CT exchange plans violating ACA women’s coverage protections

Researchers found eight violations in 2014 and thirteen violations this year of Affordable Care Act women’s coverage provisions by plans offered in CT’s insurance exchange. The new report by the National Women’s Law Center analyzed benefits and offerings of ACA-required services women need among marketplace plans in fifteen states. Violations in CT included breastfeeding supports and supplies, essential health benefits, and coverage for birth control. Other state violations also included genetic testing, prescription coverage, pre-existing condition coverage, maternity and preventative services. The Center working with local CT advocates were able to encourage state regulators to issue a bulletin to all insurers outlining legal requirements for coverage of birth control services.

SIM responds to advocates’ Medicaid concerns

Monday the Lieutenant Governor responded to a letter sent earlier this month signed by twenty independent consumer advocates and providers raising concerns about SIM’s plans for Medicaid. In her letter, the Lieutenant Governor agreed that CT’s Medicaid program has become a national model of success, improving access to care, raising quality and controlling costs. Those achievements resulted from our transition three years ago from financial risk models to care coordination – through person-centered medical homes and intensive care management. Advocates are concerned that SIM’s rushed return to financial risk models will unravel those achievements. Data systems and policies are not ready to carefully monitor financial incentives in de facto downside risk arrangements, or to identify and correct under-service driven by the new incentives. The advocates’ letter urges the administration to learn the lessons of the spectacular HUSKY MCO failure and consider well-tested, better options that have greater potential to improve quality, coordinate care and further control costs.

In her letter, the Lieutenant Governor understands our concerns and has agreed to delay implementation of the new Medicaid plan by six months. That is a good start; hopefully it will be sufficient to protect people and hard-won progress. In any event, the advocates remain committed to work constructively with the administration toward the common goal of developing a value-based program.

Appropriations Committee restores most of the Governor’s proposed health care cuts

Today the Appropriations Committee released their budget, restoring most of the deep Medicaid cuts the Governor proposed in February. The committee rejected the Governor’s proposal to cut 34,000 working parents and pregnant women from HUSKY coverage. The committee also restored funding, accounting for inevitable delays, for the innovative health neighborhoods pilots to coordinate care for fragile state residents eligible for both Medicare and Medicaid. The committee also restored much of the Governor’s proposed cuts to Medicaid provider rates. The committee also cut in half spending to implement SIM’s controversial plan for Medicaid.

Backgrounder on Hartford health needs for Malta House of Care

Last week CTHPP gave a presentation for the Malta House of Care on health care needs in Hartford and health care trends. Malta provides free primary care to Hartford’s uninsured with volunteer providers and a mobile van that travels to neighborhoods in need. Given seismic shifts in the health care environment that affect both their patients and volunteer providers, Malta House of Care is developing a strategic plan to ensure that they continue to meet the community’s needs into the future.

National health disparities summit coming to CT

June 12^th and 13^th the UConn Health Center will host the National Health Disparities Elimination Summit. Dr. Louis Sullivan, former HHS Secretary, CEO& Chairman of the Sullivan Alliance and President Emeritus of Morehouse School of Medicine, will be the keynote speaker. The conference is sponsored by UConn, the CT Institute for Clinical and Translational Science, the Cobb Institute, and CT’s Legislative Black & Puerto Rican Caucus. Click here for the agenda and to register.

Some possible, potential, small, but encouraging good state revenue news

With big disclaimers, the CT Mirror is reporting very early indications are that CT is having a good tax season. It may be premature, but right now it looks like April tax receipts are up slightly above even the very optimistic projections in the Governor’s budget. Hopefully this gives the state some room to reject proposed health care budget cuts. Let’s all cross our fingers as DRS opens more mail.

Weeds you should understand

A great NY Times Upshot article describes, in normal English, the difference between mortality and survival rates. They do sound the same, but aren’t. The article starts out with two cancer studies seem to have reached opposite conclusions. (These things really bug me because it leads people to throw up their hands and doubt all science.) Read down to the example of thumb cancer (not a real thing). I’ll be using this example with my students often.

In a related Health Affairs article, researchers estimate that false positive breast cancer results cost the US health system $4 billion annually in unnecessary treatments including more imaging, biopsies, surgery, radiation and chemotherapy.

MAPOC committee beginning work on shared savings program redesign

The MAPOC committee that is working with DSS to redesign Medicaid under the SIM directives met Wednesday to begin the process of designing a shared savings plan. The plan will be called the Medicaid Quality Improvement and Shared Savings Program (MQISSP). In good news, DSS was able to secure from SIM a delay of six months in the ridiculous timeframe. In bad news, six months is nowhere near long enough to build a new program and ensure consumers are protected, but it is better than the original plan. In very good news, we understand that the process will be driven by MAPOC, not SIM, and DSS will make all final decisions. SIM representatives are at the table, but DSS and legislators have emphasized that they value PCMH committee members’ input. DSS is very open to working with stakeholders on the process and issues to be considered. The committee agreed to create workgroups for both efficiency in this exceptionally short timeframe and to expand the voices at the table ― which is always good news.  A plan for those is forming.

The first set of decisions will be around quality. The committee has done some preliminary work on this area and DSS was very open to input, incorporating some of the committees’ suggested metrics.

Community rally about Bradley Hospital inpatient beds

The Community Committee to Save Bradley Hospital will be holding a rally April 26^th at 2pm, at the Southington Historical Society, 239 Main St. Southington, rain or shine, to convince leadership at Hartford Healthcare to retain inpatient beds at Bradley Hospital. The committee was able to convince leaders to keep the ER at Bradley open, but are still working to retain inpatient care beds. The hospital was originally donated to the town by the Bradley family; there will be exhibits about the Bradley family and the hospital at the rally. For more information, call Bonnie at 860-621-9553.

Only 36% of CT physicians have any shared savings arrangements, correcting questionable SIM estimates from 2013 driving expansive policy

UConn’s new SIM survey of CT physicians found that currently only 36% of CT physicians participate in any shared savings or ACO program. There is no information on whether shared savings are a significant part of revenues in even the minority of physicians who are in this payment model. Not surprisingly, shared savings is slightly more prevalent among physician owners of practices. This new number, based on a proper randomized survey, is far below SIM’s questionable assertion in September 2013 that 62% of CT physicians had shared savings contracts, and the number was growing quickly. At the time, advocates and provider groups raised significant concerns about the accuracy and methodology used to generate this number. Unfortunately, that number was used at the time to argue that shared savings was prevalent in our state and there was no danger to including strong SIM policies to compel the payment model across the entire state. This points out the critical need for good, unbiased data to drive policy decision-making in CT reforms.

The survey includes other interesting information. Busting another myth, 73% of physicians working in CT Patient-Centered Medical Homes are from small or medium-sized practices. Thankfully a SIM steering committee member pointed out that while only one in three physicians believe PCMHs improve the quality of care, you would get a very different answer from consumers. There is strong evidence in the literature and here in CT’s Medicaid program of improved quality in PCMHs. Echoing almost exactly CDC’s recent survey, UConn found that 73% of physicians are accepting new Medicaid patients. This is up from 61% in a survey from before Medicaid shifted its financial model away from risk to the current model that emphasizes quality and care coordination.

20 independent advocates share concerns about SIM’s plans for Medicaid

Yesterday twenty independent consumers, advocates and providers sent a letter to the Lieutenant Governor expressing our grave concerns about the “current plans for widespread precipitous changes” in Medicaid’s payment model. The letter outlines concerns about re-imposing financial risk, this time on providers of care, that creates incentives to deny needed care. States with far more experience than ours in successful reform are struggling to make this work. At the least, taking time for thoughtful policymaking and consensus building, is essential to avoid unraveling the hard won success. We remain “fully committed to building value in our system and linking incentives to quality care while protecting consumers.” And we remain committed to working collaboratively toward those shared goals.

Tolland County healthiest in CT; New Haven County least healthy

According to County Health Rankings and Roadmaps, overall residents of Tolland County are the healthiest in our state, but there is wide variation between measures. For instance Tolland County scored lowest among CT counties in physical environment with the highest rate of drinking water violations and long commutes driving alone. Tolland County is lowest in premature deaths, but neighboring Windham County ranked highest in that measure, with residents 38% more likely to die prematurely than Tolland county residents. Middlesex County ranked first in quality of life and social/economic factors; Fairfield County residents did best in health behaviors and the lowest rate of preventable hospital stays. Fascinating comparisons.

Big improvement -- almost three out of four CT physicians accepting new Medicaid patients

A new analysis by the Centers for Disease Control finds that 72.5% of CT office-based physicians accepted new Medicaid patients in 2013, better than the US average of 68.9%. This is a big improvement over a different survey in 2011 finding that only 60.7% of office-based physicians in CT were accepting new Medicaid patients – the fourth worst rate among states at the time. This improvement is no doubt due in large part to dedicated efforts at DSS since 2011 to address serious challenges to provider participation in Medicaid and the resulting quality and access improvements. This good news couldn’t come at a better time, with over a hundred thousand new members joining the program in the last year due to the Affordable Care Act expansion. However there is more work to do – 13.6% more CT physicians accept new Medicare patients than Medicaid and 18% more accept new privately insured patients. We are also behind our neighboring states of MA (76.0%) and Rhode Island (71.0%), but well ahead of New York (57.1%) in Medicaid participation. New Jersey is lowest in the nation with only 38.7% of office-based physicians accepting new Medicaid patients.

April web quiz on premiums in CT’s exchange

Test your knowledge of premiums in CT’s health insurance exchange. Take the April CT Health Policy Webquiz.

A Better Idea for SIM-Medicaid: Coordinate Care for High-Need, High-Cost Patients

Independent consumer advocates and others have raised grave concerns about Connecticut’s State Innovation Model (SIM) plans to radically change financial incentives in our state’s Medicaid program. The experience of other states offers a proven alternative, targeting resources toward high-need, high-cost patients, that would protect the impressive success we’ve achieved in the last three years. This alternative meets the same goals of improving health outcomes and further controlling costs without the dangers of broader incentives to reduce care. Read more

CT health reform progress moving backward

CT’s progress toward health reform dropped from 29.0% to 27.4% this month mainly because of SIM setbacks and state budget cuts. Both implemented and new proposed cuts to Medicaid provider rates threaten significant progress over the last three years. Cuts to the promising health neighborhood project and a rush into risky shared savings models threaten future Medicaid progress. Ethics and conflict of interest programs circle SIM. The only bright spot is a slate of bipartisan Senate bills promoting transparency, stabilizing hospitals, and building toward future reforms. The CT health reform progress meter is part of the CT Health Reform Dashboard.

Unfortunate SCOTUS decision limits Medicaid provider rights

A decision yesterday by the US Supreme Court reversed a Ninth Circuit decision and ruled that providers do not have the legal right to sue a state Medicaid program under the federal Medicaid act. Armstrong v. Exceptional Child Center involved an Idaho clinic suing the state because rates were too low to ensure adequate access to care, as required under federal law. The Court ruled that only the federal Medicaid agency can enforce that provision of law. Advocates are deeply concerned about the implications for access to care and protecting fragile consumers’ health in the program.