CT health provider capacity varies significantly

A new mapping and data tool from CMS allows web visitors to visualize the density of a range of health care providers relative to the number of consumers. The updated Market Saturation and Utilization Tool uses Medicare claims data and can be sorted by state or county. Policymakers can use the Tool for health services location planning and to assess how provider supply impacts utilization. Services in the Tool include ambulance, clinical lab, chiropractic, home health, hospice, long term care hospitals, skilled nursing facilities, and physical and occupational therapies. Users per provider vary considerably in CT from access to chiropractic care (we are in the lowest quartile) to long term care hospitals, home health and hospice care (we are in the top quartile).

ICER seeks comment on Value Framework Changes for Ultra-Rare Condition Treatments

The Institute for Clinical and Economic Review (ICER) has proposed adaptations to its value framework for very rare conditions. ICER is a leader in evidence-based analysis of the effectiveness of drugs and other medical treatments. ICER’s analyses, including benchmark value-based prices for new drugs, are used by a growing list of payers in developing fair prices. To address the different economics of value assessments for very rare conditions, ICER published a white paper on the research and ethics of the issue and convened an all-stakeholder meeting in May. ICER is now soliciting feedback from stakeholders on their proposal. Proposed adaptations include a broader range of cost-effectiveness thresholds, the context of difficulty in research on very rare conditions, a broader definition of other advantages such as improvements in school, family and community, and benefits to systems for screening and care of people with rare conditions. Send comments to publiccomments@icer-review.org by Monday, September 25^th at 5pm ET for consideration.

Quality challenges remain in CT Medicaid PCMHs

Also at Friday’s meeting, DSS reported on a selection of quality results from 2015, highlighting concerns. The results compared quality measures for patients receiving care from private practice and community health center Patient-Centered Medical Homes. In other programs, PCMHs have improved quality performance over non-PCMH practices. There remains a lot of room for improvement. Only 23.9% of children ages 1 to 17 are getting behavioral health screenings in private PCMHs (they all should be), but it’s even worse at community health centers (10.2%). Emergency department visits are still too high but are 35% higher for community health center PCMH patients. Less than half of patients in both private (47.3%) and community health center (38.6%) PCMHs are getting follow up within seven days of discharge from the hospital. The trend isn’t encouraging -- between 2014 and 2015, almost as many measures worsened as improved. Following past trends, quality at community health centers is lower than at private practice PCMHs for all but one of twelve measures listed. CT Medicaid has a great deal of work to do, but unfortunately PCMH+ and its administrative burdens, lack of evaluation, and unhelpful financial incentives to stint on care will make it much harder.

Déjà vu at Medicaid Council meeting

Friday’s Medicaid Council meeting focused on the controversial PCMH+ shared savings program reminding many observers of years of rosy DSS presentations about the very similar, failed HUSKY MCO program. PCMH+ started six months ago with 137,000 members. The concept is to give Accountable Care Organizations (large health systems) a reason to lower the total cost of care for members by sharing half the savings with them. We heard inspiring stories of consumers who have been helped by the care managers hired with PCMH+ upfront funding. (Note that many of the anecdotes could/should have been covered under the current successful PCMH (no plus) program.) To avoid the stunning failure of the HUSKY MCOs, there was to be robust tracking of quality and underservice metrics, higher spending (despite the program’s name), and enforcement of policies to ensure that ACOs do not cherry pick members to drive up false “savings” payments, as has happened in other states. Unfortunately, DSS has not lived up to their promises in implementation intending to expand the risky program to another 200,000 people in six months without an evaluation of harm or overspending. Advocates have expressed deep concerns about this among other problems, but at the meeting Friday, DSS refused to answer the question or explain their decision. Reportedly, the capacity to evaluate and report on PCMH+ performance exists at UConn and they are eager to help. We have not received an answer to that question either. Concerns about sustainability of funding for the care managers were also ignored. As questions were cut off, advocates are sending our questions to DSS and to the ACOs individually. We’ll let you know if we get any answers.

Sen. Blumenthal holding fifth hearing on ACA replacement bills

Friday at 2pm Senator Blumenthal will convene an emergency field hearing to collect input from Connecticut residents on current proposals to repeal and replace the Affordable Care Act. This is the Senator’s fifth hearing on the issue. The latest Senate version of the bill from Republican leaders was published today. The hearing will be held Friday, July 14^th from 2 to 4pm in the Weller Center (2^nd floor of Clark Building), Mitchell College in New London. Parking is available in the Montauk Avenue lot.

ACA repeal, Medicaid, personalized medicine, and bioscience highlight at ERC Annual Meeting in Connecticut next month

Join CSG-ERC for our 2017 Annual Meeting and Policy Forum August 13 to 16 in Uncasville, CT. Health programming includes a lunch talk on the promise of genomics, the potential of bioscience to improve health and grow state economies, and the potential state impact of federal proposals to replace the Affordable Care Act, significantly change Medicaid funding, and budget cuts. Registration is now open.

Lowest wage workers least likely to be offered health benefits at work

Only 22% of Americas earning the lowest ten percent of wages are offered medical benefits by their employer, according to a new report by the Bureau of Labor Statistics. This compares with 93% of the top ten percent of earners who are offered medical benefits at work. Unfortunately, the lowest wage workers also pay more for their benefits and employers pay less. Workers with wages in the lowest ten percent pay almost $125 more per month for family coverage than workers with wages in the top ten percent. Not surprisingly, even the lower wage workers who are offered benefits are less likely to accept them. Only 11% of workers with wages in lowest ten percent of Americans participate in employer-sponsored coverage, compared to 72% of those in the highest ten percent of wages. Employer offers of dental and vision benefits are lower than medical benefits among all workers, but the disparity between high and low wage earners is also reflected there. Low wage workers are also less likely to be offered retirement, paid leave, paid vacation, and paid holiday benefits, according to the BLS.