Both the Primary Care and HealthFirst Authorities met yesterday, the later most likely for the last time. The HealthFirst Authority meeting featured Jonathan Gruber, an MIT economist, who is the leading proponent of individual mandates across the US. He championed the mandate in MA and is working with other states and the fed.s on building an individual mandate for all of us. His argument is that, based on economic modeling, there is no other way to get completely universal coverage; in a voluntary system, there will always be some who choose to opt-out if given the option. Dr. Gruber crunched numbers for the Authority’s reform proposal.
The CT Health Policy Project has published a detailed list of challenges in implementing any individual mandate in CT. Despite a legal mandate, 12% of drivers in CT do not carry auto insurance. MA, despite its mandate, exempts 62,000 people due to financial constraints who remain uninsured, in addition to the 86,000 uninsured residents who are paying the mandate tax penalty. Insurance in CT is very expensive – family premiums rose 8.2 times faster than incomes from 2000 to 2007. Also, buying insurance is no guarantee of coverage in CT; thousands of people have found that the policy for which they’ve been faithfully paying premiums, often for years, does not cover them when they become ill.
The mandate is built on a myth – that uninsured people can afford coverage and are choosing not to buy insurance. The truth is that most either do not have an offer of benefits or cannot afford what is available. Only 1.5% of uninsured Americans go without by choice. High deductible plans, that do not cover preventive care, are not protecting the assets of consumers (low-income uninsured patients tend to have few assets), but are protecting institutional interests of hospitals, providers, payers and government. Forcing low-income people to buy coverage of questionable value is just another tax for the common good and we should fund it that way.
SustiNet, the only comprehensive reform package being considered in CT, does not include a mandate, but does include extensive auto-enrollment mechanisms that may work better than a legal mandate. SustiNet was developed by the Universal Health Care Foundation of CT who, together with the CT Health Foundation, paid for Dr. Gruber’s analysis of both the Health First proposal.
Dr. Gruber’s analysis of the Authority’s proposal does not yet include raising provider rates in Medicaid, HUSKY or SAGA; he expects to add that soon and the following numbers will change. He found that by 2012, without a mandate the Authority proposal would reduce the number of uninsured in CT by 35,000 to 55,000 and cost the state (net) between $275m and $425m, depending on whether individuals are allowed to join the state pool. With an individual mandate, costs rise to between $695m and $760m but almost all of the uninsured would be covered. He acknowledged that these numbers do not account for expected savings to the health care system, CT families and employers. An interesting assumption he makes (that doesn’t have a huge effect on the numbers) is that while he predicts some employers to drop coverage due to the reforms (crowd-out), he assumes that those employers would increase wages to compensate for dropping benefits, thereby raising tax revenue to the state. While most economists agree that benefits come out of wages, as a practical matter would they return those costs to workers when they drop benefits or put those resources elsewhere? Tom Swan noted that the much feared crowd-out effect did not happen here in CT when HUSKY Part B was implemented. Dr. Gruber felt that the Authority’s proposals were overly generous; he believes that most Americans are over-insured. He acknowledged that MA’s reforms, including the individual mandate, have not reduced ER visits in that state.
The Primary Care Authority’s meeting was less contentious. That group is reviewing DPH’s provider licensure forms and making recommendations to collect better information on primary care workforce in the state. The group is also considering recommendations to the General Assembly on coverage, workforce development, access to care, medical home, chronic disease management, prevention and payment mechanisms to support quality and access in primary care, and oversight.
Ellen Andrews
Thursday, April 30, 2009
Donaghue Foundation conference notes
The Donaghue Foundation held their annual conference titled “Innovation in the quest for better health: Patient driven transformations in research, technology, and treatments.” The conference was well-attended by people from a wide variety of organizations, from hospitals to banks and non-profits.
The first speaker was Alejandro Jadad, MD, Chief Innovator & Founder, Center for Global eHealth Innovation, whose topic was “Will we be able to innovate in time? Meeting the health care expectations of the Obama generation”. He said that some health care professionals are reluctant to use technology in their practices but he always asks his patients if they have found any useful information on the internet. He compiles this information into a list of resources to give to other patients. He used an example of a colleague who has his patients in the operating room call their families in the waiting room to report on their successful surgeries. Another interesting example is taking a digital photo of a post-surgical wound and emailing it to a doctor, who can look at this and let you know how the healing is progressing without your even having to go into the doctor’s office.
The second speaker was Sharon Terry, MA, President & CEO, Genetic Alliance, whose talk was titled “Participants at the center: Accelerating pathway from research to health.” Mrs. Terry and her husband started an advocacy organization when they found out that their two children had a rare genetic disorder. Through the Genetic Alliance, she promotes an environment of openness that focuses on the health of individuals, families and communities and to make sure their perspectives are at the “center of efforts to improve health systems and use of genetic information.”
The final speaker was Ben Heywood, Co-founder & President of PatientsLikeMe who spoke about “The power of sharing with patients like you: Transforming research, treatments and care.” PatientsLikeMe is an online community for people with life-changing illnesses where they can share treatment options and coping mechanisms. The site has “created a platform for collecting and sharing outcome-based patient data and real life experiences amongst patients.” The company is for profit and sells the medical information (in aggregate form and without identifiers) to pharmaceutical, medical device, and insurance companies. Patients are aware of this and some feel that it could help find treatments for their diseases. One of the goals of the site is to help participants answer the question, “Given my status, what is the best outcome I can expect to achieve, and how do I get there?” I think one of the most powerful statements made by Mr. Heywood was when he stated that he has been to many conferences about health care where they talk a lot about patients – but patients are never at the table. As wary as I would be about sharing my medical details online, maybe it provides a way to bring patients into the discussion about the medical treatments that affect them.
Jen Ramirez
The first speaker was Alejandro Jadad, MD, Chief Innovator & Founder, Center for Global eHealth Innovation, whose topic was “Will we be able to innovate in time? Meeting the health care expectations of the Obama generation”. He said that some health care professionals are reluctant to use technology in their practices but he always asks his patients if they have found any useful information on the internet. He compiles this information into a list of resources to give to other patients. He used an example of a colleague who has his patients in the operating room call their families in the waiting room to report on their successful surgeries. Another interesting example is taking a digital photo of a post-surgical wound and emailing it to a doctor, who can look at this and let you know how the healing is progressing without your even having to go into the doctor’s office.
The second speaker was Sharon Terry, MA, President & CEO, Genetic Alliance, whose talk was titled “Participants at the center: Accelerating pathway from research to health.” Mrs. Terry and her husband started an advocacy organization when they found out that their two children had a rare genetic disorder. Through the Genetic Alliance, she promotes an environment of openness that focuses on the health of individuals, families and communities and to make sure their perspectives are at the “center of efforts to improve health systems and use of genetic information.”
The final speaker was Ben Heywood, Co-founder & President of PatientsLikeMe who spoke about “The power of sharing with patients like you: Transforming research, treatments and care.” PatientsLikeMe is an online community for people with life-changing illnesses where they can share treatment options and coping mechanisms. The site has “created a platform for collecting and sharing outcome-based patient data and real life experiences amongst patients.” The company is for profit and sells the medical information (in aggregate form and without identifiers) to pharmaceutical, medical device, and insurance companies. Patients are aware of this and some feel that it could help find treatments for their diseases. One of the goals of the site is to help participants answer the question, “Given my status, what is the best outcome I can expect to achieve, and how do I get there?” I think one of the most powerful statements made by Mr. Heywood was when he stated that he has been to many conferences about health care where they talk a lot about patients – but patients are never at the table. As wary as I would be about sharing my medical details online, maybe it provides a way to bring patients into the discussion about the medical treatments that affect them.
Jen Ramirez
Tuesday, April 28, 2009
New consumer tip sheets
The Consumer Health Action Network has published new tip sheets and the new federal poverty levels. The tip sheets, available in English and Spanish, include Finding Health Insurance After You Lose Your Job, Individual Insurance Plans: What to Look Out For, and our Updated COBRA tip sheet. The poverty levels are used to determine eligibility for many public programs including HUSKY. The Consumer Health Action Network is a program of the CT Health Policy Project.
Monday, April 27, 2009
Recent media stories highlighting medical error s in CT
Efraim Gomez-Zapata, Stamford physician, will have a hearing this week before the medical examining board and is facing a civil suit. A family practitioner, Dr. Gomez is not board certified in cosmetic surgery or anesthesia. However, he has been advertising himself as a leader in laser liposuction surgery in the Hispanic community. Apparently this is allowed under CT law. However, two of his patients had to be taken to the emergency room due to problems during surgery. One suffered seizures and another difficulty breathing after Dr. Gomez administered anesthesia. Dr. Gomez is also charged with not obtaining appropriate consent from patients and operating an unlicensed and unsafe surgical facility.
Hartford Hospital will remain on probation with the Dept. of Public Health indefinitely due, in part, to medical errors including a surgeon leaving a 13 inch medical instrument, a malleable ribbon retractor, in a patient after closing this January. The instrument was removed in another surgery two days later after the patient returned to the hospital in pain.
CT hospitals reported 65 instances of “retained objects” between mid-2004 and mid-2008. Nationally, the rate of leaving something behind in surgeries is one in 7,000. Two other hospitals cited in consent orders include Yale-New Haven Hospital for leaving behind a sponge in one patient and a surgical pad in another, and John Dempsey Hospital cited for missing the tip of a needle in a patient. For DPH reports on hospital medical errors, click here.
Several safety initiatives have proven to reduce the incidence of errors during surgery. The World Health Organization has developed a set of checklists, used at three points during surgery, that has reduced deaths and complications by one third. The Agency for Health Care Research and Quality has a great deal of helpful information for consumers to ensure they receive safe, quality health care. To research your doctor, check the CT Physician Profile. To check your hospital’s record, go to Medicare’s Hospital Compare.
Ellen Andrews
Hartford Hospital will remain on probation with the Dept. of Public Health indefinitely due, in part, to medical errors including a surgeon leaving a 13 inch medical instrument, a malleable ribbon retractor, in a patient after closing this January. The instrument was removed in another surgery two days later after the patient returned to the hospital in pain.
CT hospitals reported 65 instances of “retained objects” between mid-2004 and mid-2008. Nationally, the rate of leaving something behind in surgeries is one in 7,000. Two other hospitals cited in consent orders include Yale-New Haven Hospital for leaving behind a sponge in one patient and a surgical pad in another, and John Dempsey Hospital cited for missing the tip of a needle in a patient. For DPH reports on hospital medical errors, click here.
Several safety initiatives have proven to reduce the incidence of errors during surgery. The World Health Organization has developed a set of checklists, used at three points during surgery, that has reduced deaths and complications by one third. The Agency for Health Care Research and Quality has a great deal of helpful information for consumers to ensure they receive safe, quality health care. To research your doctor, check the CT Physician Profile. To check your hospital’s record, go to Medicare’s Hospital Compare.
Ellen Andrews
Thursday, April 23, 2009
April 30th briefing on proposed elimination of legal immigrant coverage
Next Thursday, April 30th at 10:30am in Room 1E of the LOB, the CT Health Foundation will hold a briefing on budget proposals to eliminate health coverage for legal immigrants and proposals to increase copays and other costs on all HUSKY families. Two policy briefs will be released at the briefing. Speakers include Pat Baker of the CT Health Foundation, Jack Hoadley of Georgetown University, to describe his research, and Evelyn Richardson, a Medicaid consumer from Hartford, to describe the impact on her family. For more information or to RSVP, contact Midge Mongillo at midge@cthealth.org or (860) 224-2200 X33.
PCCM subcommittee to meet
At the last Medicaid Managed Care Council meeting, a subcommittee was formed to follow and advise DSS on implementation of the HUSKY PCCM program. The first meeting of that subcommittee will be May 20th at 10am in Room 3800 of the Legislative Office Building (LOB) in Hartford. For directions to the LOB, click here. The meeting is open to the public; anyone interested in PCCM and HUSKY is urged to come.
Wednesday, April 22, 2009
Obesity and overweight in Connecticut forum
May 14th the CT Public Health Institute will release their study of the problem of overweight and obesity in CT including background, costs and consequences, and possible interventions. The forum was originally scheduled for May 5th. The study was funded by the Universal Health Care Foundation of CT. The forum will be at the Wilde Auditorium, University of Hartford from 8:30 to 11:30 am on that Thursday. For more information, contact Katherine Kranz Lewis at kalewis@hartford.edu or (860) 768-5464.
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