25 CT hospitals decline to respond to Leapfrog quality survey

Only five CT hospitals reported quality and patient safety data to the Leapfrog Group this year – Bristol, Backus, Dempsey, Stamford and Windham hospitals. The hospitals that did report performed very well in general. Released this morning, the 2015 Leapfrog survey covers nineteen areas including maternity care, high risk surgeries, hospital acquired conditions and resource use. CT hospitals have not performed well in national quality rankings, including Medicare hospital readmission rates.

Community Care Teams addressing high-cost Medicaid member needs

Friday’s MAPOC Complex Care Committee meeting focused on Community Care Teams (CCTs) that collaborate across social service to help people with complex health problems. So far, seven CT communities are developing or already operating CCTs that focus on frequent ED visitors. The CCT teams include hospitals, behavioral health and primary care providers with community resources such as food and housing programs. CCTs include regular meetings of all partners, to review cases and align treatment resources, as well as dedicated staff to connect with patients and help them navigate the resources. At the committee meeting we heard from Middlesex County’s CCT, which started three years ago and has already achieved impressive reductions in ED usage and costs. The Middlesex CCT has saved an estimated $1.7 million in ED costs to date. Each ER visit avoided by a Medicaid member saves the program an average of $915.66. On behalf of DSS, CHNCT and the CT Behavioral Health Program both support and participate in CCTs across the state. Funds this year to support and expand CCTs across the state were cut from the state budget but there is optimism that funding in next year’s budget will be protected.

CTNJ Op-Ed on CT’s ACA progress covering the uninsured

Yesterday’s op-ed in CT News Junkie focused on CT’s mixed results in covering the uninsured under the Affordable Care Act. Read more

ACA and covering the uninsured: How did CT do?

An analysis of new Census data finds that 88,000 more CT residents had coverage last year than the year before, largely due to expansions under the Affordable Care Act. CT’s uninsured rate dropped from 9.4% in 2013 to 6.9% last year. However that drop was less than the US average and far less than other states like CT that expanded Medicaid. The drop in the uninsured was accompanied by a large increase in Medicaid enrollment, and a smaller increase in people directly purchasing coverage. About half the remaining uninsured are eligible for either Medicaid or subsidized coverage through AccessHealthCT, the state health insurance exchange. As in the past, CT’s remaining uninsured are more likely to be poor or near poor, less educated, non-citizens, work part time and live in Fairfield County. Employer-sponsored coverage dipped slightly last year, but it has been slowly declining for over a decade. In fact, the drop last year was less than the average annual drop since 1999. The ACA did not adversely impacted employer-sponsored coverage in CT.

Anthem, Aetna and CIGNA have 82.5% of CT health insurance enrollment

As always, this year’s managed care report card from CT’s Insurance Dept. is fascinating.  Anthem has 44% of total enrollment. Anthem is seeking to buy CIGNA for $54 billion; together they have 64% of CT enrollment. Aetna has 18.5% of enrollment, ConnectiCare has 9.2%, and Oxford/United Health Care has 6.8%. Enrollment is very low in CT’s two nonprofit insurers -- Healthy CT has only 0.3% of enrollment, and Harvard Pilgrim’s enrollment is less than a thousand people so far. The report includes 2014 medical loss ratios (MLRs) for each plan, including federal calculations and the more rigorous state MLR. The MLR is the percent of premiums that go to pay for medical care (and quality improvement in the federal calculation). Anthem’s HMO plans and all Oxford/United Health Care plans are below 80% on the state’s MLR calculation.

The report also has a wealth of useful information for consumers including customer service info, NCQA accreditation level, and number of providers by county and type. The report includes several quality measures including performance on cancer screenings, controlling high blood pressure and cholesterol levels, prenatal and postpartum care, drug utilization with costs, behavioral health, and member satisfaction.

Half of CT’s remaining uninsured eligible for subsidies or Medicaid

A new analysis by Kaiser finds that 47% of CT’s remaining uninsured are eligible for subsidized coverage. The latest Census report found that CT’s uninsured rate dropped by 2.5% from 2013 to 2014., but 6.9% of state residents are still without coverage. While 87,000 more residents gained coverage in the first year of the ACA expansion, CT’s progress lagged behind the US average (2.8%) and especially behind the average for states like CT that expanded Medicaid (3.2%). The new Kaiser analysis drills deeper into those numbers finding that half of the remaining 247,000 uninsured CT residents are eligible for either Medicaid (69,000) or subsides to purchase coverage on the exchange (62,000). Unfortunately 116,000 uninsured state residents do not qualify for subsidized coverage either because of income, an employer offer or immigration status. We have a lot of room to improve, to take advantage of the opportunities under the ACA and get affordable coverage to every state resident.

NJ conference on Medicaid ACOs – deep commitment to applying lessons learned

A CT contingent ventured to NJ last week for their 4thAnnual MedicaidPayment Reform Summit. The conference was sponsored by the QI Collaborative which is working with the state and private foundations to support accountable care in NJ’s Medicaid program. We heard from Jeff Brenner of the Camden Coalition about their impressive results in serving high-need, high-cost consumers through intensive and culturally appropriate outreach, robust provider collaboration, and strong links to social services. We heard about other effective high-cost, high-need programs from Baltimore, Boston, and New York. We heard from three ACOs that were certified for NJ’s Medicaid program and one that wasn’t but is still working toward accountable care. We heard from Jurgen Unutzer from the Univ. of Washington about what works, and what doesn’t, to effectively integrate behavioral health into primary care. Click here for slides. A panel talked about technology innovations that can support effective payment and delivery reforms. Fascinating information from people really doing the work.  NJ is well ahead of CT in designing thoughtful Medicaid reforms. We learned a lot.

CT Medicaid spending down 4.2% from FY 14 to FY 15

Happily CT’s Medicaid program is bucking the state budget trend. State spending on CT’s Medicaid program fell 4.2% between state fiscal year (FY) 2014 and 2015, largely due to higher federal reimbursements, according to an analysis by the Office of State Comptroller. Between FYs 2009 and 2015, Medicaid averaged 4.1% annual increases, lower than the state employee health plan at 4.4% and state retiree health insurance at 5.5%. According to the report, almost half of Medicaid spending goes to hospitals (28%) and to drugs (18%). Between FY 2014 and 2015, hospital spending dropped by 1.5% while pharmacy spending grew by almost 40%. The report points out that Medicaid “can have a growth rate that is consistent with or even below general medical inflation and still consume one of the largest dollar shares of the budget.”

CT MFP program success featured in Health Affairs

An article in this month’s Health Affairs describes CT Medicaid’s successful Money Follows the Person program. The study by UConn and DSS authors found that participants transitioning from institutional care to community settings reported better quality of life and life satisfaction that continued well after the transition. Some needed to return to the hospital or ER for a time, but only 14% returned to institutional care. Researchers were able to identify new predictors of re-institutionalization that will help improve the program and prevent the need for institutional care.

Administration agrees to more time to design Medicaid reform

Monday the administration announced that they will delay the redesign of CT’s Medicaid program by at least six months. In a letter sent last week by twenty one independent consumers advocates, concerns were raised about the rush back into a risky financial model that could cost increase state costs. Advocates were particularly concerned about jeopardizing recent quality, access and cost control gains in the program. 

October web quiz: Potential CT impact of the Cadillac tax

Test your knowledge of Connecticut employer health plans that may be subject to the ACA’s Cadillac tax. Take the October CT Health Policy Webquiz.

CT health reform progress down 4th month in a row

Unfortunately CT’s progress toward health reform is down again this month to 25.6%, dropping for the fourth month in a row. Medicaid’s rushed return to a risky financial model and recent provider cuts led the concerns. However Medicaid officials continue to consult with stakeholders in the design. Higher premiums on CT’s health insurance exchange added to the troubles along with SIM’s imprudent plans for community resources that are undermining Medicaid’s progress. The CT health reform progress meter is part of the CT Health Reform Dashboard.