Health Insurance Exchange CEO job description out

CT’s health insurance exchange is moving very quickly to hire a CEO. The job description includes good language about consumer education and policy background. It mentions management skills but does not mention familiarity with active purchasing on behalf of consumers. Applications are due by Nov. 9th. The Board will choose three finalists but the Governor chooses the CEO from that list. Board membership has been criticized for having no consumer representatives and including three members with strong ties to the insurance industry.
Ellen Andrews

OHA Recovers $2.9 Million for Consumers in Third Quarter 2011

The state Office of Health Care Advocate has recovered for consumers $2.9 million in the third quarter of 2011 and $9.3 million thus far in calendar year 2011. The case load this year is expected to be double last year’s number. Through public outreach, their website and a toll-free assistance line, OHA helps patients who have been denied services or payment for services by insurers, private and public. OHA prepares cases for consumers and can appear in-person for appeals. The office also identifies trends and challenges in CT’s health insurance system keeping people from getting the care they need and advocates with policymakers to fix those policies for all state residents. OHA was created in 1999 as part of CT’s managed care reform law.
Ellen Andrews

Anthem piloting plan that shares savings with consumers

In a national pilot program that includes two self-insured employer groups in CT, Anthem is giving rebates to consumers who choose lower cost providers for their care. Rebates can reach up to $250 in CT (up to $1,000 elsewhere in the US) for each procedure. The company claims that only “common, elective medical procedures and diagnostic tests” are included in the program but clinical experts dispute that. The CT State Medical Society is concerned because the rebate is based solely on cost and does not integrate quality ratings. A large employer collaboration in Maine has had great success incorporating both cost and quality into consumer incentives.
Ellen Andrews

New CT Insurer report card online

The CT Insurance Dept. has published the 2011 insurer report card. The report card compares HMO and indemnity plans’ performance across dozens of quality measures including prenatal care in the first trimester, adult access to care, cancer screenings, childhood immunizations and controlling high blood pressure. The report includes statistics on plan enrollment, number of participating providers by county, and utilization review stats for each plan. The report card is an incredibly useful tool for anyone making choices about health plans but also includes consumer assistance contact information for each plan.
Ellen Andrews

Grove health events

I co-work with amazing people doing exciting things at The Grove in New Haven. Among those amazing things are two upcoming events sponsored by the Transforming Maternity Care Partnership, a national multi-stakeholder collaboration working to implement a consensus Blueprint for Action to improve the quality and value of maternity care. The Nurse-Midwifery Week Celebration and Symposium this Sunday from 11am-3pm will feature two speakers - Tina Smillie talking about breastfeeding and Tricia Pil talking about patient safety in maternity care from the patient, provider, and systems perspective. And next Wednesday evening, October 12, they are hosting health economist and Health IT leader, J.D. Kleinke who has written his first novel about ob-gyn practice. He will be reading from his book and leading a discussion on system transformation. The Grove is at 71 Orange St. in New Haven. For more information on either event, contact Amy Romano at romano@childbirthconnection.org.
Ellen Andrews

Courant OP-ED raises concerns about Medicaid PCMH proposal

An Opinion piece in today’s Hartford Courant by Sheldon Toubman of New Haven legal aid outlines many problems with DSS’ proposal for person-centered medical homes. PCMHs have been used by payers, including many other state Medicaid programs and CT’s state employee plan, to improve the effectiveness of health care, reduce duplications and errors and rein in skyrocketing costs. However, DSS’s proposal varies significantly from best practices identified in other states. The current PCCM program, used by a majority of states, provides a set amount of funding to providers upfront to encourage investment in care coordination. DSS’s proposal asks primary care practices, on very thin margins, to pony up with the potential for funding/reimbursement later. It also builds on the current fee-for-service system that has been blamed for over-utilization that drives up costs. Most funders are moving away from fee-for-service payments.
Ellen Andrews

October webquiz, webinar slides and video online

Test your knowledge of CT’s uninsured. Take the October CT Health Policy Webquiz.

Slides and video of Friday’s webinar with CEPAC are posted.