Nominations open for New England comparative effectiveness voting panel

The New England Comparative Effectiveness Public Advisory Council is seeking nominations for new members. New England CEPAC is a group of clinicians, economists, and patient/consumer representatives that meets three times each year to take a deep dive into the evidence on the effectiveness and value of new drugs, devices and delivery system innovations. At the public meetings, CEPAC hears from experts, patients affected by the condition being discussed, and other stakeholders. CEPAC then votes publicly on the merits and value for the New England region of the studied treatments. CEPAC, and two similar councils in other regions, are programs of the Institute for Clinical and Economic Research, an independent nonprofit institute that produces reports on the evidence for effectiveness of new drugs and other health services. ICER’s reports are used by a growing list of public and private payers in maximizing value for every health care dollar. To ensure independence, CEPA members must meet ICER’s conflict of interest policies. Nominations can be sent to info@icer-review.org on or before December 1^st at 5pm. Please send a CV and letter to interest. Both organization-sponsored and self-nominations are welcome.

CT gets a C for pre-term births

A new report highlights CT’s disappointing performance in reducing pre-term births and ensuring our state’s newest citizens have a healthy start. Almost one in ten (9.4%) CT births happen before 37 weeks, ranking us 31^st among states. Hartford County was worst at 10.1%; Litchfield was best at 7.7%. There is wide disparity in pre-term birth rates across race/ethnicity in CT. 12.2% of black births in our state are pre-term compared with 8.6% of whites. CT’s record on preterm births is in contrast to Monday’s report highlighting our state’s enlightened Medicaid policy on access to HepC treatment. CT still has significant room for improvement in health and healthcare.

CT Medicaid only state to earn A+ for access to HepC drugs

A new report finds that CT’s Medicaid program leads the US in access to new Hepatitis C medications. Hepatitis C affects 3.5 million Americans and causes more deaths than any other infectious disease. CT Medicaid imposes no liver damage, sobriety or prescriber restrictions to HepC drug access that are common in other states.  The report was authored by the National Viral Hepatitis Roundtable, which discloses funding by HepC drug manufacturers, and the Center for Health Law and Policy Innovation at the Harvard Law School. New HepC treatments are very effective, but costly especially for public programs. However they can be cost effective in the long term. Only CT earned an A+ while five states earned F grades. Nearby states varied with MA earning an A, NY with a B-, NJ with a C-, and RI got a D+. The report credits legal action by New Haven Legal Assistance and patient group advocacy with CT’s enlightened policies.

New CT insurer report card online

CT’s best kept secret, the latest CT health insurer report card is out. Part of the managed care reform law passed twenty years ago, the report allows consumers, policymakers and other stakeholders to compare health plans across dozens of key performance standards, customer satisfaction rates, provider participation by county, and claims denial rates. As in the past, Anthem retains the majority of enrollment, serving 822,625 consumers in 2016. Of concern, the report cites both an increase in the number of specialists and a decline in primary care providers. The report also includes medical-loss ratios, the unfortunate term for how much of your premium goes to medical costs vs. administration and profit, for each plan. Consumers and employers lucky enough to have a choice between plans should consult the report before deciding.

President’s plan to end cost sharing payments would cost CT plans $7 million this year

An analysis by Avalere Health estimates that health plans in CT’s insurance exchange, Access Health CT, would lose $7 million in reimbursements this year unless Congress acts to restore payments. Nationally, plans stand to lose over $1 billion this year. Under the Affordable Care Act, low to moderate income Americans purchasing exchange coverage are protected from excessive premium and cost sharing payments to health plans. However, whether the federal government is required to reimburse health plans for those costs has been disputed in court. While plans can roll the lack of reimbursements into premiums for next year, because 2017 health plans contracts are already set, they cannot adjust premiums for this year. Despite the ongoing legal challenge, the federal government has consistently made those reimbursement payments every month for over three years. Last week President Trump announced he intends to end those reimbursements to health plans. Earlier this year, the Congressional Budget Office estimated that ending those reimbursements would result in more uninsured next year and actually increase the federal deficit by $194 billion through 2026 due to sharply higher insurance premiums. A Senate deal to restore the payments is moving through the process.

CT ranks 3rd highest among states in high-deductible health plans

Analysis of new federal data by SHADAC finds that most people (59.3%) in CT covered by employer-sponsored health plans were in high-deductible plans last year, up from 40% in 2013. For purposes of this study, high-deductible plans are defined as meeting the minimum deductible amount required for Health Savings Account eligibility ($1,300 for an individual and $2,600 for a family in 2016). The rate varies significantly between states but CT ranks 3^rd highest in the nation, behind only NH and KY. The national average was 42.6%.

The survey found little change in the percent of CT employers offering coverage from 2012 to 2016 (55.8% to 52.6%). Employers with over 50 workers are almost three times more likely to offer health benefits and that gap is growing. As in the past, both premiums and deductibles were higher for employers with less than 50 workers last year. CT workers employed by small firms were more likely to be enrolled in a high-deductible plan (62.4% vs. 58.7%).

Antibiotic prescribing down in CT but more needs to be done

Between 2010 and 2016, antibiotic prescriptions per person have declined 8% in CT, according to a report by the Blue Cross Blue Shield Association. The rate declined even faster (15%) for children. Unfortunately, CT’s rate is still higher than all but 16 other states. Overuse of antibiotics is blamed for contributing to the rise of antibiotic-resistant bacteria or “superbugs”. Every year 2 million Americans become infected with bacteria that do not respond to antibiotics and 23,000 die of that illness. Public health officials have been working to bring down the rate of antibiotic prescribing, especially for conditions that do not respond to antibiotics, e.g. most colds which are caused by viruses.

In more good news, the biggest drop in prescribing was for broad spectrum antibiotics, the most likely to trigger antibiotic resistance, which declined 18% in CT from 2010 to 2016 compared to 13% nationally. Unfortunately, a great deal of work remains. The study found that last year 63% of antibiotics were prescribed for conditions which might be appropriate and another 21% for conditions which were not indicated.