CT Health Care Cabinet considers WA reform strategies, CT stakeholder input

At last week’s meeting, the Health Care Cabinet heard about lessons from Washington state’s successful reforms. Washington has consolidated health care planning across both the public and private sectors. The structure isn’t the key – what’s surprising is that they can get to a thoughtful consensus through power-sharing. Like many states, they are working on integrating behavioral health and primary care and emphasizing public health initiatives. In a very fortuitous turn, they didn’t reach their ambitious goals for rushing people into accountable care/risk sharing models. Recognizing that local context in health care is powerful, Washington’s planning is locally tailored and organized by regions – one size does not fit all. They also include a locally defined “early warning system” to monitor for problems. Proposed metrics include provider payments, ED use, wait times for care, patients shifting between providers, crisis calls and prescription drug utilization changes.

Washington is the last state on our list. We’ve found some themes among the successful states we’ve studied at the Cabinet that do not reflect Connecticut – local non-profit insurers, strong histories of collaboration -- in and outside government, reliance on smart analytics and evidence, and constructive, supportive leadership that engages and respects all voices. A Washington stakeholder was quoted saying, “We are lucky here because collaboration is in the water.” They are very lucky.

Input consultants received from Connecticut stakeholders demonstrated how “siloed” our state is. Many were not aware of successful initiatives already implemented by others in our state. Now we begin framing recommendations. Given the disagreements over guiding principles, and even the definition of a principle, it may be a long haul.

Palliative care webinar offers opportunities to improve life for seriously ill people -- and save money

Today’s webinar with Dr. Diane Meier from the Center to Advance Palliative Care was moving as well as offering a very promising policy option for CT’s Medicaid program. Palliative care offers great potential to improve and extend the lives of people with serious illness, allowing them to get care at home if they wish, while controlling costs. Click here to watch a video of the webinar click here; and here for the slides. MAPOC’s Complex Care Committee, which sponsored the webinar, will be discussing the possibilities at our next meeting May 27^th at 9:30 at the Legislative Office Building.

Nine in ten CT residents have a usual source of care

A new CDC report finds that in 2014, all but 10.1% of Connecticut residents had a usual source of medical care.  The same report found great variation among states but, on average, 17.3% of Americans lacked a usual source of care. Vermont led the country with only 2.8% of residents that report they do not have a regular care site. Still there is room for improvement – 29.6% of Connecticut residents had not seen or talked to a general doctor in the last year. Vermont also led the country in that metric at 84%. Interestingly, the study found little impact on these metrics of states’ decisions to expand Medicaid or create a state-based health insurance exchange.

Health care prices higher in Connecticut but not as bad as you’d think

A new report finds that health care prices are higher in Connecticut than the rest of the US ranking us14^th among states. Alaska had the highest average prices in the nation; Florida’s prices averaged the lowest. The report by the Health Care Cost Institute averaged 2015 prices for common treatments across and within 41 states and the District of Columbia. Prices between states varied by more than double, but within states prices sometimes varied threefold and the direction is not necessarily consistent between services. For example, the average price for a knee replacement in New Haven is $37,417 – 11% higher than in Hartford. However for an ultrasound for a pregnant woman, the bargain is in New Haven, costing 64% less than in Hartford. The authors argue that some variation in prices reflects differences in labor and other underlying costs, much variation is driven by market forces such as a lack of price transparency, competitive pressures, or the availability of alternatives.

Governor offers third budget proposal -- Still cuts another 8,700 working parents’ HUSKY coverage

In the ongoing tense budget negotiations, yesterday the administration offered yet another budget proposal in response to the legislature’s latest version. However the Governor and legislature are still reportedly over $100 million apart. The new proposal retains the Governor’s plan to cut 8,700 more HUSKY parents from coverage. In a classic case of misdirection, that cut is labeled “Transition coverage to Health Insurance Exchange.” Only about a quarter of slightly higher income working parents cut off last year were able to afford coverage in the exchange and are likely uninsured now. Worse yet, another 17,688 working parents are scheduled to lose coverage this summer based on last year’s cuts.

In the new proposal the Governor restored some hospital cuts from his last version but expanded cuts to behavioral health services for children. Proposed cuts to children’s dental care, community health centers and the Medicaid ASO remain. The Governor does not include the legislature’s proposed $26 million in Medicaid savings. Advocates can help achieve that goal with smart savings. The legislative session is scheduled to end tomorrow.

CT Reform Dashboard update – opportunities for progress, but some concerns linger

Lots of changes this month in CT’s Health Reform Dashboard. The inability to finalize the state budget leaves coverage for 8,700 HUSKY parents in limbo. This is in addition to the 17,688 working parents who are already scheduled to lose HUSKY this summer. Despite this, the Health Care Cabinet continues its collaborative work to study best practices from other states to develop reform recommendations for the legislature. Many decisions about Medicaid’s redesign into shared savings are made. There are pros and cons but the state incorporated a great deal of stakeholder input, including many of the independent advocates’ recommendations. The CON taskforce has begun its work to preserve a competitive, healthy market in our state and the insurance exchange is planning to shift their focus from enrollment to making coverage affordable and meaningful.