and control costs. CEPAC is a New England group of researchers, consumers, physicians and payers that evaluates and translates the best information on treatment effectiveness into useable tools and policies to improve the quality and value of health care in the region. Past CEPAC topics have included evaluations of treatments for opioid addiction, breast cancer screening, and community health worker services. The meeting will be May 1st in Boston. Registration is free.

Medicaid MCOs not working in Missouri, inhibiting expansion, MO could learn from CT’s experience

Legislators are reluctant to expand Missouri’s Medicaid program because the managed care organization (MCO)-led program not as efficient as the traditional fee-for-service (FFS) program, according to a Kaiser Health News article. In a January presentation to the MO HealthNet Oversight Committee, agency representatives noted that while hospital admissions are lower in the population cared for by MCOs, but readmissions are higher. Five out of six clinical quality measures are also worse in MCOs than FFS. In the latest contract with the three MCOs -- Aetna, Centene and WellCare – Missouri is requiring the plans to take more responsibility for the health of Medicaid members, including wellness incentives. We should send MO officials CT’s experience shifting from MCOs to a care coordination-focused model – higher quality, more provider participation, and costs under control.

CTNJ Op-Ed: McDonald’s rejects chicken fed antibiotics

An Op-Ed today in CT News Junkie celebrates McDonald’s for refusing to sell food from chickens fed antibiotics. 23,000 Americans die each year from antibiotic-resistant superbug infections. Over use and inappropriate use of antibiotics has led many bacteria to become resistant (superbugs), rendering critical antibiotics useless. Experts are concerned that development of new antibiotics is not keeping up with the rise of superbugs. Up to 70% of antibiotics used in the US go to food-producing animals. Other restaurant chains that have made similar policy changes have benefitted financially. Student leaders, including the Op-Ed authors, who have been driving these policies, are hopeful that this signals a sustained change in markets.

Cutting HUSKY parents increases the total cost of care by $500 per person

The Governor’s budget proposal to cut 34,000 working parents from the HUSKY program into AccessHealthCT will increase the total cost of care for those parents by $500/year according to a new analysis by the CT Health Foundation. While the state will save $2,400 per person annually, two thirds of the cost shift will fall on working families, and only one third will be paid by the federal government. Unfortunately authors predict that between 7,000 and 10,000 of those parents will not be able to responsibly shoulder the families’ burden and will become uninsured. The other 25,000 that enter privatized coverage will face delays and denials of care due to much higher cost sharing in the form of deductibles and copays. Advocates are particularly concerned about pregnant women who will lose coverage and the impact on future health outcomes and costs. For more on what happened to working parents who lost HUSKY in past cuts and the impact on families, see our report In Their Own Words.

CT exchange premiums still fourth highest in US, negotiating premiums could help

 A new analysis by the Urban Institute comparing health insurance exchange premiums across the US finds that CT’s 2015 premiums are the fourth highest in the US, as they were last year. The study compares average monthly premiums for 40-year old, non-smoking state residents -- $348 in CT. Like last year, our premiums are higher than all states except Vermont, Alaska, and Wyoming. While CT’s premiums are high, they grew by only 0.6% over last year; nationally average premiums grew by 2.9%.  Premiums for Hartford residents averaged $321 monthly, a 1.5% increase over last year. Negotiating premiums for affordability is an important tool used by large employers and other state exchanges to lower premiums for consumers. But CT exchange and legislative policymakers have repeatedly rejected efforts to negotiate premiums on behalf of consumers.

Free dental clinic next weekend

The annual CT Mission of Mercy annual free dental clinic will be this Friday and Saturday at Western CT State University in Danbury. The clinic provides cleanings, fluoride treatments, extractions, fillings, limited dentures and root canals and X rays to people who can’t afford dental care. Interpreters are available. The CT Foundation for Dental Outreach and the CT State Dental Society started sponsoring the free clinics annually around the state in 2008. Last year in Hartford 2,295 people received over $1.5 million of dental care.

Health reform update – the power of price transparency, more SIM concerns

At an important Public Health Committee hearing Wednesday, Senate leaders from both parties testified together on a slate of seven bills that would make a great start to reforming health care in our state. Among other things the bills address facility fees, price variation that has no relation to quality, hospital consolidation oversight, EMR assistance for providers, health care price, cost and quality transparency, accountable care, and creates a badly needed CT Health Policy Commission, based on MA’s successful model. Together these reforms both address the acute needs facing our state, and build structures to anticipate and solve future problems, making quality coverage affordable and building value throughout the system. The bipartisan support is special cause for hope that CT can finally get beyond flawed, agenda-laden health reform planning with something constructive. The Senators, advocates, and others also testified in favor of a bill that would, among other things, create a study to consider better uses for the federal SIM grant funding.

As for SIM, yesterday the steering committee approved reductions in standards for Patient-Centered Medical Homes, considerably weakening health assessment, health literacy, and other provisions. At last month’s steering committee meeting, SIM staff over-rode the recommendations of the SIM consumer/provider/payer workgroup that spent months developing realistic standards that work for CT. In response to providers on the committee, the steering committee decided to expand practices assistance from only technical assistance in transformation to also include out-right grants of SIM funds to practices. In response to community organizations and others on the SIM committee, the grant decision was also extended to community organizations participating in SIM’s community connection program. Independent advocates have raised concerns about ethics and conflicts of interest in SIM planning and funding.