$3 million in ACA insurance rebates coming to CT residents

69,186 CT residents will soon receive $3 million in rebates from insurers that spent less than 80% (individual coverage) or 85% (large groups) of premiums on medical or quality improvement services last year. The rebates result from Medical Loss Ratio provisions in the ACA. CT’s total is down from $5.6 million in total refunds for 2012. National totals are down as well suggesting that insurers are doing a better job of pricing their products and reducing excessive administrative costs and profits. CT individual market refunds average only $14 compared to the national average of $85 but CT large group customers will do better with average refunds of $183 compared to $73 nationally. No small group consumers in CT will receive refunds in this round. The refunds could come as a check in the mail, a reimbursement to the account that paid the premium, a reduction in future premiums or through the employer but in a way that benefits the consumer.

SIM application online

CT’s SIM application has been submitted and is online. An analysis will be coming soon.

New to Book Club – Think Like a Freak

The newest addition to the CT Health Policy Project Book Club, Think Like a Freak, offers tools to unlock creativity in problem solving, using new perspectives to solve intractable challenges – and health care has a lot of those. Freakonomics and SuperFreakomomics, earlier CT Health Policy Project Book Club selections, gave us interesting examples of how a different perspective on a problem can give us better answers. The examples were fascinating, which is great if they hit the issues you work on, but we can’t wait for the authors to solve all our problems. Their new book helps the reader find that new perspective and “think like a freak”. Lessons include think like a child, focus on incentives, and learn to appreciate quitting. They also spend a good amount of time working through the barriers to thinking like a freak including no time, the comfort of running with the herd, and blindness to biases.

June CT Health Policy Webquiz: CT health system performance

Test your knowledge about Connecticut’s health system performance. Take the July CT Health Policy Webquiz.

CMS announces new assistance for states to improve health system, many SIM alternatives

Today CMS unveiled the Innovation Accelerator Program providing states with over 50 tools, programs and technical assistance to improve Medicaid programs – both delivery and payment reforms. SIM is only one of the dozens of tools listed. The tools include numerous alternatives to CT’s risky SIM proposal to achieve every one of the goals outlined in the CT SIM final plan.

SIM moving ahead with risky Medicaid plan despite 25 advocates’ objections

At yesterday’s meeting, the SIM steering committee chose to move ahead with plans to radically change the Medicaid program – to include shared savings and an 1115 waiver. The new plan, rushed out in only a few weeks, reverses earlier assurances to advocates that the state would go slowly into shared savings payment incentives, recognizing that people in the program are at higher risk of underservice.  New features unveiled at yesterday’s meeting include that the eventual plan is to move 600,000 Medicaid members into shared savings over the next six years, only beginning with 200,000 or more Jan. 1, 2016. We also had our first look at the proposed SIM budget, which includes only a small sum for monitoring underservice, less than for focus groups and other consumer education or program evaluation. The budget was developed by collecting requests from the “owners” of SIM – state agencies. However state officials assert that the grant is not motivated by bringing federal funding to the state. Twenty five independent consumer advocates, who do not stand to benefit from the decision either way, signed a letter opposing the new Medicaid plan, concerned about serious harms to Medicaid clients who struggle now to access care, and jeopardizing recent hard-fought progress in the program. But committee members were not persuaded,  believing the potential benefits outweigh the risks.

Medicaid Council voices concerns about new SIM proposal

In a special meeting yesterday, the majority of Medicaid Council members voiced concerns about the rushed, new SIM proposal for Medicaid. Legislators compared the new proposal to the failed HUSKY HMO proposal 20 years ago and made it clear that they are concerned about “going back down that road”. Concerns included the application’s aggressive pace of reform with several speakers asking DSS to slow down and revert to the original SIM plan that staged reforms with time for evaluation and improvements in between, building on lessons learned. Speakers were concerned that the move to shared savings would undermine the successful PCMH program that is improving care, engaging more providers and controlling costs. In fact, CT Medicaid spending is under control, projected to drop even, over the next several years. Strong concerns were raised about the dangers of an 1115 waiver, even if intended for a purpose everyone could support, could later be used to deny care to people as has happened in the past when the state budget runs into deficit. Advocates pointed out that there are other, less risky ways to accomplish the goals outlined for the 1115 waiver. Speakers were concerned about the priority focus on cost savings over improving quality. Concerns were raised that shared savings is relatively new across the US, and that it has not been universally successful. There were strong concerns about exacerbating underservice, which happens frequently now in the program under fee-for-service, without new incentives to deny care. SIM proponents acknowledged that the new proposal was precipitated by securing a federal grant but believe that the potential benefits outweigh the risks. Representatives from ProHealth and CT’s community health centers, both of which would potentially benefit from the proposal, spoke in favor of the proposal.