Committee develops care plan best practices recommendations for Medicaid

The Complex Care Committee of CT’s Medicaid Council has made recommendations to DSS for care plans in the Medicaid program. The importance of effective care plans has arisen often throughout the committee’s work diving deep into barriers to care for Medicaid members with complex health needs. Effective care plans ensure that people are driving decisions about their own care, that everyone is on the same page, and can be an important tool in evaluating care and holding stakeholders (including patients) accountable. The committee spent months searching for best practices within Connecticut and beyond. The recommendations include ensuring the person is the center of care planning, that the plan is clear, complete, actionable and measurable, that the plan is helpful not burdensome, for providers, privacy is protected, and anticipates future needs. The Committee will be following up with DSS to see how the recommendations can be used to improve care for people with complex conditions.

Advocates launch PCMHPlusFacts.org, giving HUSKY members balanced information on the controversial new program

Today, independent consumer advocates launched a website, PCMHPlusFacts.org, to explain the facts about HUSKY’s experimental, new payment plan to run the program. The site was developed in response to the state’s erosion of federally required notices to consumers about their right to opt-out of the program. The state changed the notices at the last minute under political pressure from the large health systems that stand to profit from the program. Reports from community members and DSS’s own survey of members find deep confusion. Advocates have repeatedly expressed concerns about the new program including the refusal to evaluate the impact on access to appropriate care, expanding without information on impact or potential increases in costs, disappointing results from other states with similar programs and great risk to reverse recent progress in improving quality and lowering costs in the HUSKY program. PCMHPlusFacts.org is part of a balanced outreach/media campaign to explain the risks and potential rewards of the program to HUSKY members.

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Correction: Opt-ing out of PCMH+ isn’t easy, and that’s not evidence that PCMH+ works

Correction – The notice sent to PCMH Plus consumers in December 2016 included the accurate phone number to  call to opt-out of the program.

Healthcare Cabinet finalizes recommendations to control drug costs

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At yesterday’s meeting, the state Healthcare Cabinet tweaked and finalized eight policy recommendations to lower prescription drug costs in Connecticut. Drugs are the largest driver of skyrocketing health costs. However, the Council acknowledged that, even if these recommendations are all adopted and implemented, a lot of work remains. The recommendations came from months of research and deliberation by four workgroups and the full Cabinet. Legislative recommendations include creating a Drug Review Board, with strong conflict of interest standards for membership, to investigate drug pricing and refer potentially unjustified cases to the Attorney General’s Office for action. Responding to reports of potential conflicts of interest in widespread industry backing of patient advocacy groups, the Cabinet is also recommending that drug companies, pharmacy benefits management companies (PBMs), and insurers publicly disclose funding to nonprofit advocacy groups. The Cabinet also recommends that PBMs cooperate with audits, and require that rebates and other reductions in drug prices be shared with consumers. Administrative recommendations include supporting meaningful discussions between consumers and providers about drug costs, priority setting, and adherence, including adding questions to consumer surveys and linking performance on those measures to funding. Other administrative recommendations include soliciting more information from insurers on the contribution of drug costs to premiums, and using comparative effectiveness research and value assessments to inform providers’ prescribing decisions.  Recommendations that aren’t ready for endorsement yet include public posting of provider compensation by drug companies, limiting coupons that may reduce costs for some consumers but raise them for the overall system, expanding access to the state employee pharmacy system to other payers, monitoring consumer and provider education efforts to ensure quality and balance with non-medication options, reimportation of drugs from Canada, and creating a public utility model for drug price oversight.

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Webinar on new HIE for Connecticut

For years, Connecticut providers and payers have been begging for a functional Health Information Exchange (HIE). An HIE allows providers delivering care to each patient to share information, notes, careplans and lab results. A functional HIE should help coordinate care, lower costs, avoid duplication and overtreatment, and make everyone’s lives easier. Despite numerous attempts, many years, and millions of tax dollars, the state has never been able to make it happen. To fill the need, the CT State Medical Society has just taken the initiative and created one, CT Health Link, funding it themselves. This Friday, Feb. 16^th at 10am the Complex Care Committee of MAPOC will hear about the project in a webinar. To join us, see the info below.

Join WebEx meeting 
Meeting number: 594 768 457 



Join by phone 
Call-in toll-free number: 1-(866) 578-5693 (US) 
Conference Code: 785 357 2699