Why we need patient centered medical homes

Government is taking over health care

Sometime next year government will overtake all other payers and fund more than half of all US health care, according to actuaries at CMS. Last year health care consumed 17.3% of our economy, the largest one year climb since 1960. We spent $282 million per hour last year on health care. Just government’s share of US health care spending last year was equal to all health care spending – government plus private payers -- in Britain and Italy. How long can we keep this up?
Ellen Andrews

Governor’s budget proposal – lots of cuts and a plan to reform HUSKY HMOs

In her budget proposal released yesterday, the Governor proposed shifting the current HUSKY HMOs away from capitation back to a non-risk arrangement. For a few months in early 2008, the Governor ordered a similar switch from capitation to an Administrative Services Organization (ASO)-model, in which the HMOs administered the program for DSS but passed all the medical bills onto the state. There is evidence that the state saved money under that non-risk arrangement. At the time, the HMOs were paid $18.18 per member per month (pmpm) for those services; a back of the envelope calculation suggests that the state expects to pay about $15 pmpm this time. Under PCCM, a new alternative to HUSKY HMOs, providers are paid only $7.50 pmpm for services that include care coordination. The 2008 switch resulted from advocacy efforts for transparency and accountability in the program. This year’s switch is prompted by cost pressures. An audit by the Comptroller last year found that HUSKY was overpaying the HMOs by $50 million/year. The Governor estimates that switching HUSKY to an ASO model will save the state $29 million next year.
Unfortunately, the Governor’s proposal also includes copays on Medicaid services, eliminating coverage for non-prescription drugs, vision services for adults, cuts to subsidies and increased premiums in the Charter Oak Health Plan, increased premiums and copays in HUSKY Part B, vision and transportation cuts to SAGA, and cuts HUSKY outreach. Those cuts total $53 million. None of these cuts is necessary; we have thirteen ways to save money in CT’s state budget that improve health.
Ellen Andrews

Free clinic makes a difference

Yesterday’s massive free health clinic at the CT Convention Center in Hartford had provided care to 700 uninsured people in just the first three hours. Almost 1,100 people signed up to volunteer. The clinic was run by the National Association of Free Clinics; CT has over a dozen free clinics providing care to the uninsured. I was an exam room runner – getting patients where they needed to be, getting supplies and answers to questions, and generally filling in. I spent a lot of time talking with patients – most were working, some at more than one job. Most had been uninsured for a long time and hadn’t seen a doctor in over a year. Unfortunately, I saw three people whose problems were so serious that ambulances needed to be called. Volunteers came from all walks of life; I met doctors, nurses, medical administrators, PAs, social workers, students, an investor, community organizers, retirees, some people who are unemployed, and a computer programmer. Services provided included physician services, seventeen specialties, lab tests, help with prescriptions, counseling, HIV testing, immunizations, dental and vision testing. Everyone was connected with follow up care, appropriate public and private medical and social programs at check out. The organization involved was mind-boggling and carried off with professionalism and good humor. It was a tremendous treat to be involved, a nice break from policy analysis and advocacy, but it was exhausting.
Ellen Andrews

February webquiz – PCCM/HUSKY Primary Care

Test your knowledge about CT’s PCCM program -- HUSKY Primary Care. Take the February CT Health Policy Webquiz.
This month’s quiz was developed by Sabina Klein, CTHPP Student Fellow and soon-to-graduate Yale senior. Sabina is one of the “army” of students/volunteers working to get out the word about this exciting new option for HUSKY families. (Sabina is second from the right in the picture).

PCCM update for Appropriations Committee

Friday from 10am to 1pm at the Legislative Office Building the Appropriations Committee will receive a report from DSS about their progress in implementing PCCM/HUSKY Primary Care. Following the department’s report will be a panel including physicians, a consumer, and this advocate about the program.
Ellen Andrews

Quality and Valerie Jarrett at Families

Regions of the US with higher health care spending actually have worse health outcomes, according to Elliott Fisher from Dartmouth. Friday’s Families conference started with a fascinating plenary about the disconnect between what we spend on health care and what we get, followed by concrete guidance for providers who want to improve the quality of care they deliver. As a state based advocate, I found the workshops on exchanges, subsidies, benefit packages, and states’ roles in reform were very useful. At lunch, Valerie Jarrett, White House Senior Advisor, came to thank us for our advocacy and to urge us on.
Ellen Andrews