Insurance public hearing to add consumers to insurance exchange board

Today, the Insurance and Real Estate Committee held a public hearing on HB-5013 – a very weak bill that would have added only one, narrowly defined consumer advocate and one small business person to the exchange but not before July 1st. It also would have given the State Health Care Advocate a vote But again not until July 1st – safely after all the important decisions have been made. The Board has been criticized for having three members representing insurance interests and no voting consumer representatives. The Board is now choosing a CEO and a team of other senior management (at eye-popping salaries) and considering whether to cede the small business exchange toCBIA. Many people, including consumers, advocates, brokers, small businesses, providers and labor representatives, spoke to the need for at least two consumer reps and two more small business people on the Board. Speakers also emphasized that the CEO being hired should be independent of the insurance industry, to help build some credibility for the exchange among the people who will rely on it for affordable coverage in 2014 when the individual mandate becomes effective. Speakers also strongly opposed allowing CBIA to run any part of the exchange. CBIA has lobbied against state and national reform in the past; handing the exchange to opponents of reform invites failure. Speakers also asked for the legislature to clarify that the Ethics Commission enforces conflict of interest provisions in the original law, specifically excluding Board members affiliated with insurance companies.
Ellen Andrews

Medicaid Council update

Friday’s Medicaid Council meeting featured DSS Commissioner Bremby’s comprehensive, long overdue client services system overhaul. To say the current systems are outdated is a massive understatement – fragmented, ancient, paper-based, and under-resourced. DSS’ plans for the future are as good as the current system is bad. Phone and online systems will be integrated, information for clients will be consistent and easily available, processes will respect how people use systems (not the other way around), clients will be able to pre-screen for eligibility saving everyone a lot of time. Staff are getting training on courtesy, responsiveness and keeping promises. We still need to hear about privacy protections, but this is a wonderful thing.

DSS then described their evolving model to redesign how they pay for the care of possibly 50,000 people eligible for both Medicare and Medicaid. They are proposing to build on the ASO model’s care management services available now to every Medicaid member with data integration and advanced analytics, intensive care management to coordinate between the two programs, and other consultative services such as pharmacy, disease educators and nutritionists, if CMS allows. They are also planning to foster the development of three to five medical neighborhoods, loose affiliations/networks of local providers each serving about 5,000 people offering team-based care individually matched to the patient’s needs. DSS has proposed to split any savings with the feds 50/50. DSS intends to develop strong quality monitoring systems to ensure that needed care is not inappropriately denied. The really big question, how the savings will be shared with providers -- primary care and their neighbors, remains to be decided. This could be a quantum shift improving the lives of fragile patients, or a complete disaster. It is unlikely that the first iteration will work perfectly – there will be winners and losers, financially and in quality. It will be up to policymakers to actively monitor those imperfections, and have the will to make unpopular changes that may not benefit large, powerful institutional providers. We’ll see.
Ellen Andrews

Governor’s proposed budget adjustments – one major health change

The Governor’s proposals to adjust the current biennial budget include changes to LIA (the former SAGA program). When SAGA was merged into Medicaid in 2010, creating LIA, the asset limit of $1,000 was removed. Since that time enrollment has grown significantly due in part to removing the asset limit (the economy doubtless had something to do with it as well). Because program costs are now matched by the federal government, significant new revenues came into the General Fund. While enrollment growth has moderated, the Governor is proposing re-imposing a more generous $25,000 asset limit, and counting family income for applicants under age 26 living with a parent or claimed as a dependent for taxes. He has also proposed unspecified limits on medical services. The changes would save $22.5 million in the next fiscal year. In 2014, those applicants will become eligible for Medicaid anyway under national reform.

Other proposals include changes to who can administer medications, expanding childhood vaccinations, cost of living increases for private providers, expanding Money Follows the Person, among others.
Ellen Andrews

Yalies oppose federal needle exchange program cutback

Yesterday, a group of Yale students, the Student Global Health and AIDS campaign, protested the recent Congressional reversal of a 2009 Obama administration decision to fund needle exchange programs. The programs are an important, very effective public health measure preventing the spread of disease including HIV/AIDS.

CT Health Reform Dashboard -- 10.4% progress to date

How is CT doing reforming our broken health system? Are we making smart choices? Are we taking advantage of opportunities? Having trouble keeping up with the many moving parts? Visit our CT Health Reform Dashboard at www.cthealthreform.org

February web quiz – Insurance exchange planning report

Test your knowledge of CT’s health insurance exchange planning. Take the February CT Health Policy Webquiz.

Hospital errors rising, state investigations dropping

An analysis by the CT Health I-Team of DPH hospital adverse event reports finds that the number of errors has risen steadily over the last five years. The same investigation finds that DPH investigations of serious medical errors in hospitals have been rare and the numbers are dropping. Of 17 patients who reportedly died or were seriously injured during surgery in 2010, DPH investigated only six. For the first time, hospitals are named individually in DPH’s report. Hospitals with the highest rates of reported errors were New Milford, St. Raphael’s, Sharon, Johnson Memorial and Backus, in that order. It is important to note that the data is based on self-reporting; DPH does not audit hospitals’ error reports (or lack of reports). A national study found that voluntary reporting systems miss 90% of errors.
Ellen Andrews