Connecticut ranks 4th in nation for health of women and children

The  newest report by America’s Health Rankings finds that women and children in Connecticut are healthier than women and children in all but three other states. While we rank best in outcomes for children, we are 48^th in clinical care for infants. Our strengths include cervical cancer screening, the lowest rate of smoking in pregnancy in the US, and low prevalence of adverse childhood experiences. However, we have very high rates of excessive drinking during pregnancy and for women overall. We have too many low-risk cesarean deliveries and too few early childhood developmental screenings. The report examines 60 measures important to the health of women and children from health care services such as vaccines and check ups, to environmental factors such as safe homes, safe neighborhoods and health behaviors. The report’s detailed summary for Connecticut has important specific information on our achievements and where we need to do more.

Kaiser Medicaid and state marketplace implementation brief highlights CT

Three years into ACA expansions, the Kaiser Foundation has highlighted how four states, including CT, are streamlining eligibility and enrollment. Researchers used focus groups and case studies to find that eligibility and enrollment systems worked well through the expansion and while Medicaid enrollment grew quickly in the beginning, it has now stabilized. While marketplace enrollment grew in each state, affordability has been the greatest challenge to further growth. Local outreach and enrollment by a broad range of community partners is key and states continue planning to sustain and expand coverage.

Recognize the people that keep CT healthy -- Nominate a Health Care Hero

The Hartford Business Journal is again seeking nominations for outstanding health care leaders who epitomize a "hero" when it comes to helping others in central CT. They can be companies, teams, doctors, nurses, specialists or managers. The deadline for nominations is October 6^th. In addition to an awards event on Dec. 1, finalists and winners will be recognized in a special issue of the Hartford Business Journal. Click here for more information and for the nomination form.

CTNJ highlights concerns with Cabinet reform proposal

“It’s not everyday that healthcare advocates and the Department of Social Services agree, but that’s what’s happening in a debate on how to save money and make sure residents, especially those on Medicaid, get the care they need”, according to today’s CT News Junkie. The article gives a very understandable description of the Health Care Cabinet’s Strawman proposal to shift everyone in CT into downside risk financial arrangements. “Under the model Bailit [consultants to the Cabinet] wants to explore, also known as downside risk, doctors will lose money if they don’t save enough money on their patients.” Advocates are concerned providers will leave Medicaid if downside risk is implemented, as happened under the similar capitated model in the 1990’s.  Matt Katz, CEO of the CT State Medical Society isn’t a fan, stating that downside risk is a “perverse incentive.” Many concerns have been shared with the Cabinet, including ours. The Cabinet meeting for next Wednesday the 28^th  to discuss proposed alternatives to the Strawman has been cancelled. Details to follow.

Medicaid update – HUSKY parents’ fate, access monitoring plan, eligibility systems update and first look at Medicaid impact of controversial Health Care Cabinet proposal

This month’s Medicaid Council meeting began with ongoing concerns about what happened to HUSKY parents cut off the program at the end of July. There were lots of numbers but of the original 18,903 slated for the cut in last year’s budget at least 7,713 were lost to HUSKY or AccessHealthCT coverage. Almost 4,000 more were lost to the program during the last year for various reasons. As these parents are low income, it is likely that many thousands of working parents in our state just joined the roles of the uninsured. The Council strongly recommended a follow up study to determine the impact on these families, where they get care now, how it is paid for, and health outcomes. Policymakers want to know if the cuts really saved the state any money.

The Council heard quickly about the consultants’ proposal for health reform across CT for the Health Care Cabinet. Most Council members were not aware of the plan or any proposal. Members raised strong concerns about the profound impact of the proposal on the Medicaid program and risk to our successes. This month the Council will have a webinar with the consultants who drafted the proposal. DSS shared their comments on the proposal.

We also heard about DSS’s plan to monitor access to care for Medicaid members including the number of participating providers, geographic access, openings for new patients, utilization of services, secret shopper studies and consumer surveys. DSS agreed to consider input on potential problems, such as budget cuts, to help focus future monitoring. DSS also described their plans for ImpaCT, the new, state-of-the-art integrated eligibility system. ImpaCT will replace the 30 year-old EMS system that is badly out of date. ImpaCT is designed to ensure accurate eligibility across programs, improve the accuracy of payments, and streamline processes for DSS workers.

Census finds 211,000 CT residents without coverage last year, down 35,000 from 2014

New Census health coverage numbers finds that CT’s uninsured rate went down to 6% last year, a significant drop from 9.4% two years ago before ACA implementation. That rate puts CT ahead of the entire US at 9.4% and ahead of our neighbor NY at 7.1%; we are well above MA’s uninsured rate at 2.8% and slightly above RI at 5.7%. While 211,000 CT residents remained uninsured last year, 122,000 gained coverage since 2013.  The majority of coverage growth was to Medicaid, which gained 82,000 net members, followed by people directly purchasing coverage, including through AccessHealthCT, which was up 45,000 net. The slow decline in employer-sponsored coverage that began many years ago continued with a drop of 13,000 people over the two years.

Comments and alternatives to the Health Care Cabinet’s draft proposal for reform

As directed in a law passed last year, the Health Care Cabinet is considering a draft Strawman proposal drafted by consultants for comprehensive, statewide health care reform in Connecticut. Many concerns have been raised about the very ambitious proposal which includes merging all state agencies that touch health care, ACOs with downside risk, an 1115 waiver for Medicaid, aligning the state employee and Medicaid coverage plans, among other ideas. Comments on the Strawman from the CT Health Policy Project, and an alternative set of options, focuses on building trust in our state by piloting lots of ideas that are working in other states. A one-size-fits-all solution dictated by the state is unlikely to succeed. Our comments focus on pilots, evaluating what works and what didn’t, and making appropriate adjustments. We need to follow what works, abandon what doesn’t and we need evaluations and data to know the difference. The Cabinet reconvenes tomorrow morning to continue the discussion. Independent advocates and providers sent a letter Friday asking for an opportunity for public input into the Cabinet’s final recommendations.

Letter urges public input into Cabinet reform plan

Serous concerns have been raised by diverse stakeholders about the Health Care Cabinet’s Strawman proposal for health reform. Among the proposal’s very ambitious plans are merging a dozen state agencies that touch on health under one person, close “alignment” of Medicaid and the state employee plan, creation of a new agency to oversee and regulate all of Connecticut’s health care purchasing,  and expand untested downside risk across the state giving providers little choice but to accept financial risk (although for Medicaid they can just leave the program). Acknowledging the concerns, twenty one independent consumers and providers sent a letter yesterday urging the Health Care Cabinet to take the time for a public process to get input from all stakeholders and consider other options to develop a workable reform plan.

September webquiz -- C section rates in CT

Test your knowledge of C-Section rates in CT. Take the September CT Health Policy Webquiz.

GAO reports find individual insurance markets concentrated in most states in 2014, but largest in CT losing market share

Recent news about insurers leaving AccessHealthCT, CT’s health insurance exchange, have raised concerns about lowering competition and rising prices for health insurance. CT is not alone. Prior to 2014 health insurance markets in most states were highly concentrated, according to the US General Accounting Office. However, the largest individual coverage insurer in CT, Anthem/Wellpoint, has lost market share every year from 52% of the state’s total individual market in 2010 to 37% in 2014, the first year of ACA implementation. It was hoped that the Affordable Care Act’s  insurance exchanges would reverse that trend expand options for consumers through expanding competition. A new GAO report finds small decreases in competition for most states in 2014 for small or large group market competition, but individual coverage markets in most states continued the trend toward less competition. Connecticut lost two small insurers from the individual m

arket from 2013 to 2014. The GAO report authors note that many exchanges were new in 2014; subsequent years’ experience will be important to assess the impact of the ACA.

CT Health Reform Dashboard – Cabinet reform proposal concerns, Medicaid evaluation affirmed

September’s CT Health Reform Dashboard update reflects the controversy surrounding the Health Care Cabinet’s ambitious and controversial proposal for state health reform. But in good news, DSS and the advocates’ call for a proper evaluation of Medicaid reform, and using it to improve and adjust the program, have been affirmed. Concerns about SIM ethics and conflicts of interest, as well as hospital mergers, remain.

CSG-ERC brief on VT’s drug price transparency law

In recent years drug costs have grown far faster than other health care services, last year growing 8.1% compared to overall health spending growth of 4.8%. Forty five new drugs were approved in the US last year, up from 41 the year before and 27 in 2013. Those increases are straining government budgets, squeezing out resources for other priority areas. When asked about their top concerns affecting Medicaid spending, state officials most often cite pharmaceutical costs. As Congress has not been able to act to control costs, states are moving into the gap. Drug costs and prices are complex and much is hidden from view, which makes finding solutions difficult. While many states are considering drug price transparency legislation, this June Vermont became the first state to pass a law requiring drug companies to explain large price increases. In response to questions from state and provincial policymakers, CSG-ERC has published Vermont’s Drug Transparency Law: A Promising Work in Progress. The brief explores how Vermont’s law evolved, what it includes, how Vermont was able to pass legislation over the objections of a very strong lobby, where the process stands now, and what state leaders hope to accomplish with the information.