CTNJ reports on SIM conflict of interest in grant applications

Today’s CT News Junkie highlights the ethics loophole that has allowed a SIM steering committee member to apply for SIM funds to his organization. The loophole in the law, identified by the Citizen’s Ethics Board, is that appointees of the Lieutenant Governor are not subject to the Public Official’s Code of Ethics. The Code prohibits applying for funds an appointee has a role in directing and overseeing. The law defines Public Officials as appointees of the Governor or General Assembly; the Lieutenant Governor is not listed. Earlier this year advocates asked for an opinion from the Ethics Board, hoping to prevent conflicts, after receiving no answer to a sign on letter urging SIM to adopt the Code of Ethics. The Ethics Board is planning to ask the legislature to fix the loophole and has appealed to the Lieutenant Governor for SIM to adopt strong ethical standards in the meantime. That same steering committee member also appealed to a different SIM committee to change the rules allowing his organization to apply. Advocates on the committee agreed to the change finding that it was reasonable and made sense, but agree that the steering committee member should not have advocated personally for the change or applied for a grant.

Webinar: Caring for High-Need, High-Cost Patients – Lessons for Connecticut

Join us Monday, June 22^nd at 2pm for a webinar on best practices in complex care management for the most fragile and costly patients. Evidence is growing that we cannot fix our health care system without addressing the needs of the small number of patients with very complex and costly health problems. Luckily CT can learn from other programs across the US as we build reforms for our state and our Medicaid program.  On the webinar we’ll hear from Clemons Hong, MD, MPH, of Massachusetts General Hospital and Harvard Medical School. In addition to coordinating complex care management programs on the ground, Dr. Hong has written extensively about lessons learned across the country. Click here to register for the webinar.

CSG/ERC webinar highlights best practices for state exchanges, power of state-state collaboration

Last week’s CSSG/ERC health committee webinar highlighted just a few of the benefits of the collaboration between CT and MD’s state health insurance exchanges. Peter VanLoon, of AccessHealthCT, and Subramanian Muniasamy of the Maryland Health Benefit Exchange, described how sharing resources and lessons between their states has helped both exchanges improve over the last two years. Well beyond technical assistance, collaboration also touched on contracting out services (and what not to contract out), outreach, Medicaid integration, and customer service among other issues. Click here for a replay of the webinar.

Ethics Commission recommends SIM adopt conflict of interest policy, pursuing change in the law to close “loophole”

At yesterday’s meeting, the state Ethics Commission issued an opinion that, due to a giant loophole in the law, SIM committee and Consumer Advisory Board (CAB) members are not subject to the Code of Ethics for Public Officials but acknowledged significant potential for conflicted interests and so recommend that SIM adopt such a policy voluntarily. The Code prohibits members of committees like SIM from benefitting from decisions and funding related to their service on the committee. Unfortunately the statutory definition of a public official includes only gubernatorial and legislative appointees; the Lieutenant Governor appoints all SIM members.

SIM has been granted $48 million in federal funds to spend and intends to change the payment standards for CT’s entire $30 billion health system. If it works as intended, SIM’s decisions will touch every life in the state.

It is critical that all SIM decisions on standards of care and spending are ethical and not driven by self-interest. For six months, independent advocates have been trying to proactively prohibit conflicts of interest by SIM and CAB committee members to ensure the best decisions are made from the beginning. We did not want to file a “gotcha” complaint after a problem occurs, but to prevent them. Over the last six months, we made a proposal to the CAB and sent a sign on letter to the Lieutenant Governor urging them to adopt the Code of Ethics that applies to all other policymaking and grant making groups in the state. We have received no answer and no action has been taken. In January, we requested the opinion from the Ethics Commission.

Unfortunately in the meantime, exactly the situation we were trying to avoid has happened. A member of the SIM steering committee has applied for support for his organization under a $650,000 RFP issued by SIM. That same member appealed to another SIM committee that he is not a member of to ease their standards so his organization could qualify. The committee agreed and he then reportedly applied under the lower standards.

Advocates argued to the Commission that this could not have been the legislature’s intent and called for a change in the law to close the loophole and, in the meantime, for SIM to halt current procurements that violate the Code of Ethics. Commission members agreed and thanked the advocates for being proactive in preventing ethical violations. They discussed plans to seek changes to the law and to send their own letter to the Lieutenant Governor recommending SIM adopt strong ethical policies voluntarily until the law is fixed. Unfortunately the questionable RFP procurement is now in process.

Ten CT hospitals paid over $1 million to an employee last year

Ten CT hospitals paid over $1 million each in total compensation to 19 employees last fiscal year, according to a new DPH report. The lowest paid top employee was at Essent-Sharon (CT’s only for-profit hospital to date) and the highest was at Yale-New Haven topping out at $3.5 million. Sharon Hospital had four millionaires on staff, Yale-New Haven had seven, and the other eight hospitals had only one each. Fifteen millionaires were CEO/Presidents; others included clinicians (7) and other administrators (2). Most CT hospitals (19) did not pay anyone over $1 million last year.

Webinar Wednesday: Health Insurance Exchanges – States Sharing Resources, Solving Problems

Join CSG/ERC’s health policy committee for a webinar this Wednesday, May 20^th – Health Insurance Exchanges – States Sharing Resources, Solving Problems. We’ll hear from two states – Connecticut and Maryland – that shared expertise and best practices on health insurance exchanges. Depending on the Supreme Court’s ruling this summer in King v. Burwell, eight million Americans could lose federal insurance subsidies unless their states create state-based exchanges. The CSG/ERC webinar will be at 2pm May 20^th; click here to register.

CAB continues closed meetings to make decisions

Yesterday’s SIM Consumer Advisory Board (CAB) meeting to choose consumer representatives to SIM committees was again held in secret. An FOI complaint is pending over their lack of transparency. This time applicants were notified that their applications were being reviewed but less than 24 hours before the meeting. One applicant requested, as allowed under state law, to open the meeting and CAB complied by opening the meeting for discussion only of his application. Several speakers gave glowing reviews to his qualifications. The public was then asked to leave again while the CAB made their decision. The public re-entered the room and the CAB voted on a slate of recommended candidates, that did not include the member who received strong endorsements in the only public discussion. Despite the very strong quality of the applicant pool, two consumer representatives appointed to SIM committees include a representative of UConn, which is receiving large grants from SIM, and a person with only experience consulting for the insurance and hospital industries.

Applicants were not notified that they could ask for their application to be discussed in the open. At least one applicant wished they had known; they would have exercised that right.

One member of CAB asked why they were going into secret session to discuss candidates and if other councils did the same. The answer was no, that it is unusual, but that they might be discussing some applicants’ medical information. But that was not the case, according to reports, and the applicants were reportedly alerted in the application that the information they provide could become public.

We will see what the FOI Commission decides, but this doesn’t even come close to a transparent, open process and the taint remains. 

CSG/ERC webinar to highlight CT’s exchange services for other states

Join CSG/ERC’s health policy committee for a webinar, open to all, May 20^th – Health Insurance Exchanges – States Sharing Resources, Solving Problems. We’ll hear Peter VanLoon of Access Health CT, describe opportunities to assist other states with their exchanges. Depending on how the Supreme Court rules in King v. Burwell this summer, eight million residents of states now using the healthcare.gov exchange may lose federal insurance subsidies unless their state creates its own exchange. Some existing state exchanges have struggled with implementation over the last year but Connecticut’s exchange avoided most problems. Building on their success, Access Health CT is offering technical assistance and business services to states wishing to create or enhance their state-based exchange. The webinar will be at 2pm May 20^th; click here to register.

Community Health Worker Symposium

Learn more about Community Health Workers in CT at a Symposium sponsored by the Hispanic Health Council May 27^th from 8am to 2pm at the Mark Twain House in Hartford. Hear from CT hospital, academic, philanthropic and payer leaders about evidence-based models that integrate CHWs into clinical teams and community settings and options for sustainable funding. For more information contact Ivn Maldonado at ivanm@hispanichealth.com

CT conference on SIM payment reforms in other states

Yesterday the CT Health Foundation hosted an interesting conference highlighting SIM plans from leading states – VT, OR, MN, and ME. The conference started and ended with reports from CT’s DSS about our significant Medicaid successes in improving quality and access while controlling costs – and how that progress was only possible when we shifted from a financial risk, fully-insured model to one that focuses on care coordination and quality.

So it was unfortunate that the underlying assumption of the conference, stated often, was that the only way to move toward value-based purchasing is “moving up” the ladder of financial risk toward full capitation (at least they put those more risky models in orange on the slide). This is despite the opposite evidence from our own state. Nothing is simple and even economists are coming around to understand that theoretical incentives and financial risk are not the only drivers of health care spending or quality – not even close. In fact, CT’s Medicaid experience shows they can get in the way.

We heard a lot about other states’ payment reforms and impressive work to tie payments to quality. These states, and their SIM planners, deserve the credit and recognition for their accomplishments.  They have been at this a long time and have engaged all stakeholders in transparent, thoughtful planning processes. One best practice that resonated with the audience is that you should never underestimate the number of conversations needed and the need for clear communications and expectations. They all emphasized that reform won’t happen if everyone isn’t on board. Lisa Letourneau from Maine acknowledged that shared savings along isn’t going to really transform care. These states moved into reforms gradually, testing their progress at each step, and revising accordingly. However these states are different from CT in important ways that make a direct translation of their lessons to our state risky. I also know that while it was great to hear from state SIM officials and consultants from those states, we would have gotten a richer description of the challenges and lessons if the voices of consumers, advocates, legislators, and providers from those states had been included. 

The conversation also would have benefitted from a discussion of CT’s collaborative plans to build health neighborhoods for our state’s dual eligible beneficiaries – a model of thoughtful policymaking that includes shared savings but with good consumer protections and strong quality backstops. But overall, there was a lot of good information for CT.

May web quiz on CT adult health risk factors

Test your knowledge of health risks among CT adults. Take the May CT Health Policy Webquiz.

CT Medicaid/CHIP programs lost 11,019 members between January and February

A new CMS report found that enrollment in CT’s Medicaid and CHIP programs dropped by 11,019 (-1.5%) from January to February of this year. This is very usual, especially among states that have chosen to expand Medicaid under the ACA. Among expansion states, Medicaid/CHIP enrollment averaged 0.98% growth; even non-expansion states saw an average 0.43% expansion in enrollment. Four in ten CT Medicaid/CHIP members is now a child (40.56%), down from 55% at the end of 2013. Now you know the answers to the June webquiz.

CT health reform progress moving backward again this month

CT’s progress toward health reform dropped from to 27.0% this month mainly because of SIM setbacks again, but the Appropriations Committee’s vote to reverse many proposed budget cuts is a ray of hope to maintain Medicaid’s progress. A six-month delay to SIM’s rush into risky shared savings models is a good start to begin thoughtful Medicaid reform. Ethics, conflict of interest, and secrecy problems continue to circle SIM. The CT health reform progress meter is part of the CT Health Reform Dashboard.