Large majority of CT hospitals and health systems making money

Last year, 23 of CT’s 28 hospitals and half the 20 health systems made money last year. Collectively, CT’s 28 hospitals’ net margins (profits) totaled $877,878,858 last year. The biggest total winners were Dempsey/UConn at $286 million and Yale-New Haven netting $160 million. Waterbury Hospital lost the most money -- $16.5 million or 7.6% of revenue. As a percent of revenue, Dempsey was also the biggest winner at 43.3% of revenue as profit/margin. Sharon Hospital lost the most as a percent of revenue (-35.5%), but most of that was non-operating revenue losses. CT’s 20 health systems collectively netted slightly more than hospitals at $910, 016,203. Biggest winners were Yale-New Haven (again) netting $150 million and Hartford at $207 million. Yale (12.5%) and Dempsey (11.2%) also led health systems in profits/margin as a percent of revenue. Waterbury again lost the most at $31 million total, and Sharon lost the most as a percent of revenue at -30.7% but again, that was mainly due to non-operating expenses. More financial data on CT hospitals and health systems is available here.

Analysts predict CT would lose $7 billion under the American Health Care Act

A new analysis by the Urban Institute finds that per capita caps on federal Medicaid spending under the American Health Care Act (AHCA) would reduce federal Medicaid funding to states by $457 billion or 9.8% from 2019 through 2028. If the bill passes, Connecticut stands to lose $7 billion or 10.9% of federal Medicaid funds. To fully offset the loss of federal funds, Connecticut would have to increase our state Medicaid budget by 13.6%. The state is now facing a $1.7 billion deficit for next year, under current law with the ACA intact. The authors project that use of the AHCA’s proposed trend factor will disadvantage children and adult Medicaid categories most. The analysis models the impact of the AHCA as originally proposed. The bill is being negotiated in the House as of this writing.

Medicaid Council update – PCMH + and national Medicaid proposals

Friday’s MAPOC meeting started with an update about the shared savings experiment that covers 137,037 members and started January 1^st. Contracts have been finalized with nine ACOs.

	enrollment	% of total
NEMG/Yale	7,509	5.5%
St. Vincent's	18,086	13.2%
Fairhaven HC	7,811	5.7%
Cornell Scott-Hill HC	13,781	10.1%
Generations Family HC	8,000	5.8%
Southwest CHC	8,299	6.1%
Community Health Center, Inc.	44,917	32.8%
Optimus HC	21,304	15.5%
Charter Oak HC	7,330	5.3%
Total	137,037	100.0%

Concerns were raised and dismissed by DSS about the timing of the planned next wave of 200,000 members into the experimental program without the benefit of a robust evaluation of the impact on first 137,037 and on the state budget.

The Council also discussed troubling national proposals to limit Medicaid funding, add administrative complexity (because it’s not bad enough now), and the impact on CT.

CT seventh in nation in Medicaid payments for opioid addiction treatment

While the opioid epidemic impacts all income levels, Medicaid is the largest source of behavioral health care and opioid addiction treatment. However that rate varies considerably by state, according to an analysis by STAT News. Connecticut Medicaid pays for 44.3% of opioid agonist (buprenorphine) prescriptions compared to the national average of 24.2%. Connecticut is just below the national average in opioid prescription use per population (611 per 1,000 residents vs. US average of 695) but well above the national average in the rate of opioid treatments compared to opiid prescriptions (CT 9.7 treatment Rx per 100 opioid Rx, vs. 5.6 national average). Proposed changes to Medicaid in Congress could reduce Medicaid’s ability to address the epidemic by reducing the number of people covered, and eliminating the requirement to cover mental health and substance abuse treatment. 

Latest ACA replacement expected to cost CT up to $1 billion/year and increase premiums for residents

An analysis by CT’s Office of Policy and Management estimates that the House Republicans’ American Health Care Act (AHCA) would severely stress the state’s budget far into the future. Extra costs would start at $6.8 million next fiscal year and rise  to $1 billion after 2020 when fully implemented. Policymakers are now trying to fill a projected deficit of $1.4 billion in year’s state’s budget even without passage of the AHCA. The largest AHCA contributor to the state’s deficit is the proposed per capita Medicaid cap, estimated to cost between $50 and $450 million in 2020. Individuals buying coverage with subsidies through AccessHealthCT would face increases averaging between $938/year for people under age 30 to $4,799 for people over age 60. In addition, under the AHCA, members would lose cost-sharing assistance, raising their costs even more. Preliminary estimates find that the law would increase premiums for all consumers by 40% or more next year. Yesterday the Congressional Budget Office released their report on the impact of the AHCA nationally finding that 14 million more Americans would lose coverage next year, growing to 23 million more uninsured in four years. Fourteen million Americans would lose Medicaid by 2024.

Health reform dashboard reflects uncertainty, good and bad trends

March’s CT Health Reform Dashboard update reflects good, bad and uncertain policy movement in CT and DC. Most troubling is the level of mistrust among stakeholders in our state’s health system first recognized formally by out-of-state consultants to the Health Care Cabinet. This problem undermines even well-intentioned efforts to make progress, that otherwise would receive universal support. Other issues affecting the dashboard include proposals to cut Medicaid both in CT and DC, and recent erosions in the new Medicaid payment experiment with disappointing plans for a weak, late evaluation of the first wave, undermining consumer notices to accommodate conflicted ACOs, and efforts to make MAPOC committees irrelevant. In good news, leadership-sponsored bills to control drug costs and Cabinet deliberations have legs, and the most controversial Cabinet recommendations are not reflected in legislative proposals.

CT stuck at C+ grade for health reform, Mistrust is high and pervasive

Connecticut health care thought leaders again gave our state a C+ grade for health reform last month, but our GPA dropped from 2.4 to 2.2. Connecticut’s grade for effort didn’t change from last year still at a B-/C+ (GPA 2.5) in this survey. Connecticut continues to earn higher marks for Medicaid and the health insurance exchange. Grades for patient-centered medical homes were down from past years. Lowest marks went to efforts to address the health care workforce, the only area that received a D grade overall. Unlike past years, thought leaders gave more C’s across the majority of issue areas mirroring the overall grade. A new question assessing the level of trust between stakeholders in Connecticut health policymaking elicited low responses, averaging only 26 out of 100 possible points, with zero to ten being the most common response. Low trust scores were found in every stakeholder group