Medical home and PCCM meetings

Yesterday’s organizational meeting of the SustiNet Patient-Centered Medical Home Advisory Committee was very encouraging. There is a lot of energy across stakeholder groups, especially among providers and payers. We are soliciting input on who/what groups to consult for input and what issues to consider. Suggestions include business coalitions, NCQA, medical homes from other states, consumer and provider groups. Issues raised include integrating primary care with behavioral health, the role of chiropractic care, primary care shortages, health IT, the costs of implementation, and savings to the health care system. It was also noted that while policymakers are learning about the medical home model, most providers still need to understand it.

Unfortunately, the meeting of the Medicaid Managed Care Council’s PCCM Subcommittee that followed did not go as well. DSS has refused to remove the irrelevant and intimidating Freedom of Information clause in PCCM provider contracts. As one provider in the room put it – the first time a provider gets a request or a subpoena, that will be the end of the program. It is important to note that providers participating in HMOs are not required to sign similar contract language. DSS also continues to refuse to devote any resources to marketing PCCM, despite the overwhelming marketing allowed by the HMOs, paid for out of tax dollars. DSS estimated that the HMOs were spending 1% of the cap rates on marketing, which is roughly $7 million/year. Marketing activities by HMOs, approved by DSS, and paid for out of tax dollars, include free ice cream and haircuts to sign up with an HMO, a banner behind an airplane at a community festival, gifts, radio and billboard advertising, and raffles for school uniforms and supplies. DSS noted that when they talk to providers about signing up for PCCM, they also encourage them to sign up for the HUSKY HMOs and Charter Oak. It is unclear whether providers understand that they can sign up for just PCCM or if they believe they have to also sign contracts with the HMOs. DSS also announced that they will hire Mercer to conduct an evaluation of PCCM to be done by July. However, they acknowledged that the very small enrollment in the program so far makes it nearly impossible to make valid statements about how well the program is doing in providing care, reducing costs, or improving quality. Mercer was the DSS contractor that approved the 24% HMO rate increases for the HUSKY HMOs, which were called into question by the Comptroller’s independent audit, and derives a great deal of their business from managed care plans, in CT and nationally.
In the meantime, advocates are working without any tax dollars to market PCCM to both providers and consumers in New Haven and Hartford in anticipation of the program’s roll out there January 1st. We have an army of volunteers and energetic students mailing and calling providers, practice managers, community organizations and consumers. We are holding two forums open to anyone interested, and eligible to join, the program. By far the largest obstacle we are encountering is skepticism about DSS’s commitment to the program and a strong distrust of the state. If you are considering PCCM, for more information click here.
Ellen Andrews

Governor’s health reform council meeting

In Governor Rell’s message when she vetoed HB-6600, the SustiNet bill, she created a CT Health Care Reform Advisory Board. Her board mirrors the SustiNet Board in many ways, but largely includes people appointed by or who work for her. While the legislature over-rode her veto and the SustiNet Board has been up and running for months, the Governor has decided to convene her group anyway. They met for the first time yesterday. Membership is very conservative including the insurance industry, an insurance broker representing a very conservative small business coalition, state agencies, and some providers. No consumer voices are at the table. Members urged payment reform, health system reform, and health information technology. Covering the uninsured rarely came up; ensuring that people get the value they pay for out of insurance, curbing insurance company abusive practices, limiting administrative overhead and profits, and protecting consumer rights were never mentioned. There was a great deal of criticism of current federal reform proposals. Aetna made a remarkable, and expensive, offer – they will provide free actuarial support to cost out the group’s recommendations. I guess they are confident that the group will only endorse options they agree with. Aetna also got the Chair to agree to move up the date for final recommendations from January 2011 (after Governor Rell’s term is over) to the middle of 2010.
Ellen Andrews

CT’s hospital safety system questioned

Media reports have raised concerns about patient safety in CT hospitals and the system that is meant to protect us. A Hartford Courant article on Sunday uncovered thousands of “adverse events” or dangerous mistakes at CT hospitals that were never reported to DPH. A 2002 law mandated public reporting of serious errors, but a 2004 law watered down the reporting requirement so that most of the errors do not need to be reported at all, and those that are, remain secret. Proponents of the 2004 law maintain that shielding error reports from the public encourages reporting and development of constructive plans to fix the problems. However there is no evidence that it is working that way and the number of investigations is down since 2004. The AG has called for a return to strong public reporting requirements. Indiana, Minnesota and Massachusetts all provide consumers with detailed, specific information on medical errors, and in at least one state that reporting has served as a “catalyst for change” leading to adoption of best practices and better quality care. Sunshine heals.
Ellen Andrews

Medicaid Managed Care Council meeting

Friday’s Medicaid Managed Care Council meeting was very frustrating. Upon questioning, DSS made clear that they will not be recovering the $50 million in overpayments to the HUSKY HMOs that were identified by independent auditors commissioned by the Comptroller, proposed by the Governor to cut for the current state budget and agreed to by the General Assembly. To be exact, they stated that they are “in negotiations” but in response to questions they stated that they are concerned that the HMOs might choose to leave the program and echoed the perennial, tired complaint that the HMOs aren’t making enough money. They claimed that the Milliman audit was based on earlier financial information. (Leaving aside the issue that DSS refused to share more recent financial information with the auditors.) They had no answer when reminded that the HMOs have always whined that they don’t make enough money on this program, including the years that Milliman used in their analysis. They also raised the threat that any cut to the HMOs will result in reduced services to consumers. Why the HMOs can’t manage on rates comparable to what other states are paying, and why DSS wouldn’t enforce their contracts was not addressed. Apparently, re-bidding the program is too hard, which led to the point that if DSS is not willing to lose any of the HMOs, it can’t be much of a negotiation. They also conveniently forgot that the advocates and the General Assembly have given them an alternative, a bargaining chip (not to mention a better option for consumers based on patient-centered medical homes) in PCCM which DSS has been unable and/or unwilling to implement.
Although it was on the agenda, PCCM wasn’t discussed at the meeting, again.
Ellen Andrews

SustiNet Board and Workforce Task Force meetings

Yesterday the SustiNet Board heard from eHealthConnecticut , a CT nonprofit created four years ago to develop a secure statewide health information exchange. The Board includes broad representation across the health care spectrum including physicians, hospitals, clinics, pharmacists, employers, insurers, academics, quality organizations, state agencies, policymakers and consumer advocates including the CT Health Policy Project. Scott Cleary described eHealthCT’s three main projects to date. The CT Health Quality Cooperative allows physicians to compare their performance on a variety of quality measures to their colleagues across the state and nation. CHQC is one of only a handful of similar quality comparison projects in the US. eHealthCT is also working on a pilot health information exchange set to go live next February for Medicaid clients. (Editorial comment: How great is it that we are starting health information exchange in CT with the Medicaid population – usually the last to benefit from innovation.) eHealthCT has also submitted CT’s application for federal stimulus funds to create a health information technology regional training center to assist providers adopting electronic medical records. The SustiNet Board also began approving members of the advisory committees, but is continuing to accept names. The next meeting of the Board will be with committees on Nov. 23rd. As much of the work is now happening in the committees and task forces, the full Board will not meet again until January. You can sign up for alerts on SustiNet meetings and publications online.

At the Health Care Workforce Task Force meeting yesterday afternoon, the group finalized a list of groups we will reach out to for input and recommendations. The next meetings of the task force will be early next year with these groups. There was interest in mapping providers across the state geographically, tracking not only numbers of providers but patient access to care, particularly for Medicaid and HUSKY, including the public health workforce in our deliberations, how technology can help improve training, and measures to address skyrocketing prescription drug costs. The task force agreed to ask for a joint meeting with the Allied Health Workforce Policy Board which has been working for several years to identify and address areas of need. Chancellor Mark Herzog provided the task force with a compilation of the allied health and nursing programs at each of CT’s community colleges. Decisions about what programs to offer is driven by community demand, market forces, and constraints on state funding. Nursing is the most expensive program to offer.
Ellen Andrews

Hartford area PCCM/HUSKY Primary Care forum

A forum for providers and consumers eligible for and considering the new HUSKY Primary Care/PCCM option is being held in Hartford on Tuesday November 24th from 5 to 7pm. The forum will be at the offices of Greater Hartford Legal Assistance, 999 Asylum Avenue, 3rd floor, Hartford. HUSKY Primary Care, a form of Primary Care Case Management (PCCM), will be available to HUSKY families by January 1st. A forum will also be held for the New Haven area, at our offices, 703 Whitney Avenue in New Haven on Thursday, November 19th from 6 to 8pm. For more information on either or to RSVP, call (203) 772-2817 or email information@cthealthpolicy.org. The forums are hosted by the CT Health Policy Project and the New Haven Legal Assistance Association.

Governor’s Health Care Reform Advisory Board to meet

The Governor’s Health Care Reform Advisory Board will hold its first meeting November 17th from 9 to 11am; the site has not been determined. The committee was created by the Governor’s Executive Order No. 30 accompanying her veto of HB-6600, the SustiNet bill. The General Assembly subsequently overturned her veto. The SustiNet Board has been meeting for two months and is constituting its advisory committees. Various members of the administration have attended and participated in SustiNet Board meetings. The Governor’s committee is Chaired by Cristine Vogel, Deputy Commissioner of Public Health, and also includes Thomas Sullivan, Commissioner of Insurance, Mike Starkowski, Commissioner of Social Services, Robert Galvin, Commissioner of Public Health, Robert Dakers, OPM, Nancy Wyman, State Comptroller (who Co-Chairs the SustiNet Board), Mark Bertolini, Aetna, Jim Cox-Chapman, ProHealth Physicians, Christopher Dadlez, St. Francis Medical Center, Rick Willard, National Federation of Independent Businesses, Lenny Winkler, former legislator, Cathy Bartell, and Carole Noujaim.
Ellen Andrews