Hartford Business Journal 2016 economic outlook including health care

The Hartford Business Journal is looking ahead to next year for trends, predictions and stories to watch in CT’s economy. Health care contributors included Matt Katz of the CT State Medical Society, Elliot Joseph of Hartford Healthcare, John O’Connell of the CM Smith Agency and Ellen Andrews of the CT Health Policy Project. Trends included the impact of market consolidation, protecting Medicaid’s progress, insider advantages in policymaking, HIT, medical liability, the feasibility of independent practice, new care coordination models, the Cadillac tax, price and quality variation, health care’s role in CT’s economy, a shift to consumer-focused care, and that coverage doesn’t necessarily equal access. Interesting reading -- lots of overlap despite different perspectives.

Advocates urge SIM not to disrupt successful Medicaid PCMH program

In a letter to SIM steering committee members, the Medicaid Study Group urged support for DSS’s decision to build Medicaid reforms on the successful person-centered medical home program. Specifically the Group applauded DSS’s decision to only include members served by certified PCMHs in the new, untested shared savings model being planned for Medicaid. The Medicaid Study Group includes over twenty independent consumer advocates who’ve taken a deep dive into research surrounding Medicaid reforms. Under the PCMH program, quality of care in CT’s Medicaid program has enjoyed sustained improvement, rivaling private coverage in many cases, while at the same time controlling the total cost of care. There is ample evidence of the benefits of PCMHs across states, payers and programs. Advocates are concerned that practices that do not reach PCMH standards may not be equipped to serve Medicaid members’ needs adequately in the new program. The advocates urged SIM to respect the hard work of all Medicaid stakeholders to improve the program in their recommendations to DSS.

British medical humor for the holidays

Formerly known as the British Medical Journal, the BMJ Christmas issue is out with critical additions to the scientific literature such as a study of doctors’ coffee purchasing at work (surgeons drink the most, hierarchical position is positively correlated with high consumption and generosity in paying for others’ coffee) and the growing frequency of quotes from Bob Dylan songs in the scientific literature (the study was inspired by a long-running bet among scientists at a Swedish institute over how many they could sneak in, apparently “The Times They are a-Changin” is most frequently cited overall).  For the last 35 years, BMJ’s last issue of the year has included novel, sometimes irreverent, often Christmas-themed articles. Unlike April Fool’s, the articles must meet the same rigorous scientific standards as the rest of the year. Prior issues have included a scientific explanation of why Rudolph’s nose is red (more blood vessels), debunking a Danish myth that people can get drunk by soaking their feet in alcohol, and a survey of sword swallowers’ medical issues. My favorite this year is Rejection of Rejection – Overcoming Barriers to Publication. The bane of academic life, leading scientific journals reject 80% of submissions. The piece includes a form letter response to a returned article thanking the journal for the rejection, but adding “Unfortunately we are unable to accept it at this time.” It goes on to explain that the author, as you might imagine, receives many rejections every year and is unfortunately unable to accept them all. I think advocates should expand the concept. We could refuse to accept state budget cuts, the death of an important bill, or the loss of HUSKY eligibility for parents. This has potential.

Advocates offer comment on MQISSP design proposals to date

As requested, the Medicaid Study Group has drafted comments to DSS on current design proposals for MQISSP, CT’s Medicaid reform plan. The Medicaid Study Group, with over twenty independent consumer advocates, has taken a deep dive into the health reform literature and the experience of Medicaid reforms in other states, and providing feedback and recommendations to DSS as they design MQISSP. Our latest comments address concerns about networks that include non-person-centered medical home (PCMH) practices. We are especially concerned about the danger of internal cherry-picking which could result in moving patients who need it most out of PCMHs, and overspending in the program by segmenting risk and generating false “savings”. We offer suggestions to mitigate that risk. The comments also address communications, governance, entity oversight, Community Care Team inclusion, the role of SIM’s CCIP program, procurement, and shared savings methodology and distribution.

Briefing focuses on CT nurses’ role in improving population health

The CT Nursing Collaborative-Action Coalition held a briefing today on Building a Culture of Health in Hartford with the CT League for Nursing and the Robert Wood Johnson Foundation. Sue Hassmiller from RWJ briefed the audience on the critical role of prevention and population-based services in improving health and the central role of nurses in that effort. One RWJ program pairing visiting nurses with high-risk families returned $5.70 for every dollar spent supporting pregnancy and early childhood. She emphasized that much of health outcomes are outside the traditional medical system, commenting that “the choices we make are based on the choices we have.” The CT Nursing Collaborative-Action Coalition is working to build healthier communities in our state through a strong, diverse nursing workforce. Efforts include engaging nurses to serve on Boards,  developing models to help nurses progress up the career ladder, and creating an online tutorial for population health concepts. A new survey of RN and LPN programs in CT found that most students are ages 22 to 25 (RNs) and 26 to 30 (LPNs), most faculty teach part time, and the vast majority are white.

December web quiz: CT Medicaid quality

Test your knowledge about the improvements in quality of care in Connecticut’s Medicaid program. Take the December CT Health Policy Webquiz.

Medicaid update: New data on high-cost, high-need members

Friday’s Medicaid Council meeting focused on CT’s participation in a national technical assistance program to identify and meet the needs of high-cost, high-need patients. This population has received a great deal of attention from policymakers as the best opportunity to both improve access and quality of care as well as control costs. The concept offers exceptional opportunities for CT’s Medicaid program, that cares for some of the state’s most fragile and costly residents. An initial look at the top 10% of children and adult CT Medicaid utilizers, measured by total spending, ED use and inpatient care, finds 4,385 adult and 3,913 child high cost members. Fortunately, there is little evidence of racial or ethnic disparities among high-need Medicaid members in CT – likely due to DSS and CHNCT’s substantial outreach efforts. However both inpatient admissions and total costs among high-need adults are more than twice the rate for high-need children. More study is needed to determine the reason(s). The program offers exciting potential for data-driven solutions targeted to specific problems and great potential to save money in the program.

CT tied for fifth among states in health system performance

CT’s health system performs better than 45 other states according to the 2015 Commonwealth Fund State Scorecard on State Health System Performance. We improved on eight metrics, but lost ground on four. States are ranked on 42 indicators such as avoidable hospitalizations, health risk behaviors, childhood vaccinations, and hospital patients discharged with information to help recover at home. CT did well on all but one distinct dimension of health system performance. CT was tied for fifth in Access and Affordability of Care, ninth in Prevention and Treatment, tied for second for Healthy Lives, and third in Health Equity. However CT ranked far lower at 28^th among states on Avoidable Hospital Use and Cost. The rankings offer Connecticut guidance to improve health system performance especially around avoidable hospitalizations.

Report details dangers of hospital consolidation, especially YNHH and L&M

A new report by a coalition of labor and consumer advocacy groups including the CT Health Policy Project, calls for caution and more study before the state approves pending hospital consolidations. Concentration in CT’s health care system is being driven by new, untested shared savings payment reform models being adopted in Medicare, Medicaid and private insurance plans. CT already suffers from a highly concentrated hospital market, with the fourth highest health care costs in the US but lagging quality. Twenty years ago all CT hospitals were independent, but if pending mergers across the state are approved, 80% of inpatients will be cared for in large, multi-hospital systems. The report highlights Yale-New Haven’s proposed acquisition of L&M’s hospital system and “slow motion” takeover of Milford Hospital facilities and functions. This consolidation, if approved, would further consolidate the market in CT’s currently most concentrated market. Studies find that consolidations in already concentrated markets can raise prices by 20%. The authors urge policymakers to study the impact of current mergers, determine the impact on prices, access and quality of care, and develop protections to ensure value and protect consumers.

CT health reform progress meter ticks up slightly

December’s CT health reform progress meter ticked up very slightly this month. Medicaid redesign planning is still on track, working collaboratively with all voices at the table. New Medicaid quality data confirms the program’s improvements and the number of person-centered medical homes in the program passed 100. However that good news was balanced by troubling news on the fate of the first HUSKY parents cut from coverage, SIM ethics problems continue and SIM’s push to make their new, but not promising CCIP program a mandatory burden on new Medicaid networks. In other good news however, an RFP went out to hire health planners for the study of CT reform options from SB-811 last session. The CT health reform progress meter is part of the CT Health Reform Dashboard.