SIM public comments: diverse and mostly critical

Last month Connecticut’s State Innovation Model (SIM) planning group, working for most of the year, solicited public comment for the first time. SIM is the administration’s plan, based on federal grant provisions, to radically transform Connecticut’s health system – payment and care delivery. The federal grant requires the plan to cover at least 80% of state residents within five years – Medicare, Medicaid, employer-sponsored, and private coverage. SIM received 84 comments from a broad range of stakeholders; the majority were critical of the plan. Top themes in the comments were concerns about excluding key stakeholders, incentives to deny necessary care, excluding consumers and advocates, a lack of transparency and downside risk that could jeopardize recent progress improving Medicaid.

Safety net hospitals expect to see more uninsured undocumented immigrants

CT hospitals are expecting a growing burden of uncompensated care for undocumented immigrants next year, according to C-HIT. Undocumented immigrants cannot benefit from expansions of coverage under the ACA. They are not eligible for Medicaid regardless of income level and cannot purchase coverage on the insurance exchange, even without a subsidy.  The ACA also decreases federal funding (DSH) for uncompensated care next year, under the assumption that the number of uninsured state residents will drop with coverage expansions. Last year, CT hospitals provided $233.6 million in total uncompensated care; Yale-New Haven highest at $31.8 million, Sharon Hospital lowest at $1.4 million. Hospitals hope to counter the myth that the ACA covers everyone.

CT Health Reform Progress Meter moves up to 28.3%

CT policymakers have completed 28.3% of the tasks necessary for health reform, up slightly from November. Most tasks on the Progress Meter list are due in just a month. Medicaid accounted for the forward progress in again this month, largely due to strong quality and care management performance reports. Once again, deep concerns about payment reform in the SIM process and the insurance exchange’s premium increases are holding Connecticut back. The Progress Meter is part of the CT Health Reform Dashboard.

December CT Health Policy Webquiz – CT health insurers’ performance

Test your knowledge of CT health insurer performance. Take the December CT Health Policy Webquiz.

CT Mirror Obamacare Maitre d’ – everything you wanted to know

CT Mirror has created a set of tools to guide the confused through Obamacare’s maze. Obamacare Maitre d’ steps you through the basics, simple questions about CT’s health insurance exchange, and the Medicaid/HUSKY program. Helpful articles include Obama and you – an explainer, What you need to know (overview) – and resources, and 6 things to know when buying health insurance.

SIM plan comments focus on protecting consumers

CT’s SIM draft plan to reform health care for at least 80% of state residents in five years is out for public comment. SIM is the state’s newest plan to radically reform health care delivery and payment across the entire state. Concerns raised in the CT Health Policy Project’s comments include potential incentives in the proposed payment system to stint on necessary, appropriate care. Advocates have urged the committee not to reward stinting -- to include monitoring for inappropriate under-treatment and deny shared savings payments that are generated by denying needed care. The comments also outline concerns about the process, including the exclusion of critical stakeholders from decision-making, about the danger of reversing hard-won improvements in CT’s Medicaid program, and highlight leading examples of responsible reform from CT and other states.

This is the first opportunity for the public to comment on the SIM plan that is to be finalized by the end of next month. Early next year the state intends to apply for a follow up federal grant of about $50 million to implement the plan.

CT hospital ER waits longer than US average

Average waits at CT hospital emergency departments vary from 82 minutes at Hartford Hospital to 14 minutes at Windom Hospital, according to a new analysis by the CT Health I-Team. CT’s average wait time is 30 minutes; the national average is 28 minutes. While CT hospitals are implementing quality improvements, experts expect wait times to increase with ACA coverage expansions starting in January, especially in Medicaid. From 2011 to 2012 ER visits in CT rose by 55,000.