Courant editorial critical of CT physician oversight

Authorities in CT are too lax in approving physicians to practice here, according to the Hartford Courant’s editorial page. The editorial was based on an article by the CT Health I-Team. The authors highlight numerous cases of disciplined doctors who’ve lost their license in neighboring states who are later approved to practice in CT. Hospital error reporting has improved in our state, but physician oversight lags. The authors blame a stubborn cultural bias of excusing bad practitioners over patient safety. Physicians in CT are regulated by a volunteer board including mainly other physicians. A recent report by Public Citizen ranks CT 47th among states in regulating doctors; we’ve been in the bottom ten states for each of the last three year reporting cycles. The report lays out qualities of top states with the best records of protecting patients including adequate staffing, independence of the board, and reasonable legal standards. Both Norma Gyle, Deputy Commissioner of Public Health, and the CT State Medical Society have proposed changes to improve patient safety.
Ellen Andrews

Waterbury uninsured have a place to get care

Yesterday’s CT Mirror highlights Waterbury Project Access, a free health clinic program providing care to uninsured patients in the area. Because of the program Dennis Hayes, a truck driver with no coverage and $50,000 in medical bills from a heart attack, doesn’t have to ration his medications or doctor visits – keeping him working and out of the hospital. The program, led by Leslie Swiderski since 2003, brings together volunteer providers, donated labs, medications, and hospital care with uninsured patients who aren’t eligible for any public programs. In the last four years, the program has helped over 1,200 patients and provided $4.6 million in donated care. A Project Access program opened this summer in New Haven.
Ellen Andrews

Factoid: Even wealthier Americans more likely to face barriers to health care than lower income consumers in most countries

It’s no surprise that low income Americans are almost twice as likely to encounter at least one barrier to accessing health care than the wealthy. But an analysis of an international comparison study finds that higher income Americans are more likely than even low income residents of seven out of ten industrialized countries to face barriers to health care. The only country with no income disparity, the UK, also had the lowest level of barriers overall. So much for the US having the best health care system in the world – rich or poor.
Ellen Andrews

Reading for the holiday break

The Wall Street Journal Blog has health care book recommendations for the end of the year promising ideas on how to fix a flawed system. Let us know what you think of them. Send us your suggestions for the Book Club. From the reading obsessed at CT Health Notes.

It’s official – 2010’s biggest lie of the year . . . .

PolitiFact, the Pulitzer-prize winning antidote to deliberate misinformation, has named the assertion that national health reform is a “government takeover” of health care as the biggest lie of the year. If only it were true -- no public option, consumers required by law to purchase a costly product from private companies, reliance on weak state regulators to enforce value in the product – it’s laughable. And 2009’s Lie of the Year? Death panels. Why does health care attract lies? How did we get so lucky?
Ellen Andrews

New estimates of savings needed for medical care in retirement

Too many people assume that Medicare will cover their medical costs after age 65 and fail to save. While Medicare does pay almost two thirds of seniors’ health costs, a new analysis by EBRI finds that an average American 65 year old man retiring this year without employer-sponsored premium assistance needs $109,000 in savings just to be 50% sure of covering his future medical bills. Women need to save even more at $146,000. To be 90% sure, they would need $211,000 and $242,000 respectively. That man, if he retires in 2020, needs $183,000. Retirees lucky enough to have employer subsidies are not off the hook – men retiring in 2010 need $66,000 and women need $88,000 in savings to meet just median likely health costs. Not surprisingly, CT is the most expensive state for Medigap coverage and we should be saving even more.
Ellen Andrews

Vote for the most influential health policy articles of 2010

For all the wonky types, RWJ is taking votes online for this year’s most influential research articles. You may have missed one or two (I did) so it’s also a chance to catch up.

A constituent who made a difference

Eva Bunnell was a mother whose husband was about to lose his job because he was spending time with their daughter with complex medical problems when she spoke to Sen. Christopher Dodd. Out of that conversation came the Family and Medical Leave Act. Eva told that story to advocates assembled to honor Sen. Dodd’s service to Connecticut. Sen. Dodd persisted for decades to make that law a reality in 1993. The law protects the employment of people who need to take time off for their health or that of a family member. Because of the law, Eva’s family was able to be with her daughter at the end of her life earlier this year. Defying the experts, Jacinta lived to the age of 27.
Full Disclaimer: In addition to being an inspiring advocate, Eva Bunnell is a former CTHPP Board member and a dear friend.
Ellen Andrews

Cost cutting commission final proposals

The state Commission on Enhancing Agency Outcomes issued its final recommendations to save money in the state budget including over $145 million from health care spending. Proposals include more efficient Medicaid drug purchasing, drug recycling, preventing falls, and reducing the number of nursing home beds in the state and re-balancing long term care to emphasize care delivered in the community.
Ellen Andrews

Almost half of CT physicians are using electronic medical records

A new survey from the CDC finds that 48% of office-based physicians in CT are using some form of an electronic medical record/health record (EMR, EHR) this year, just under the national average (50.7%). State rates varied from 38% (KY) to 80% (MN). But only 10% of US physicians have fully functional EMRs; most are using basic systems. The national rate has been increasing since 2003 when it was 17%. Interoperable electronic health information is a critical driver of health care system reform in our state, will improve patient safety and is one of the few ways to save money in the system that improves efficiency and does not involve shifting costs between stakeholders, most often onto consumers.
Ellen Andrews

Medicaid Council update

Financial numbers released at Friday’s Medicaid Care Management Oversight Council meeting highlighted the need for more sophisticated accountability or, even better, moving the program to a self-insured ASO model and removing any HMO incentives to game the system. The Council first heard about Aetna’s underwhelming and vague performance improvement programs; Aetna’s quality performance for members varied between the 25th and 90th percentiles among states. No numbers were given to quantify any efforts by Aetna to improve members’ health. In several areas, it was not clear that Aetna’s programs were making any difference at all given considerable efforts by public health programs such as Healthy Start and community health centers.

Interestingly, Aetna was the only plan among the three HUSKY HMOs to make a profit on every program – HUSKY A, B and Charter Oak – in both 2009 and 2010. Aetna was paid more per person than either of their competitors for each program in each year, in one case 31% higher, and spent less on medical care than any other HMO or program in both years. The three Mercer actuaries at the meeting (yes, three actuaries at the meeting) stated that they build in a 1% profit margin into their rate estimates – that would be about $8 million/year for all three HMOs. Aetna alone made $14.7 million in profits on HUSKY and Charter Oak in 2009. In fairness, their profits were down to only $5.3 million on HUSKY A in FY 2010, but both AmeriChoice and CHN reported losing money last year. Aetna’s unique profit experience in the program raises concerns about adverse selection, especially given that the plans were given essentially unlimited authorization for marketing during the time frame. From the poor performance measures described at the beginning of the meeting, Aetna’s profits are unlikely to be due to keeping members healthier than the other plans.

DSS was then questioned about their decision in August, retroactive to July, to allow the HMOs to reduce provider payments below Medicaid-fee-for-service levels. The Council only learned of the policy change at last month’s meeting. DSS claims they don’t believe the policy change will impact access to care and that they are monitoring it. Concerns were raised that it is not reasonable to assert that reductions in rates will not reduce access in a program that has struggled with poor provider participation over most of its history. Advocates also questioned relying on DSS’ inadequate monitoring, which even if it can pick up a reduction in access, would not find it until months or years have passed, and serious damage has been done.

In response to the rate reduction policy change, each of the HMOs reported that they have no intention and have not reduced provider rates below the Medicaid fee-for-service floor. However, this advocate reported that I have seen a letter to a provider citing the new policy and reducing rates to 70% of Medicaid fee-for-service levels.

All these concerns would be erased if the program moved to an ASO-model as was included in the latest budget passed by the General Assembly and signed by the Governor projected to save the state $79 million this year. Advocates, policymakers and the plans could get back to working on improving care in the program.
Ellen Andrews

New journalism focusing on CT health

The CT Health I Team, led by veteran CT journalists Lisa Chedekel and Lynn DeLucia, will publish original investigative reports on health and safety in Connecticut and surrounding states. Top stories include Disciplined Docs Practice Freely in State and PTSD Cases in State Up. C-HIT is sponsored by the Online Journalism Project.

CT fourth healthiest state

America’s Health Ranking has placed CT as the fourth healthiest state in the nation, behind only VT, MA and NH. Since 1993 CT has been in the top ten healthiest states. However performance on specific indicators varied widely. CT was the top state in recent dental visits, but 27th in air pollution and 31st in public health funding. Measures of the nation’s health used in the rankings improved by one percent from last year, however from 1990 to 2000 health measures improved by 1.5% annually.
Ellen Andrews

Rally for SustiNet December 14th

The Interfaith Fellowship for Universal Health Care is holding a rally for SustiNet December 14th from 5:30 to 6:30 pm at the Emmanuel Lutheran Church, 311 Capitol Avenue, Hartford. Governor-elect Malloy will join the Rally. For more information, go to http://www.ctneweconomy.org/

OLR reports on major issues for 2011

The Office of Legislative Research’s annual list of issues likely to be addressed in the coming session includes:
· Considering alternatives to HMOs for the troubled HUSKY, including statewide PCCM
· Reconsidering last year’s budget requirement that HUSKY move from the current capitated HMO-based model to a self-insured ASO model, as is common to most large insurance groups
· Cuts to eligibility and/or benefits in DSS programs, but higher caseloads due to the economy will require more funding
· Creation of a state health insurance exchange
· Health insurance premium rate review – directing the use of federal funds to the insurance dept. to improve capacity for reviews and requiring public hearings on excessive rate increase requests
· Requirements that employers provide workers with paid sick leave
· Possible implementation of the SustiNet plan and the recommendations of its taskforces and committees

What the report does not include is any mention of re-balancing long term care spending (LTC). At 53% of all Medicaid spending, CT is second in the nation in the proportion of Medicaid spending that goes to LTC. CT’s is 12th highest among states in the share of our LTC that is spent on nursing homes. Advocates have long called for re-balancing our LTC spending, making community-based care options more available – letting seniors stay in their homes and saving the state money.

For 15 other ways to save money in CT’s health care budget without harm, and in most cases improving quality and access to care, visit our brief and paper. There are many alternatives for thoughtful, sensible and responsible budget reforms in CT. Let’s hope the new administration is open to new ideas and new voices.
Ellen Andrews

CT insurance premiums up more than 30% from 2003 to 2009

An analysis by the Commonwealth Fund finds that single health insurance premiums in CT grew 34% and family coverage by 39% from 2003 through 2009. Interestingly, the rise in premiums was greater for employees of large firms than for workers in small firms, both in CT and nationally. CT family premiums were the 7th highest among states last year, but one of the lowest as a percentage of median income. Nationally premiums rose 41% and deductibles by 77% between 2003 and 2009. Without health reform, premiums would be expected to grow another 79% by 2020. If health reform slows the growth in health care spending by 1.5% (hopefully we can do much better), the average CT single policy will be $1,283 lower annually and $3,674 less for family coverage by 2020.
Ellen Andrews

SustiNet Board update

The SustiNet task force met yesterday to refine their final recommendations for proposed legislative language to the General Assembly. In an earlier survey of task force and ex-officio members there was agreement that the plan should merge state employees, Medicaid members and municipal employees. However, there was disagreement about including small businesses, nonprofits and the uninsured. Sal Luciano noted that the original intent of SustiNet was universal coverage and it is critical to provide access to an affordable, transparent public option to CT’s uninsured. The group also decided to “encourage” patient-centered medical homes, although Norma Gyle noted how important delivery reform is to the success of SustiNet and the larger health system and suggested substituting the stronger language of providing incentives for medical homes. There was also lengthy discussion about whether to raise HUSKY and Medicaid provider rates to private pay rates or leave them at the current lower rate. It was proposed that rates be raised only after compensating savings can be demonstrated in the program. Cristine Vogel argued that the group needs to make a “bold statement” about raising provider rates. Rates for care provided to poor children should be equal to those for state employees’ children. The group will deliberate further before their recommendations for proposed legislation are finalized. Special thanks should go to Sal Luciano, Norma Gyle (CTHPP Board members) and Cristine Vogel for their thoughtful, principled and consumer-centered comments.
Ellen Andrews

Courant Live Chat today on why insurance rates keep skyrocketing

Join Matt Katz of the CT State Medical Society and Jackie Aube of CIGNA today at noon for a live chat to discuss why health insurance rates continue to climb. If you can’t join at noon, you can email questions ahead.

SustiNet public briefings scheduled

Two SustiNet public briefings have been scheduled.

Monday Dec. 6 6pm to 9pm Hill Regional Career High School, 140 Legion Avenue, New Haven
Tuesday Dec. 7 9am to noon Legislative Office Building Room 1D, Hartford

A legislative briefing has been scheduled for Dec. 16th from 9am to noon at the LOB Room 2C.

State panel recommends $140 million in health care budget savings

Over half the recommended budget proposals for state budget savings from the Commission on Enhancing Agency Outcomes focus on health care spending. The savings center on prescription spending in Medicaid and moving nursing home residents to assisted living. The Commission is Co-Chaired by Sen. Gayle Slossberg and Rep. James Spallone.
Ellen Andrews

Most CT doctors will reduce Medicare participation if rates are cuts

An online survey by the CT State Medical Society found that 78% of the 360 state physicians who responded would restrict access to care for Medicare and TRICARE patients if rates are cut. Nineteen percent of respondents would stop taking any Medicare or TRICARE patients at all, 31% would limit the number of new patients and 28% would only continue seeing current patients. However it is unclear whether many physicians will be able to restrict their participation in the programs that cover more than 600,000 state residents, particularly in specialties that disproportionately treat elderly health issues. Since the survey was conducted, the scheduled rate cuts were postponed from Dec. 1st to Jan. 1.
Ellen Andrews

New Book Club post -- The Treatment Trap

A study found that one third of people who were told they needed heart bypass surgery did not need it. Tens of thousands of Americans have back surgery for pain when there is no evidence to support it; studies have found that pain management and therapy are more effective. The 70 million CT scans performed in 2007 will cause 29,000 cancers in Americans and 15,000 deaths. One third of Americans believe they have received medical care they did not need. There are powerful interests heavily invested in providing too much care, whether we need it or not. The Treatment Trap, by Rosemary Gibson and Janardan Prasad Singh, collects mountains of evidence that we are being overtreated and it is killing us. Moreover, we can't afford it. The authors include heartbreaking real life stories and recommendations that are commonsense and practical. Before people get worked up about "rationing", they need to read this book.

For more additions to your gift giving list for the health policy wonk in your life, check out our CT Health Policy Project Book Club.

Advocates ask CMS to intervene in HUSKY rate reductions

Two years ago, the state increased payment rates to providers in the Medicaid fee-for-service program and required that the HUSKY HMOs pay providers at least fee-for-service rates within the managed care program. The change in HMO contracts to require higher rates was included in the program’s federal waiver and capitation rates paid to plans were raised to pay for the change. (At the time, advocates found the HMO rate increase interesting as plans maintained that they routinely paid providers above fee-for-service rates.)

At the last Medicaid Care Management Oversight Council meeting DSS reported that they have reversed that policy and exempted the plans from the requirement to pay at least fee-for-service rates, retroactive to July 1st. However there has been no reduction in capitation rates to plans allowing the HMOs to reduce their medical costs and divert more state funds to administration and profit. At the October Council meeting we learned that the HUSKY HMOs made $19 million in profit on the program last year while they were still required to pay fee-for- service rates.

A group of advocate and provider organizations have sent a letter to CMS alerting them to the violation of the terms of the federal waiver that “threatens substantial harm” to more than 400,000 HUSKY members struggling now to access care in the program. Advocates are concerned that payment rate reductions will cause more providers to leave the program that already suffers from low provider participation rates. The advocates are asking CMS to intervene and reverse DSS’ policy decision to reduce provider rates.
Ellen Andrews

From the consumer helpline: Medicaid consumers being charged

Two calls just this morning came from consumers covered by Medicaid being charged by hospitals. One was a mother on HUSKY Part A charged $281 by a hospital for services she already received. But the first call was from a man on Medicaid who was told by the hospital that they would not schedule the second surgery he needs to heal an injury and get back to work until he pays $2,000 up front. They were both sent to the appropriate authorities and strongly urged to call their Senator and Representative as well.
Ellen Andrews

Estimated costs of SustiNet options described

Stan Dorn of the Urban Institute outlined the estimated costs of six SustiNet coverage options at yesterday’s Board meeting. Under any of the options Connecticut’s uninsured rate drops by more than half, the state budget deficit is improved, small businesses save (mainly by reducing the number of workers they cover), SustiNet grows into a significant, but not dominating, market presence (which can be leveraged to drive important reforms) and there is little impact on household incomes.

The estimates are based on economic modeling by Jonathan Gruber from MIT, and are estimated for 2017 when implementation should be complete. The committee was given two scenarios -- one extremely conservative that assumes no savings due to delivery system reforms already occurring in CT such as patient-centered medical homes, and another, more likely, scenario that still conservatively estimates those savings to only reduce skyrocketing cost increases by 1%. (Other researchers estimate that delivery system reforms could save twice that much. Below are the more modest 1% savings estimates.)

· Just including state employees and Medicaid in SustiNet saves the state $371 million, saves employers $485 million and covers 620,000 people in SustiNet by 2017.
· Adding the Basic Health Plan option to the model, taking advantage of a federal option to cover people under SustiNet to higher income levels with better coverage, lower costs to families and saves federal dollars, covers 650,000 state residents, saves the state $418 million, and saves employers $459 million.
· Also allowing small employers, nonprofits and municipalities to buy into SustiNet brings coverage in SustiNet up to 815,000 people, saves the state $425 million and employers $466 million.
· Opening SustiNet to everyone covers 1 million people, saves the state $427 million and employers $498 million.
· Raising provider payment rates to private pay levels covers the same 1 million people and saves employers the same $498 million but reduces the state’s savings to a still respectable $244 million. (Note: this option does not include any potentially significant savings from reductions in private pay rates as there will be no need to cost shift to cover Medicaid underpayments and that increasing rates will attract more participating providers, keeping HUSKY families out of expensive emergency rooms.)
· The last option expands HUSKY to higher income adults before national health reform’s schedule which would cover 600,000 people in the program, save employers $217 million but costs the state $103 million. (This is the only option under which the state doesn’t save money).

The Board will consider the options next month and make recommendations to the General Assembly in January.
Ellen Andrews

Consumers protest Anthem rate hike request

Consumer advocates demonstrated their concerns at a CT Insurance Dept. public hearing about Anthem’s request to raise premiums 20% or more. The consumers outlined the enormous economic burden this places on state residents and businesses while unemployment remains high and Anthem’s parent company made millions in profits last quarter. Policymakers questioned Anthem’s documentation to justify the increases. This is the latest in a string of double digit rate increase requests by Anthem that have been approved by the department.
Ellen Andrews

CT's Medicare patient centered medical home application -- bad and good news

Unfortunately, CMS did not approve CT’s application to include Medicare in our patient-centered medical home plans for state employees and Medicaid. If it helps, we are in good company – Massachusetts and Maryland, states with sophisticated reform efforts – also did not get approved.
But the good news is that the partners are all interested in moving forward with the project anyway. And our Congressional delegation is working on finding support at CMS for our project. We should consider this Round 1.
Thank you to everyone who gave their support to this effort. We will be calling on you again soon.
Ellen Andrews

eHealthCT’s Medicaid health information exchange up and running for real patients

CT’s pilot Medicaid health information exchange (HIE) project is up and securely sharing patient information successfully. Affirmative consent is collected from patients and registered with the HIE. The system can accommodate, among other things, secure email, eReferrals, lab data exchange, radiology image viewing and should conform with meaningful use criteria. The project has taken years to develop; as an advocate I have been amazed at the enormous amount of work involved in what looks effortless to most of us. Successful, secure exchange of accurate health information is crucial to reforming, and even sustaining, our health care system – to collect data driving intelligent reform, to improve patient safety, to align incentives and reward value, and to “bend the cost curve”. Congratulations to all the collaborators – you get five minutes to rest on your laurels, then the rest of the state needs this system.
Ellen Andrews

NY Times budget deficit graphic illustrates the scope of the problem

Yesterday’s NY Times Week in Review included a compelling graphic comparison of the federal budget deficit and options to fill it. The page long piece uses blocks to illustrate the size of the hole and how much or how little each option contributes to the solution. The options include spending cuts and revenue enhancements (taxes); many are health-related. It is interesting to see how much difference each option makes. For example, eliminating farm subsidies (often linked to rising obesity levels) saves a pittance. But capping Medicare growth at GDP rates + 1% starting in 2013 makes the most difference among all the options, spending cuts or tax hikes, saving $560 billion by 2030 and filling 41% of the budget hole. That is more than allowing all the Bush tax cuts to expire on everyone or reducing the tax break for employer-sponsored health insurance.
Someone should do this for CT’s budget hole.
Ellen Andrews

State Strategies for Health Reform Implementation conference

I’ve been in DC for a fascinating conference for state-based advocates on how we can influence and support health reform at home. First, it is an incredible opportunity to connect (and reconnect) with advocates from across the states, get ideas, share stories and learn what is really happening. For example, Utah’s much publicized insurance exchange is not working and they have problems getting accurate information from their state agencies as well. We’ve heard from leaders at CMS and the new Office of Consumer Information and Insurance Oversight. We’ve heard from strategists, think tanks, state officials, advocates, and communications experts. We’ve heard from states with great success reducing Medicaid spending, without disturbing services. We’ve heard a lot about how to build insurance exchanges, market reforms inside and outside the exchange, preventing adverse selection, linking Medicaid to the exchanges, benefit design, , setting up selective contracting processes with integrity, transparency and to get the best price for consumers in the exchange. We’ve also heard about hospital community benefit requirements. The Obama administration is eager to hear from advocates – we heard over and over that they know the rubber is hitting the road in states and they want to support us in making this work (including giving us personal email addresses).

Families USA, Community Catalyst, the Georgetown Center for Children and Families, and the Center on Budget and Policy Priorities put together an exceptional conference. I usually only learn one or two new things on most trips – I am walking away from this one with a full notebook of ideas.

Wednesday I also visited with health staff in some of CT’s Congressional offices. People were generally reassuring. While there will be attempts to repeal the Accountable Care Act, they won’t succeed. There will also be attempts to defund and repeal parts of the Act, staff also felt that they would largely fail as well. I felt much better.
Ellen Andrews

Candidate briefing book online

The 2010 CT Health Policy Project Candidate Briefing Book is now available online. Password protected access was sent before the primaries to every candidate registered with the Secretary of the State’s Office for all statewide offices, Congress, State Senate and House. The book has been updated periodically and is now available without a password at www.cthealthbook.org. Many thanks to all the students who worked on the book.

Health Care Advocate position posted

The state is seeking to fill the position of Health Care Advocate. The agency assists consumers struggling to access care in an increasingly hostile environment and makes recommendations to policymakers. For more information, click here.

NY hospital takes artwork in exchange for care

28% of NY artists are uninsured. To meet the needs of their community – both artists and patients -- Woodhull Medical Center in Brooklyn gives 40 credits toward health care services for every hour artists share with the hospital. Artists in Woodhull’s Artist Access Program take professional first photos of newborns and moms, provide storytelling in the pediatric ward, perform music in the lobby, and act as surrogate patients teaching residents how to break bad news. Credits can be used for appointments, lab tests and medical procedures.
Why can’t we do something like this in CT?
Ellen Andrews

Fifteen ways to save money in CT’s health care budget

The next administration faces an unprecedented budget deficit. The good news is that CT has barely scratched the surface of policy opportunities that save money, many of which also improve health care. Taking guidance from other states and other payers, we have assembled 15 ideas potentially reaching hundreds of millions in savings. We include PCCM, patient-centered medical homes, fiscal accountability in HUSKY, wellness programs, payment reform, and engaging the power of consumers and markets to reward value. Click here for the policymaker issue brief; click here if you want the long version.
Ellen Andrews

Courant photoblog on health care salaries

One of the Hartford Courant’s online featured photo galleries compares average salaries for health care workers in Connecticut. The highest are obstetricians and gynecologists at $209,160; lowest are home health aides averaging $29,020.
Ellen Andrews

YNHH surgeries under scrutiny after wrong site operation

The New Haven Independent is reporting that on June 9th a car crash victim had a skeletal traction pin surgically inserted into the wrong leg at Yale-New Haven Hospital. The error was the result of poor communication between surgeons during a “handoff” of the patient and had to be corrected in another surgery. The mistake was quickly caught and reported to DPH. DPH found that the staff should have taken a “time out” to review the records and double check the planned surgery. Handoff and time out procedures at YNHH have been updated. YNHH’s spokesman says the patient was not “seriously or permanently harmed.” All surgeries at the hospital will be monitored by DPH staff for three months through Dec. 1st.
Ellen Andrews

November web quiz

Test your knowledge of CT managed care plan performance. Take the November CT Health Policy Web Quiz.

State Supreme Court to decide if widows are responsible for nursing home bills

The New Haven Advocate reports that the CT State Supreme Court is considering a case that could have a devastating impact on CT’s 28,000 nursing home patients and their families. The case involves who should pay the $60,795.32 nursing home bill of a man who died two years ago. The nursing home, Wilton Meadows, is suing the patient’s widow citing a law that requires a spouse to pay bills from dentists, doctors, hospitals or items bought to benefit the family; nursing homes are not listed in the law. The lawyers argue that nursing home care is an “item” that benefited the whole family but a lower court disagreed. Nursing homes claim they have no other choice than to bill families because of low Medicaid rates. Too often families bringing patients to nursing homes sign papers taking responsibility for applying for Medicaid and agreeing to pay the bills that Medicaid doesn’t cover. Medicaid applications are difficult and it can take years to qualify.
Ellen Andrews

CT managed care report card out and medical loss ratios

The CT Insurance Dept. has published this year’s comparison of health insurers with interesting comparisons across managed care plans. (Study up for next month’s webquiz). Near the end, on p. 48, medical loss ratios are reported across insurers. It is important to note that the MLR definition used for the report is stricter than the proposed federal reform standards. Even so, all CT HMOs are well above the 85% level that will be required January 1st. Among CT indemnity insurers below 80% (the standard for individual coverage), Golden Rule is the only company with over 350 members.
Ellen Andrews

Health information privacy complaint filed against Hartford Hospital

State employee unions have filed a complaint with HHS’ Office of Civil Rights about Hartford Hospital sending letters to union members and patients about tense rate negotiations with Anthem. The union contends that the hospital is trying to scare patients to create leverage in their negotiations with CT’s largest insurer. The state uses Anthem’s network to provide health care to most of the plan’s 200,000 employees, retirees and dependents. The complaint alledges that the hospital improperly used protected patient information to influence payment negotiations.

"Hartford Hospital is manipulating our members, many of whom are deeply worried about the future of their medical care," said Jean Morningstar, president of University Health Professionals, Local 3837 in AFT Connecticut. "The hospital is simply trying to achieve a better financial outcome in their negotiations with Anthem. This is a shameful and dangerous tactic to engage simply for profit."

Ellen Andrews

CT Health Foundation seeks a communications Officer

The CT Health Foundation is hiring a Communications Officer to manage their Web, social media and e-mail efforts and contribute to overall Web vision and strategy. The Foundation is looking for at least five years experience in journalism or communications, strong writing and editing skills, extensive experience with Web sites and hands-on knowledge of social media tools. Knowledge of health policy and the world of philanthropy are a plus.

CID will hold rare public hearing on Anthem’s 2011 increase request

The CT Insurance Dept. has decided to hold a public hearing on Anthem’s requests for 2011 premium increases. The Commissioner was strongly criticized for approving Anthem increases of 47% for the end of this year with little review and no modification. Anthem has not yet submitted their proposal for 2011 rate increases, and the hearing date has not been set. As part of a $1 million federal grant, CID will now publish all insurer rate requests online. Politico is reporting that Commissioner Sullivan, who has been critical of national health reform, was “aggravated” by a strongly worded letter from HHS about the Anthem rate approval given the federal grant. Reportedly, he would have preferred a private phone call over a public letter.
Ellen Andrews

Countering campaign spin and negative ads

Yesterday’s NY Times top editorial is a list of fact checks on campaign distortions about national health reform, the Accountable Care Act. For the record, the law does not require patients to go through a bureaucrat to reach a doctor, reform is not a “government takeover” of health care – the law relies heavily on the current, very private, fragmented, inefficient, purely American health care system, some lousy insurance plans that don’t meet minimal standards for value won’t count as coverage (but the administration is being very generous with waivers, so maybe they will), health care costs are going up but it has little to do with the law, under reform Medicare is stronger and most recipients will be far better off with preventive care and lower drug costs, the vast majority of Medicaid costs are covered not by states but by the feds (states are big winners under national reform), and the law is already helping people with changes that became effective last month.
Ellen Andrews

New campaign describes benefits of Connecticut reforms

The Universal Health Care Foundation of CT has launched a new public education campaign about the benefits of SustiNet and national health reform to our state. A new brochure describes SustiNet, outlines the savings it will bring to businesses and individuals, and why we need Connecticut needs health reform now.
Ellen Andrews

CT teen pregnancy rates down

The rate of pregnancies among CT teens dropped to 22.9 per 1,000 girls in 2008, down from 23.1 the year before and 35.8 ten years before. CT’s rate has consistently been below the national average; our 2008 rate was the fourth lowest in the nation behind only MA, NH, and VT. The bad news is that racial and ethnic disparities among CT’s teens are very large. Non-Hispanic black teen girls in CT are 4.5 times more likely to be pregnant than whites and among Hispanics the rate is 8 times higher. Babies born to teen mothers are more likely to be preterm and low birthweight than babies born to mothers in their twenties.
Ellen Andrews

Large employers urge Hartford Hospital to be reasonable in Anthem negotiations

Rate negotiations between Anthem and Hartford Hospital have become tense as the October 31st contract end date nears, according to a CT Mirror article. On Monday a coalition of self-funded health plans, including the Office of State Comptroller on behalf of CT’s state employees, sent a strongly-worded joint letter to Hartford Hospital questioning the hospital’s case for double digit rate increases and critical of efforts to frighten patients. The large plans are not part of the negotiations but will have to pay large rate increases and out-of-network costs if reasonable rates cannot be agreed on. Next year’s state budget is expected to be $3.4 billion in deficit. The letter urges Hartford Hospital to agree to performance-based payment reform, to improve the quality and efficiency of care, ensuring that any increases are linked to increased value.
Ellen Andrews

Feds urge CT Insurance Dept. to reverse Anthem 47% rate hike approval

HHS has sent a letter to CT Insurance Department (CID) Commissioner Sullivan asking him to reconsider the department’s approval of Anthem 47% health insurance rate hikes for next year. "The consumers of Connecticut expect and deserve transparency and a fact-based rationale as to why their rates are increasing," according to the letter. The insurance department recently received a $1 million federal grant to build capacity for better rate reviews.

"HHS is therefore surprised that, after being awarded this grant, the CID has
approved a substantial increase by Anthem Insurance Company without holding a
public hearing, without having tested or validated the proposed rates and the
assumptions underlying those rates, and without publicly disclosing any data
filed by Anthem, analysis done by the CID, or correspondence between the CID and
Anthem."
Letter from Jay Angoff, HHS

Anthem and the Commissioner blame the new national health reform act for the increases, but actuaries allot increases of only 2 percent to the new act. Other CT insurers have asked for far more modest increases. No hearings were held before the department approved the rate hikes without any modification.
Ellen Andrews

Celebrate 30 years with the Hispanic Health Council

Join the Hispanic Health Council in celebrating their 30th anniversary. The party is next Thursday, October 21st from 5 to 8pm at the HHC offices, 175 Main Street in Hartford. For over three decades, HHC has been a pillar of Hartford’s large Latino community -- working to improve health, fighting for social justice, and building a healthier community. Click here to RSVP.

Office of Health Care Advocate saved CT consumers over a million dollars this quarter

CT’s Office of Health Care Advocate (OHA) returned $1.36 million in savings to health care consumers in our state between July and September of this year. OHA assists consumers struggling with insurance companies to access the care they need. So far this year, OHA has saved consumers $3.3 million in health costs. The savings include the costs of services denied by health insurers; without OHA’s help those costs would have been shifted onto consumers or providers. With rising unemployment OHA’s caseload is up 24% over the same period last year. Anyone needing help accessing care from an insurer can call OHA toll free at 1-866-HMO-4446 or email healthcare.advocate@ct.gov.
Ellen Andrews

SustiNet Board considers governance and structure recommendations

At today’s meeting the SustiNet Board considered three different structural options for the new SustiNet Plan. Options varied in whether the new SustiNet governing body will oversee or directly administer the plan, whether the SustiNet option will be a licensed state insurance product offered in the new state health insurance exchange, the relative roles of SustiNet and existing state agencies, liability and responsibility for complying with federal Medicaid laws, and layers of administration. Pros and cons of offering SustiNet inside and/or outside the new exchange were discussed – federal premium subsidies are only available inside the exchange, but undocumented immigrants may not purchase coverage in the exchange. Concerns were raised about levels of authority, raising capital reserves necessary for state licensure under current state law, and ensuring SustiNet is compatible with efforts to coordinate delivery system and payment reform across all payers. Next month we get the cost and financing numbers.
Ellen Andrews