Cadillac tax will affect 13.6% of single premiums in CT in 2018

Under the Affordable Care Act, in 2018 high cost employer-sponsored health plans will begin paying a hefty 40% tax, termed the Cadillac tax, on the value of the plan over specified threshold levels. A new report by the Congressional Budget Office estimates that 13.6% of CT single premium plans and 11.9% of CT family plans will exceed the threshold and trigger the tax.  The 2018 threshold levels will be $10,200 for single premiums and $27,500 for family plans, with modifications for some groups. As the threshold levels for the tax will rise every year linked to the rate of general inflation, experts expect the 2018 national percentage of plans subject to the tax to rise from 10.2% single and 6.0% of family plans to double or triple those rates by 2028. Proponents of the tax argue that it serves as a powerful incentive to control health costs, but opponents feel it is unfair to groups with high cost workers or those who negotiated their compensation to favor health benefits. Congress is considering proposals to repeal the tax.

CSG ERC health panel shares innovation lessons, resources for policymakers

Today’s Health Policy panel at CSG/ERC’s Annual Meeting in Wilmington DE focused on health care innovations that build value. States shared lessons learned and resources.  We heard from Heidi Louise Behforouz, MD of AnansiHealth and Brigham and Women’s Hospital about the value of including community health workers into the health team. We also heard from Jeff Brown of NJ’s Quality Improvement Collaborative about that state’s plan to move Medicaid members into Accountable Care Organizations, by improving access to quality care and using the resulting savings to improve community health. We heard from Kerri McGowan Lowrey, J.D., M.P.H. of the Network for Public Health Law -- Eastern Region about the rich resources and technical assistance their project provides to Eastern Region policymakers seeking help with public health law and analysis. And finally we heard from Secretary Rita Landgraf of Delaware’s Department of Health and Social Services about innovations in their state. As with ten other ERC states, DE has been awarded a State Innovation Model grant from CMMI. But understanding that all stakeholders need to be engaged and involved for successful reform, DE has chosen to create a nonprofit to shepherd patient-centered reform in their state. For the effort, DE has devoted $100 million in state funds to supplement $30 million in federal funding.

SIM update, equity planning questions

At Thursday’s SIM steering committee meeting in public comments, SB Chaterjee raised concerns about DPH’s planning to address health equity. Important planning meetings occur in closed meetings, without public notice or minutes. (Sound familiar?) Questions were also raised about how federal funds have been spent and the required conflict of interest policy is not available. (Also familiar). But in contrast to SIM, DPH’s representative had the right answer. He thanked SB for raising the issues, DPH is taking the concerns seriously, are looking into answers for his questions, and will work to make all meetings public. (That’s how advocacy is supposed to work.)

Consultants gave a presentation on the SIM Practice Transformation Task Force’s (PTTF) plans for a Community and Clinical Integration Program. CCIP is meant as a resource of services in the community, clinical and non-clinical, to supplement PCMHs. It was reported that it will focus on Medicaid’s reforms and will be a requirement in DSS’s RFP for networks to receive shared savings. The consultants reported that the PTTF has made important decisions about the target populations, core elements of the program, and program design. They are now finalizing standards for the program. Target populations that Medicaid networks can choose among for care management include complex patients, people experiencing equity gaps, and people with behavioral health needs. They plan to develop an algorithm to identify target patients. There was a great deal of discussion about consulting with other SIM committees and aligning with SIM’s goals. Connecting with Medicaid, or its existing, very successful Intensive Care Management program and existing risk profile data work was not mentioned. PTTF leadership sitting in at the table made it clear that decisions are still being made and nothing is set in stone.

There was a presentation on CAB’s communications plan to explain SIM to consumers and get feedback. There were several recommendations from steering committee members to include both the risks and benefits of shared savings, especially risks of underservice. One member felt it was too early to be talking with consumers about reforms, it would be too confusing for them and the minutes of SIM meetings are available online, but other members disagreed. CAB’s representative agreed to bring the comments back to the committee.

Evaluators for SIM proposed creation of a Rapid Response Team, with membership similar to the Steering Committee, to monitor progress toward SIM’s goals, such as moving half the state’s population into shared savings by 2017 and 88% by 2020. If the state doesn’t reach SIM’s goals, the team would enact policy changes to move faster. It was suggested that it would function like a SWAT team. There was no discussion of who would appoint members to this very powerful, new committee or if their work would be public. (See above) However, the Steering Committee didn’t see the need for a new committee that would replicate their functions.

CTNJ op-ed: Insurers blocking underservice protections, again

Consumer protections had a good start in Connecticut’s latest health reform plan. But, as always, the devil is in the details. Unfortunately insurers are working to sabotage those protections to benefit their bottom line.

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Testimony FOI never got to hear

Last week the Freedom of Information Commission held a hearing on my request for SIM documents related to their Consumer Advisory Board’s (CAB’s) votes on appointments to SIM committees. Those committees are making very important decisions about CT’s $30 billion health care system and ethical questions have been raised about committee members receiving substantial SIM grants. I also asked for an opinion about CAB’s secret meetings to choose those representatives. SIM objected to submitting my prepared testimony so it was not allowed. Questions have been raised about the adequacy of SIM’s response to the FOI request. For example, their response included only one ballot from voting on the second round of candidates. If that had been the only vote cast, the outcome would have been different. There are seventeen CAB members and the FOI response included about a dozen ballots from voting on the first round of candidates.

CT still lags most states in Medicare hospital readmission rates

According to Kaiser Health News, ninety percent of CT’s acute care hospitals will be assessed a penalty by Medicare because of high readmission rates, starting October 1^st. 54% of US hospitals will be penalized this year for the percent of Medicare patients with certain conditions who return to the hospital within 30 days, down slightly from last year. As for last year, CT is second highest among states in the percent of hospitals facing penalties, behind only NJ. CT’s rate of penalized hospitals has changed little since last year, however the average penalty per hospital jumped from 0.22% last year to 0.66% of revenue this year. This year the highest penalty rate goes to Milford Hospital, followed by Middlesex and Johnson Memorial. Experts estimate that half of readmissions could be prevented by improving care including more clear discharge instructions, coordinating with community providers, and reducing complications during hospital stays. Other quality-based Medicare hospital bonuses and penalties will also begin in October.

New Gallup survey finds CT uninsured rate down more than half

Contrary to early CDC numbers, a new survey by Gallup finds that CT’s uninsured rate dropped from 12.3% in 2013 to 5.0% for the first half of this year. CT’s drop was similar to other states that chose to both expand Medicaid and create a state-based health insurance exchange. Rhode Island is tied with Oregon for the third biggest drop in uninsured rates among states, from 13.3% to 2.7%. An early CDC survey published in June found that CT’s uninsured rate had dropped very modestly from 9.1% in 2013 to 7.0% last year.