SIM update -- questions about numbers driving policy

Significant questions have been raised about the methodology and sources for the Sept. 17^th SIM presentation (slide 30) asserting that 62% of primary care providers in CT currently have provider risk/shared savings/total cost of care arrangements with providers. Questions relate to whether the populations included are representative of the state, provider types included, whether the number relies on one payer disproportionately, and the possibility of double counting among other issues.

Unfortunately this questionable number is being used as the foundation of a proposal that may undermine even the minimal quality standards in the current SIM proposal. Last week, in a private email, SIM steering committee members were asked for input on whether, given the perceived prevalence of provider risk, SIM should propose allowing provider incentives even in the absence of medical home status. Presumably this is to avoid jeopardizing the primary SIM goal of moving at least 80% of state residents into provider risk arrangements, regardless of quality protections. Advocates have called on SIM leaders to build a robust quality monitoring system before any provider incentives are implemented. Advocates are hoping to both improve the quality of care in CT and prevent the harm to people that occurred in managed care risk arrangements in the past.

The current SIM medical home plan is to create a CT-specific, lower standard than the commonly-used, well-vetted national accrediting bodies. (They have taken “person/patient-centered” out of the label for their lower standard.) There are currently 821 NCQA certified PCMHs in CT and the list grows every month. One third of Medicaid consumers are now cared for in a PCMH. It is important to note that a large proportion of Medicaid providers, with lower payment levels, have earned PCMH designation.

CT exchange premiums 4th highest in US

A new analysis from the White House finds that CT’s insurance exchange premiums are among the highest in the nation – behind only Alaska, Mississippi, and Wyoming. CT residents and small businesses buying unsubsidized coverage through the exchange will pay 28 to 37% more than most Americans depending on which plan they choose. We will pay about 24% more than New Yorkers. Passage of SB-596 this session would have directed the insurance exchange to negotiate prices on behalf of consumers, which would have lowered premiums. The bill passed the Senate but died in the House; even a provision allowing the exchange to negotiate (which they can do without legislative authority) died in the last hours of the session. New York negotiated rates with the plans. 

HUSKY is growing outreach tool for community organizations

Connecticut’s Medicaid/HUSKY program is significantly expanding effective January 1st. 700,000 state residents are already benefitting from the program and up to another 130,000 may qualify under new eligibility rules. Many people denied Medicaid or HUSKY in the past will now qualify. Medicaid and HUSKY provide comprehensive health care coverage without cost.

To ensure that every eligible state resident is enrolled as soon as possible, CTHPP summer intern Tanusha Satavalli developed a “HUSKY is growing” toolkit for community organizations to help people know about the expansion. The tools can be customized for your organization.

CT Health Policy Roundtable: CT’s APCD

Join national and state experts for a Roundtable to learn more about the potential for Connecticut's new All-Payer Claims Database in health care planning, improving health care quality, capacity and promoting health equity. The Roundtable is sponsored by the CT Health Policy Project, the CT Center for Patient Safety and Access Health Analytics and made possible with support from the CT Health Foundation. The Roundtable will be Thursday, October 24^th from 1 to 3pm in Room 1E of the LOB. Registration is encouraged.

Moderator: Pat Baker, CT Health Foundation

Speakers:

Josephine Porter, APCD Council

David Newman, Health Care Cost Institute

Cynthia Millane, FairHealth

Tamim Ahmed, Access Health Analytics

Kevin Lembo, CT State Comptroller

SIM update

The September meeting of the SIM steering committee changed little to the plan except the name of the payment model. The planners reported to the committee what will happen in the next phase of the process. They changed the name of their provider risk-based payment model from Total Cost of Care to Shared Savings, apparently because people associated TCC with capitation. But it became clear that members’ assumptions that Shared Savings had the generally accepted, Medicare-based meaning, that in fact Shared Savings also includes capitation. They are looking for a term that includes capitation but doesn’t evoke strong negative reactions from stakeholders. (The problem isn’t the term.) They also intend to re-create the committee structure, possibly including consumers and/or advocates in some of the new committees. In response to advocates’ concerns, they are including an Equity Access and Appropriateness Council to monitor for denials of inappropriate care under their provider risk models. However, there is no assurance that a meaningful quality monitoring system will be in place before people are placed in the potentially harmful payment model the committee is designed to prevent. They are continuing their individual, private meetings with insurers and others to test the model. 

CID seeking comments on mental health parity enforcement

The CT Insurance Department is seeking public comments on methods to monitor and ensure compliance with state and federal mental health parity laws. CID has chosen to move ahead with enforcement of the law, despite delays in getting federal regulations. Insurers have urged CID to wait for final federal rules. CID encourages anyone with expertise or experience in the area to comment. They will be accepting comments through October 15^th. 

Medicaid Council updates: Medicaid enrollment changes

The majority of September’s Medicaid Council meeting focused on massive changes to how people will apply for Medicaid coverage over the next few months. DSS reported that the new ConneCT system is close to caught up on scanning client documents, but work on the indexing system (assigning documents to the right client’s file) continues. Call wait times have increased to average 20 minutes since the new phone system was instituted. There was no information on the rate of dropped calls. DSS is working on technical improvements of the online system to reduce the need for clients and providers to call in. DSS intends to develop a public, online dashboard on how ConneCT is progressing and will update the Council monthly; they are open to ideas on what measures should be included. AccessHealthCT reported on their integrated portal for both exchange and Medicaid applications. After January 1^st all online Medicaid applications (except aged, blind and disabled) must go through the integrated portal. Leadership acknowledged that the system won’t be perfect and there will be mistakes and complaints. They will take paper applications but strongly urge people to apply online. Unfortunately that online application will take about an hour to complete. Data on income levels the system uses will be two years old; they are trying to develop a relationship to use only 6 month old income data. Acknowledging that this is not reliable to accurately determine eligibility, DSS will accept self-reported income and give applicants 90 days to send in supporting documentation. DSS will continue to have to manually enter information in the eligibility system from a pdf generated by the online application for the foreseeable future. There was also a very rich presentation on CHN’s ASO programs and services, but unfortunately there wasn’t sufficient time to explore the information.