CT Health Reform Dashboard redesign

Two years after the main Affordable Care Act expansions were implemented and almost six years after it became law, we’ve re-designed our CT Health Reform Dashboard to reflect the changing challenges and opportunities. Most of the 125 tasks and decision points in the original progress meter have been set in place. New opportunities to reform our health system are now occupying policymakers. The new dashboard includes a quick look at the status of CT reforms, a list of action items to ensure the reforms are effective and a more detailed breakout by issue area/silo with links to more information. We will still update the dashboard every month. We welcome feedback on items and content.

The archives are still available, as a reminder of what CT did, and didn’t, accomplish in the last four years.

Benefits of sponsoring out-of-state trips for policymakers

A new Health Affairs blog highlights the benefits of learning trips for state health policymakers working on systemic change. The author, President of New Jersey’s Nicholson Foundation, notes that out-of-state trips are very effective in fostering new perspectives on problems and finding innovative solutions.

“The Nicholson Foundation is dedicated to addressing the complex needs of vulnerable populations in New Jersey’s urban and other underserved communities. Over the years, we have sponsored many trips that have sent hundreds of New Jersey health leaders beyond the Garden State to study approaches used and innovations practiced elsewhere. The knowledge these leaders have brought back has helped transform how care is delivered at home.”

We couldn’t agree more. A delegation from CSG/ERC’s health committee visited New Jersey in October for a conference sponsored by the Nicholson Foundation, to hear more about New Jersey’s success with high-cost, high-need Medicaid members. We learned a lot and bought their experience and best practices back to Connecticut. It’s great to hear others who appreciate the value of travel and policymakers learning from each other; CSG/ERC has been doing this since 1933.

Article finds Medicaid managed care offers mixed results

Echoing CT’s experience, researchers writing in the Journal of Managed Care & Specialty Pharmacy found little evidence that states’ rush to move Medicaid members into risk-based commercial managed care plans has saved money or improved quality. Currently half of all Medicaid members nationally are enrolled in these plans. States moving to commercial managed care are seeking cost reductions, budget predictability, and improved access to care. While capitation does provide short term budget predictability, evidence for overall cost control or improved access to care is lacking. The authors also note that most states, like CT, without commercial plans have already taken advantage of managed care’s main tools, including intensive care management, patient-centered medical homes, disease management and prior authorization. Consequently there is little opportunity for more improvement by simply switching to a different form of management. In fact, since switching away from commercial plans, CT’s Medicaid program has experienced significant savings along with improvements in both quality and access to care.

Radiologists’ cuts discussed at Medicaid committee meeting

Friday’s MAPOC Complex Care Committee included a presentation on the cut to radiologists’ rates this last session. Representatives of the Radiological Society of Connecticut outlined the across-the-board cuts effective last April that dropped payments for interpreting images from 100% to 57.5% of Medicare rates, lower than rates paid by other states. The physicians are concerned that the cuts will impact Medicaid members’ access. Many private offices are no longer able to accept Medicaid patients who are shifted to hospitals which are paid higher rates than community providers. The presenters predicted that the state may not realize any savings, and consumers will have fewer options for care. Cuts were proposed to many specialty rates last year; all but radiologists were restored in the final budget. DSS stated that imaging rates are in line with other specialties, with other states, and that the state budget is very tight and cuts were necessary.

CEPAC coming to Connecticut – effectiveness of palliative care

The March meeting of CEPAC, New England’s comparative effectiveness council, will be in Hartford on the 31^st at the Bushnell. CEPAC is an independent council of clinicians, academics and consumer advocates who take a deep dive into research around treatments for specific conditions, sorting out and voting on clinical effectiveness, but also which are worth the money specifically for New England. Previous meetings have addressed opiod addiction, breast cancer screening and depression treatments. CT is well represented on CEPAC by Rob Aseltine and Stacey Brown of UConn, practicing physician Claudia Gruss, Claudio Gualtieri from AARP-CT, Julie Rothstein Rosenbaum from Yale, and Rob Zavsoki, DSS’s Medical Director. The March 31^st meeting will address Palliative Care: Barriers, Opportunities and Considerations for Quality Improvement. Very smart, independent people discussing how to do the best thing for patients and pocketbooks on the issues vexing the health system. We are lucky to have them coming to our state. Click here to register for the free meeting.

Health care not immune from gender wage gap, but the size depends on your job

American women workers make 82.5 cents for every dollar men do, according to 2014 data from the US Bureau of Labor Statistics. However that ratio varies considerably by industry from 91.3 in construction to 56.7 cents in legal positions. In health care support positions, women so better than average American women but still 87.9% of men’s wages. But worse, for women health care practitioners and technical positions make only 78.3% of men’s wages, the 9^th worst gender wage gap among all 22 industries. Health care support positions include aides, medical and dental assistants. Health care practitioners include doctors, nurses, lab techs and medical records technicians.

CT Mirror reports on drop in per person Medicaid spending

Friday the CT Mirror reported on the remarkable falling cost of care for Medicaid members, down 5.9% just last year. The program now covers one in five state residents, more than any other government or private plan. Reasons include changing four years ago from a traditional insurer model to a single administrator, progress getting care for fragile members in their homes and communities rather than nursing homes, emphasizing primary care for all members, and intensive care management for high-need members. Budget cuts may have also contributed. Unlike other states, in 2012 CT replaced a poorly regulated managed care industry with the current data-driven, care management-focused system that rewards quality – both members and taxpayers are seeing the benefits. ER and hospital visits are down, access to care is up, and more providers are taking Medicaid patients. Other states are taking notice.

Health care as economic driver in CT

CT By the Numbers is reporting on the CT Health Council’s campaign to highlight the importance of the health care industry in our state’s economy. The Council, a group of health care industry leaders, has installed a set of posters this month in the LOB to make the point. For example, CT’s health care sector has grown 12.5% over the last seven years and now employs 266,400 in our state. All true – agree completely. But CT is not unique in this. A very revealing slide show from the Bureau of Labor Statistics shows that in 2013 health care/social assistance was the largest employer in all but 16 states, up from zero in 1990.  

Consultants hired to study options for CT to improve value in health care purchasing

Bailit Health has been hired to work with the Healthcare Cabinet for a study to identify successful practices in other states and make recommendations to the General Assembly by Dec. 1^st. Researchers will collect successful cost containment practices from other states and identify factors that are driving health care cost growth in CT.  Recommendations will include a system to monitor costs, identify high cost providers, and assist them to improve value as well as development of insurance standards that reward value, and policies to mitigate cost drivers. The researchers emphasized that every state is different and they will ensure that the recommendations will be tailored to CT’s unique features. The study was included in SB-811 passed last year; advocates sent a sign on letter supporting the study and offering to help.

How CT can save $1 billion

Per person costs in CT’s Medicaid program fell, actually went down, by 5.9% last year. If the rest of CT’s state budget could match that performance, we would have a $1 billion surplus. Following is my list for how we could spend it (this was fun).

·      Reverse the HUSKY parents cut

·      Reverse the Medicaid provider cuts

·      Restore funding for Health Neighborhoods for people eligible for both Medicare and Medicaid

Then with the remainder:

    ·      Forgive student loan debt, lower higher education tuition

·            Public transportation – so we can eliminate traffic jams from our state

·             Free state park admission

·            Support for affordable, nutritious food, safe places to exercise, and smoking cessation for anyone who wants it

·            Tax breaks

·            Ice cream for everyone
 

A little perspective -- health care is expensive, but less than housing or transportation

In 2013 Americans of all ages devoted more of total household spending to housing and transportation than health care, according to the Bureau of Labor Statistics. For most age groups that year, health care spending was also behind food and pensions/Social Security. Spending on health care peaked for ages 65 to 74 at $5,188/person; children spent the least at $943. Americans under age 34 spent more on entertainment than health care on average and children under age 25 and seniors age 75 and older spent more on clothing than health care.

Medicaid still saving $ hundreds of millions

Four years after shifting from managed care organizations to a care-management focused program, CT’s Medicaid program continues providing significant relief to the tight state budget. At today’s Medicaid Council meeting we learned that per person spending was down 5.9% from FY 2014 to 2015, saving the state $360 million just last year compared to no change. Nationally however, per person Medicaid costs are growing, averaging +1.3%/year from 2011 to 2014. So CT’s savings are even greater. Per person costs for HUSKY D members, which includes new eligibles under the ACA, are about equal to the average for the program, suggesting that the reduction isn’t because we added a low cost population. Given that the reductions have continued long after the switch away from capitated MCOs four years ago, the savings are likely due to the new model. Person-centered medical homes and intensive care management are likely to be driving costs down, as they have in other programs. We also heard about important quality improvements, enrollment growth, and progress improving enrollment processes.