Health IT privacy meeting

The first meeting of the HITE-CT privacy committee will be January 11th from 12:30 to 2pm at the LOB. This committee was created in response to legislative proposals to ensure consumers agree to protect their private health information on CT’s new electronic health information exchange. HITE-CT is the quasi-public entity federally funded to create an electronic health information exchange for CT. HITE-CT’s membership is dominated by providers and state agencies. Over the objections of consumers and advocates, in an opaque and unpublicized process, HITE-CT voted against an opt-in privacy process in which requires affirmative consumer consent to share health records. Instead, HITE-CT chose an opt-out policy in which all consumers’ information is shared by default unless they hear about and navigate the as yet undefined opt-out process. The process for opt-ing out and educating consumers about their rights has not been determined, but is severely under-resourced in the HITE-CT budget. All our surrounding states use an opt-in privacy policy in their successful exchanges and between 88 and 97% of consumers agree to share their information. Several states that used to have opt-out policies are converting to opt-in. In HITE-CT’s proposed policy, providers would be required to segregate any sensitive health information in patients’ records relating to ten conditions protected in law such as HIV and behavioral health status and treatment. Providers would also be required to accept liability for accurately and appropriately segregating all legally protected information.
Ellen Andrews

Overtreatment webinar slides and video posted

Slides and video from Rosemary Gibson’s webinar on What States Can Do About Health Care Overuse are posted. Rosemary Gibson has authored several books on the overuse of medical care, how it is harming our health, fueling health costs, and what we can do about it.
The next webinar is The Promise of Shared Decision-Making - Engaging Patients and Improving Care. with Shannon Brownlee, author of Overtreated, and Ben Moulton, from the Foundation for Informed Medical Decision-making January 10th at 1pm. To register, click here.

CER Webinars

Join us for two upcoming webinars on similar themes.

The first is next Wednesday, December 28th at 10am with Rosemary Gibson, author of The Treatment Trap. Rosemary will describe the Overuse of Medical Care and what can be Done to Prevent It. To register, go to https://www1.gotomeeting.com/register/828589337.

The second is the Promise of Shared Decision-Making – Engaging Patients and Improving Care, Jan. 10th at 1pm. Hear Shannon Brownlee, author of Overtreated, and Ben Moulton, from the Foundation for Informed Medical Decision-making, talk about how policymakers can help inform patients about all their options and avoid unnecessary treatment. To register, go to https://www1.gotomeeting.com/register/968183345

Electronic health record breaches up 32% this year over last

As more patient records move to electronic formats, the number of breaches, or losses, of that information is also up sharply rising 32% this year over last, according to the NY Times. Lost or stolen laptops and phones make up almost half the breaches. Nationally, 57% of office-based physicians use electronic health records. Breaches cost the industry $6.5 billion/year but can cost patients far more. Records lost can include name, birthdate, and social security numbers in addition to sensitive health information. Breaches of unsecured protected health information that affect 500 people or more are listed online by law. The site, called the Wall of Shame, includes seven breaches in CT over the last two years together totaling 170,339 people. Organizations that lost information included providers and insurers, and involved theft, loss and unauthorized access. Unfortunately, in only some cases are entities required to notify patients that their information was breached. This highlights the need for strong security of electronic records and, just as important, patient control over their information. Informed consent is the basis of a respectful partnership between people and the health care industry that keeps us well. A breach should not be the first time any patient learns that their information is being shared.

CT Insurance Exchange News

New on the CT Exchange Watch Blog – www.ctexchangewatch.org – Mercer finishes report to exchange board, more press and more calls for consumer voices in the exchange.

CEPAC meeting – comparing treatment resistant depression treatments

Friday’s CEPAC meeting in Providence was fascinating. We spent the day comparing the clinical and cost effectiveness of some common and some new treatments for people with treatment resistant depression (TRD). Between 13 and 14 million Americans experience clinical depression each year, but only about half seek treatment and only 20% of those get adequate treatment. Unfortunately about half of those who get treatment do not respond to medications. One study found that medical and disability claims from employees with TRD are more than double the costs for other employees with depression. Options for these patients used to be limited but technology has advanced in recent years. CEPAC is a New England regional public advisory group convened to consider the clinical and cost effectiveness of competing treatments. CEPAC includes clinicians, academics, patient advocates and (nonvoting) payer representatives. Friday’s discussion centered on Repetitive Transcranial Magnetic Stimulation, a new, slightly more expensive alternative to Electroconvulsive Therapy, which has been in use for over 70 years. There are some small studies with promising results suggesting rTMS may work better for some patients with fewer side effects. We discussed the impact on subpopulations, underserved populations, Medicaid and private payers, clinicians and, most importantly, patients and their families desperate for help. We reviewed evidence that everyone agreed was inadequate and conflicting. There are almost no studies that measured long term effectiveness. And then we voted.

Upcoming webinars on overtreatment and shared decisionmaking

Join us for two upcoming webinars on similar themes.

The first will be December 28th at 10am with Rosemary Gibson, author of The Treatment Trap. Rosemary will describe the Overuse of Medical Care and what can be Done to Prevent It. To register, go to https://www1.gotomeeting.com/register/828589337.

The second is the Promise of Shared Decision-Making – Engaging Patients and Improving Care, Jan. 10th at 1pm. Hear Shannon Brownlee, author of Overtreated, and Ben Moulton, from the Foundation for Informed Medical Decision-making, talk about how policymakers can help inform patients about all their options and avoid unnecessary treatment. To register, go to https://www1.gotomeeting.com/register/968183345

New blog – CT Health Insurance Exchange Watch

A new blog, CT Health Insurance Exchange Watch, is tracking development of CT’s Health Insurance Exchange. The blog is jointly sponsored by Small Business for a Healthy CT and the CT Health Policy Project. The latest entry includes an analysis noting that the percent of small businesses in MA offering health benefits to workers rose by 2% from 2005 to 2010, while the US average fell 4% and CT’s rate dropped 7%. MA implemented sweeping health reforms in 2006, including creation of a health insurance exchange. Members of CT’s exchange Board have been hyper-focused on low small business enrollment in MA’s exchange, but they are asking the wrong question. If offer rates are up, who cares if they are buying their coverage in the exchange or outside it? If building a source of affordable, quality health care puts pressure on the rest of the market, it has done its job. CT’s Board needs to focus on building a functional exchange that exerts competitive pressure on the entire market to expand coverage options with value.
Ellen Andrews

45% of CT individual health plans last year would not have triggered consumer rebates under new federal rules

A Hartford Courant analysis of 2010 individual health plans sold in CT finds that 45% did not spend at least 80% of premiums on members’ medical expenses. A rule requiring plans to meet that standard, termed medical loss ratio, did not take effect until this year. Plans that don’t reach that standard, overspending on administration and profit, will have to refund the difference to individuals. If the rule had been in place last year, 48,300 CT residents would have received refunds. Up to 9 million Americans could be eligible for rebates averaging $164, totaling $1.4 billion according to HHS. While almost half of CT individual plans would not have achieved the new standards last year, almost all small groups plans would have comfortably met the standard.
Ellen Andrews

New slides posted to cthealthbook.org

Updated slides from a health policy undergraduate class are available online at cthealthbook.org. Class topics include CT’s health care system, health care finance, international comparisons, Medicare, Medicaid, food policy and health, drugs, long term care, and national health reform, among others.

Small businesses ask HHS for help with CT insurance exchange

Small Business for a Healthy CT, a coalition of small companies, sent a letter yesterday asking HHS Secretary Sebelius to intervene with CT policymakers and reverse insurance industry domination of the CT Health Insurance Exchange Board. SBHCT is among at least a dozen advocacy groups that have voiced concerns about the Board membership which includes three insurance industry representatives but no voting consumer representatives and only one small business owner. The exchange is being created under national health reform with federal funding and is meant to be a consumer-friendly marketplace for coverage. It is expected that one in ten CT residents will get their coverage through the exchange. State law excludes anyone “affiliated” with insurance companies from Board membership and federal regulations state that consumer representatives should be a majority of voting members. The Board will decide which insurance plans are allowed to offer plans in the exchange, what benefits they have to offer, what standards they have to meet and how much they can charge consumers. Press reports include radio reports, CT News Junkie, the New Haven Register, Hartford Business Journal, Public News Service, CT Mirror, and The Hill.
Ellen Andrews

Yalies invent 3D imaging system for skin lesions

Three Yale undergraduate students have developed the 3Derm System, a small imaging device to transmit 3 dimensional images of potential skin lesions. The device allows patients to take an image of a questionable lesion at home and send it to a dermatologist, who can assess it. It will allow doctors to monitor changes in a lesion over time. The 3D image allows doctors, wearing special glasses, to assess the texture of a lesion. They hope to be able to reduce unnecessary doctor appointments by 40%. The students have won over $100,000 in prizes in two competitions for the device. They hope to eventually sell the 3Derm System in drug stores for under $100.
Ellen Andrews

CT hospitals well below US average in patient satisfaction

Patients at New Haven hospitals are the most satisfied in CT, but the bar is pretty low. New Haven’s hospitals ranked 204th out of 295 hospital referral regions in patient satisfaction, according to a calculation by Kaiser Health News based on HHS data. Hartford’s hospitals ranked 215th and Bridgeport’s were 227th. If you were thinking of going out of state for a better experience, you’ll have to go far. Only Maine and New Hampshire among the eight Northeastern states had hospital regions with better than average patient satisfaction ratings. To see how specific CT hospitals fared, go to CT Health I-Team’s hospital search page. Medicare will soon begin paying hospitals based, in part, on patient satisfaction.
Ellen Andrews

New regional patient safety organization created

NEVER is a new collaboration of New England consumer advocates working to improve the safety of health care services in our region. Connecticut’s Jean Rexford, founder of CT Center for Patient Safety, is a leader in the new effort. The group is working to give consumers tools to improve their care, compare providers and facilities in quality, and reduce costly, harmful overtreatment.
Ellen Andrews

CT asthma rates up, cities hit hardest

A CT Health I-Team analysis of new DPH data finds that almost one in ten CT adults had asthma in 2009, up from 7.8% in 2000. Adults in CT’s five largest cities are three times more likely to visit an ER or be hospitalized for asthma than the state average. We often forget that it can be a fatal disease; urban adult state residents are also twice as likely to die of asthma. The urban/suburban divide is also reflected among children – 19.2% of children in Hartford, Waterbury, New Haven and Bridgeport suffer from the disease while only 7.4% of students in Darien, Madison and Greenwich are affected. It’s also very costly – CT spends over $17 million and $6 million annually on asthma hospitalizations and ER visits, respectively, mainly paid for by Medicaid and Medicare. The article describes nine programs and initiatives aimed at helping patients manage and prevent the disease.
Ellen Andrews

Advocates file ethics complaint over health insurance exchange insurance reps

A group of eight organizations, led by Citizens for Economic Opportunity and including the CT Health Policy Project, have requested an inquiry into the appointment of three members of the CT Health Insurance Exchange. The letter asserts that the appointments violate the law that created the Exchange which excludes membership by anyone “affiliated with or otherwise a representative of” insurance companies. The three members outlined in the letters have long work histories with insurers and little evidence of significant or recent experience outside the insurance industry.
Ellen Andrews

Super Committee and HEP, PCMH webinar videos and slides online

Webinar slides and videos are now posted for our last two webinars. Last week we heard from Kate McEvoy of the State Comptroller’s Office about the state employee plan’s Health Enhancement and Patient-Centered Medical Home Projects. Chris Whatley from CSG’s Washington office talked Monday about the Congressional Super Committee, federal budget negotiations and the impact on states.

CSG/ERC Webinar – update from the Congressional Super Committee

Join Chris Whatley from CSG’s Washington office Monday, Nov. 14th at 10 am to hear where the Congressional “Super Committee” is in their deliberations and what it means for states. The Super Committee (Joint Select Committee on Deficit Reduction) was formed as part of the budget deal this summer and includes 12 members evenly divided between the parties and the houses of Congress. The committee is scheduled to report on its recommendations by the 23rd of this month to save $1.2 trillion over the next ten years. If the committee doesn’t report or their recommendations are not adopted by the full Congress, significant budget cuts are automatically triggered. To register, go to https://www1.gotomeeting.com/register/535091305

Advocate and small business concerns about CT insurance exchange

Together with Small Businesses for a Healthy CT, the CT Health Policy Project has been meeting with CT Health Insurance Exchange Board members. The Board has been criticized for lacking consumer representation. Our concerns center on rebuilding public trust, effective outreach and public education, active purchasing to use the collective power of the exchange to get the best value for members, maintaining an even playing field inside and outside the exchange, a grownup conversation on mandates, and coordination with Medicaid. We are finding a lot of overlap and some of our best support is coming from unlikely sources. The Board is currently seeking a CEO.
Ellen Andrews

Medicaid PCMH update

Today’s Care Management Committee meeting (formerly the PCCM Committee) in Hartford was frustrating. DSS and their consultants outlined their final plan for CT Medicaid’s person-centered medical home (PCMH) transformation. Unfortunately the final plan is not substantially different than the original proposal which raised concerns among advocates. Most contentious was DSS’ refusal to match consumers and PCMHs prospectively, and to pay providers based on that linkage. Based on strong evidence of improved health outcomes, advocates argued for an enrollment/attribution process to ensure that every person knows who their personal PCMH is -- who they should call first with a problem, who is watching out for their health. It is equally important that every PCMH understand, up front, which people they are responsible for. The lack of attribution also creates the possibility that NCQA-certified PCMHs will get enhanced payment rates for services provided to patients whose care is being coordinated by another practice, similar to criticisms of retail clinics by primary care practices. DSS raised some operational issues within the department as barriers to creating that essential linkage and remains committed to an enhanced fee-for-service (FFS) payment system. Advocates and others have criticized FSS for encouraging duplication and over-utilization of services, and discouraging care coordination and non-traditional care delivery such as email, phone communication, group visits, etc. Enhanced FFS also provides practices with incentives to hire more clinicians to drive more visits while per member per month prospective payments support whatever resources are most effective to improve care, including hiring care managers. The modest increase in payment rates (10% to 20%) DSS is proposing will occur in the context of much larger Medicaid primary care rate increases in 2013 under national reform when, for example, adult medicine rates will double on average, for all providers regardless of whether they are PCMHs or not. DSS acknowledged the issue and stated that they intend the program to serve only as a bridge to a wider transformation of Medicaid and will likely only appeal to providers who already serve a significant Medicaid population and are already planning PMCH transformation. While improved over the last version, the proposal’s reimbursement model budget justification continues to emphasize physicians over other members of the PCMH team, devoting almost half of total on-going costs to physician time. They did increase upfront payments to small practices (5 FTEs or less could get up to $25,000 per year for 3 years) above the original glide path payments before practices are PCMH certified. While providers and consultants were intimately involved in development of the plan and their concerns are reflected in added costs for the proposal, advocates strongly objected to representations that the process was respectful and inclusive of all voices.
Ellen Andrews

Office of Health Care Advocate seeking attorney

The state Office of Health Care Advocate is hiring a staff attorney. OHA is an incredible resource for CT consumers struggling to access care from their insurer. OHA assists individuals, but also collects those experiences and makes recommendations for legislative and executive policy changes as needed. The position requires experience with health insurance or health care and at least two years of practice. Applications are due by Nov. 4th.

Webinar: State employee plan new health enhancement program

Join Kate McEvoy, Assistant Comptroller/Policy Director of the CT Office of State Comptroller, to hear about the goals for the new Health Enhancement Program and how it works for state employees. Kate’s webinar will be Wed. November 9th at 10:30am. To register, click here.

Small businesses know health insurance exchange is a jobs issue

In a CT News Junkie opinion piece, Kevin Galvin of Small Business for a Healthy CT, wrote -- When asked to identify their biggest challenges, small business owners in Connecticut and across the country have said that one of the greatest is the prohibitively high cost of providing health insurance. CT cannot become a business-friendly state without addressing the difficulty of insuring workers. He also notes that the insurer-dominated CT Health Insurance Exchange Board does not inspire confidence. He calls for the addition of consumer and small business representatives to that Board, as does proposed federal regulation. He calls on the Governor and General Assembly to include those representatives in the upcoming jobs bill and special session.
Ellen Andrews

Health Insurance Exchange CEO job description out

CT’s health insurance exchange is moving very quickly to hire a CEO. The job description includes good language about consumer education and policy background. It mentions management skills but does not mention familiarity with active purchasing on behalf of consumers. Applications are due by Nov. 9th. The Board will choose three finalists but the Governor chooses the CEO from that list. Board membership has been criticized for having no consumer representatives and including three members with strong ties to the insurance industry.
Ellen Andrews

OHA Recovers $2.9 Million for Consumers in Third Quarter 2011

The state Office of Health Care Advocate has recovered for consumers $2.9 million in the third quarter of 2011 and $9.3 million thus far in calendar year 2011. The case load this year is expected to be double last year’s number. Through public outreach, their website and a toll-free assistance line, OHA helps patients who have been denied services or payment for services by insurers, private and public. OHA prepares cases for consumers and can appear in-person for appeals. The office also identifies trends and challenges in CT’s health insurance system keeping people from getting the care they need and advocates with policymakers to fix those policies for all state residents. OHA was created in 1999 as part of CT’s managed care reform law.
Ellen Andrews

Anthem piloting plan that shares savings with consumers

In a national pilot program that includes two self-insured employer groups in CT, Anthem is giving rebates to consumers who choose lower cost providers for their care. Rebates can reach up to $250 in CT (up to $1,000 elsewhere in the US) for each procedure. The company claims that only “common, elective medical procedures and diagnostic tests” are included in the program but clinical experts dispute that. The CT State Medical Society is concerned because the rebate is based solely on cost and does not integrate quality ratings. A large employer collaboration in Maine has had great success incorporating both cost and quality into consumer incentives.
Ellen Andrews

New CT Insurer report card online

The CT Insurance Dept. has published the 2011 insurer report card. The report card compares HMO and indemnity plans’ performance across dozens of quality measures including prenatal care in the first trimester, adult access to care, cancer screenings, childhood immunizations and controlling high blood pressure. The report includes statistics on plan enrollment, number of participating providers by county, and utilization review stats for each plan. The report card is an incredibly useful tool for anyone making choices about health plans but also includes consumer assistance contact information for each plan.
Ellen Andrews

Grove health events

I co-work with amazing people doing exciting things at The Grove in New Haven. Among those amazing things are two upcoming events sponsored by the Transforming Maternity Care Partnership, a national multi-stakeholder collaboration working to implement a consensus Blueprint for Action to improve the quality and value of maternity care. The Nurse-Midwifery Week Celebration and Symposium this Sunday from 11am-3pm will feature two speakers - Tina Smillie talking about breastfeeding and Tricia Pil talking about patient safety in maternity care from the patient, provider, and systems perspective. And next Wednesday evening, October 12, they are hosting health economist and Health IT leader, J.D. Kleinke who has written his first novel about ob-gyn practice. He will be reading from his book and leading a discussion on system transformation. The Grove is at 71 Orange St. in New Haven. For more information on either event, contact Amy Romano at romano@childbirthconnection.org.
Ellen Andrews

Courant OP-ED raises concerns about Medicaid PCMH proposal

An Opinion piece in today’s Hartford Courant by Sheldon Toubman of New Haven legal aid outlines many problems with DSS’ proposal for person-centered medical homes. PCMHs have been used by payers, including many other state Medicaid programs and CT’s state employee plan, to improve the effectiveness of health care, reduce duplications and errors and rein in skyrocketing costs. However, DSS’s proposal varies significantly from best practices identified in other states. The current PCCM program, used by a majority of states, provides a set amount of funding to providers upfront to encourage investment in care coordination. DSS’s proposal asks primary care practices, on very thin margins, to pony up with the potential for funding/reimbursement later. It also builds on the current fee-for-service system that has been blamed for over-utilization that drives up costs. Most funders are moving away from fee-for-service payments.
Ellen Andrews

October webquiz, webinar slides and video online

Test your knowledge of CT’s uninsured. Take the October CT Health Policy Webquiz.

Slides and video of Friday’s webinar with CEPAC are posted.

State chooses CHN to run Medicaid

The administration announced that they will be negotiating with Community Health Network to administer the entire state Medicaid program as of January 1st. Based on the state’s community health centers, CHN has been a participating managed care provider for HUSKY since its inception sixteen years ago. The managed care program will expand beyond the current 400,000 children and families to include 120,000 seniors, single adults (formerly SAGA members) and people with disabilities. The new program will not be capitated and will focus on coordinating care and building patient-centered medical homes to both improve quality and rein in costs. CHN’s contract is estimated to be between $70 and 73 million for the first year. CHN expects to contract with McKesson for intensive care management and data analytics and with Value Options for intensive case management.
Ellen Andrews

Friday webinar: Cutting costs and improving quality through research

New technologies and treatments are a significant driver of skyrocketing health costs and the resulting overtreatment is harming our health. Join us for a webinar Friday at noon with The New England Comparative Effectiveness Public Advisory Council (CEPAC) to learn more about comparative effectiveness research and how it is being evaluated and applied in New England. CEPAC is an initiative of the Institute for Clinical and Economic Review in Boston, funded by the US Agency for Healthcare Quality and Review. To make informed healthcare decisions policymakers, patients and clinicians need rigorous evidence on the comparative risks and benefits of care options. But that science must be integrated with patient values, individual clinical needs, costs, current patterns of practice, local health system characteristics and public values. CEPAC provides a forum to discuss all these considerations. CEPAC’s mission is to provide objective, independent guidance on how information from AHRQ evidence reviews can be used across New England to improve the quality and value of health care decision making. CEPAC includes clinicians, scientists, policymakers and patient advocates with members from all the New England states.
Ellen Andrews

CTHPP brief: One in ten CT residents still uninsured last year

Results of two new Census surveys found that the rate of uninsurance in CT was stuck at one in ten last year. The number of uninsured in CT is higher than the populations of five counties and exceeds the total populations of Hartford PLUS New Britain PLUS Stamford. Not surprisingly, Black, Hispanic and lower income state residents were more likely to be uninsured, but noncitizens were at highest risk. Among cities, Stamford leads the list with 24% of city residents without coverage; nearby Norwalk had the lowest rate among cities at 10%. Among counties, Fairfield had the highest uninsured rate at 11.7%; Tolland was lowest at only 5.1%. The new numbers reinforce the need for health care reform.
Ellen Andrews

Editorials support consumer representation on CT health insurance exchange

Today’s Hartford Courant and yesterday’s New Haven Register have both run editorials calling on policymakers to add consumer and small business representatives to the CT Health Insurance Exchange Board. Advocates have raised concerns about insurance industry dominance in the Board membership and the lack of consumer and small business representation. One in ten state residents are expected to rely on the exchange to purchase coverage in 2014 when the federal individual mandate becomes effective. An estimated 140,000 state residents will have no choice but to purchase coverage in the exchange to access affordability subsidies. The Board will make important decisions about which plans are included in the exchange, how much they can charge, and what services they will cover. Consumer voices must be at the table, with a vote.
Ellen Andrews

Health care jobs bubble?

An entertaining video from Marketplace explains the folly of policymakers who expect health care to solve their economic troubles.

Oh The Jobs (Debt?) You'll Create! from Marketplace on Vimeo.

eHealth conference

October 20th at Capitol Community College in Hartford there will be a conference explaining health information technology implementation and options. The conference, Connecting Connecticut: EHRs, Meaningful Use and Health Information Exchange, is designed for providers, administrative staff, and payers. The conference is cosponsored by Capital Community College, DPH, DSS, HITECT, and the UConn School of Medicine. CME applications are pending.

CT Health Policy Project comments on DSS proposal for Medicaid person-centered medical homes

To implement the administration’s directive to develop person/patient-centered medical homes for every Medicaid consumer, DSS has proposed a payment model very different from other successful state programs. CTHPP has submitted comments on the proposal including concerns about reliance on retrospective enhanced fee-for-service and P4P payments, the lack of risk adjustment, opaque incentives, and a weak attribution system. For example, under an enhanced fee-for-service arrangement, a provider would have an incentive to bring a healthy child who had recovered from a routine infection back into the office to get paid for care management costs making the child take time from school, a parent time off from work, exposing the child to a waiting room full of sick children, incurring transportation costs, and taking up a slot on the schedule of a busy primary care practice. To read our concerns, click here for comments.
Ellen Andrews

New Census numbers on uninsured – no progress

The number of uninsured CT residents remained essentially unchanged from 2009 to 2010, according to new Census numbers; however that number is up 54% from 1999. CT’s unemployment rate rose from 8.3% in 2009 to 9.1% last year. One in nine (11%) state residents remained without coverage in 2010. Six percent of children had no insurance last year and only 2.2% of seniors over age 65. The percent of CT residents with employer-sponsored coverage is down from 73.4% in 1999 to 65.2% last year, while the percent of us covered by Medicaid rose from 6.6% to 12.4% over those same years.


Ellen Andrews

Study finds new brain stent actually associated with More strokes, approval process faulted – CEPAC webinar

A study of the effectiveness of a brain stent, designed to reduce strokes, instead caused so many more strokes in patients (14.7%) than a control group (5.8%) that the study was quickly halted. The expensive stents had been approved by the FDA under a humanitarian exemption from usual safety reviews. The stent has been implanted in thousands of patients.

The study adds to a growing set of evidence that medical treatments are not always based on the best evidence of safety, effectiveness or cost effectiveness. To learn more about comparative effectiveness research and evaluations of treatments, join us for a webinar with CEPAC September 30th.
Ellen Andrews

Uninsured Cincinnati man dies of untreated tooth decay

Kyle Willis, an unemployed, uninsured 24-year old father, died Tuesday of an infection in his wisdom tooth. He couldn’t afford to have the tooth removed, but went to an ER when his face began to swell and the pain grew. He was prescribed an antibiotic and a pain killer. He could only afford to fill one prescription and he chose the pain killer. The infection spread to his brain. A potent reminder that dental care is integral to health and that uninsurance kills.

An expert commented "He [Willis] might as well have been living in 1927. All of the advances we've made in medicine today and are proud of, for people who don't have coverage, you might as well never have developed those."
Ellen Andrews

September CT health policy quiz – CT health care quality

Test your knowledge of health care quality in CT. Take the September CT Health Policy Webquiz.

NC employers buying into Medicaid patient-centered medical home system, CT NASW job posting

NC’s Medicaid patient-centered medical home network is so successful that large employers, including state employees, in the state are buying in for their workers. Bucking the private HMO-style managed care trend of other states in Medicaid, NC has had impressive improvements with a community-based PCMH network in improving access to and quality of care while enjoying significant savings. Could CT’s new and improved PCCM program (or whatever they plan to call it) eventually attract private employers here in CT?

NASW/CT is seeking a part-time Director of Political Advocacy. They are specifically seeking an individual with a MSW degree and experience in policy and community organizing. NASW/CT has a broad agenda that includes both guild issues and social justice issues.
Ellen Andrews

Comparative effectiveness council webinar

New technologies and treatments are a significant driver of skyrocketing health costs and the resulting overtreatment is harming our health. Join us for a webinar September 30th at 1pm with The New England Comparative Effectiveness Public Advisory Council (CEPAC) to learn more about comparative effectiveness research and how it is being evaluated and applied in New England. CEPAC is an initiative of the Institute for Clinical and Economic Review in Boston, funded by the US Agency for Healthcare Quality and Review. To make informed healthcare decisions policymakers, patients and clinicians need rigorous evidence on the comparative risks and benefits of care options. But that science must be integrated with patient values, individual clinical needs, costs, current patterns of practice, local health system characteristics and public values. CEPAC provides a forum to discuss all these considerations. CEPAC’s mission is to provide objective, independent guidance on how information from AHRQ evidence reviews can be used across New England to improve the quality and value of health care decision making. CEPAC includes clinicians, scientists, policymakers and patient advocates with members from all the New England states. Our first meeting was in June in Boston and focused on treatment strategies for atrial fibrillation.
Ellen Andrews

Health Insurance Exchange Board meeting moved

Monday’s scheduled meeting of the new CT Health Insurance Exchange Board has been moved to Sept. 15th at 9am in Room 1A of the LOB.

Exceptional example of medical homes in a safety net clinic

A New England Journal of Medicine article highlights the success of Clinica Family Health Services, a safety net clinic serving a largely low income, Latino population near Denver. Half of Clinica’s patients are uninsured. Over the last thirteen years, Clinica has implemented both the chronic care and PCMH models of care. Important lessons include the power of teams, improved access to care, and re-orienting the entire process and culture of care to center on patients. The transformation also significantly improved working conditions and job satisfaction for providers. Allowing every team member to work at the top of their license allowed clinicians to see 30 to 40% more patients per hour. More pregnant women are coming into care earlier in their pregnancies, more women are getting Pap tests, more children are getting immunizations, more diabetic patients are controlling their hemoglobin levels, and blood pressures are down among patients with hypertension. Please go to the PCMH video on Clinica’s home page – it is the best investment of 23 minutes you’ll make this week. I urge you to get to the description of patient activation – they buried the lead but it is the whole point of patient-centeredness. Highly recommended.
Ellen Andrews

Insurance Exchange Board members dominated by insurance interests, no consumer representatives

Members of CT Health Insurance Exchange Board were announced last evening. Despite federal law calling for a majority of members to represent consumers, there are no consumer advocate voting members. (Thankfully Vicki Veltri, State Health Care Advocate, will sit at the table but cannot vote.) In addition, three members have long ties to insurance companies as recent employees. This is despite CT law barring members affiliated with insurers, among others, in strong conflict of interest language that has been a beacon among states. Advocates are concerned that representatives of the insurance industry lobbied hard to stop passage of health reform in Washington but are now placed in charge of implementing it here in CT. One in ten state residents are expected to rely on the exchange to purchase coverage in 2014 when the individual mandate becomes effective. It is critical that consumers eligible for Medicaid who apply through the exchange are appropriately referred to that program rather than diverted into insurance plans in the exchange. Advocates sent a letter to members urging them to set aside insurance ties and make consumers their top priority. For press reports, click here, here, here, here, here and here.
Ellen Andrews
Ellen Andrews

Updated CT health policy 101 primer

The updated primer on health policy in CT used for CT Health Policy Project student and volunteer training is online. The primer covers background on health financing, public coverage programs, private insurance, the uninsured, Affordable Care Act implantation, SustiNet, politics and trends in CT and what you can do about it.

Boston hospital gives doctors treatment price list

Beth Israel Deaconess Medical Center has taken the revolutionary step of giving primary care providers a one page price list for 56 services they routinely order for patients. Doctors generally have no idea what services cost and many are shocked by the list. Just providing the information has changed ordering habits and challenged the traditional medical practice of doing “everything possible” without regard to cost. Much care is delivered just because the technology is available, not because it is necessary or better than less expensive options. Doctors are becoming more aware of the harm to patients that can come from rising costs. A recent study found that 62% of US personal bankruptcies are due to medical costs. There are growing efforts to inform physicians about prices and resources for patients to compare costs.
Ellen Andrews

Advocates urge CT Health Insurance Exchange Board members to consider consumers’ needs

In a letter to the newly appointed members of the CT Health Insurance Exchange Board, eleven consumer advocacy organizations offered to help in their important work and urged the members to keep the needs of consumers in mind in all decisions. The insurance exchange was created in response to national health reform; most states are taking the option to create their own exchange with federal start up funding. The exchange was designed to provide CT consumers and small businesses with a rational, fair marketplace to purchase health insurance. It is critical that this market be a trusted credible source for consumers who will be required to purchase health insurance in 2014. It is estimated that one in ten state residents will secure coverage through the exchange by 2016 including 140,000 eligible for federal premium subsidies who will be required to purchase coverage through the exchange. The Board will have a number of difficult and controversial decisions to make including whether to allow any willing insurer to participate, as Utah has chosen, or actively purchase coverage to get the best deal for consumers, the Massachusetts model. The Board will have to decide which state mandates, if any, beyond the federal essential benefit package (EBP) to require of exchange plans, with the state likely paying the cost for those benefits. The proposed EBP is expected to be announced this fall. The Board will have to decide whether to create separate exchanges for individuals and for small businesses, whether to merge the small group and individual markets, and hire staff to run the exchange. CT’s law creating the exchange included very strong conflict of interest language supported by advocates, excluding people currently affiliated with the insurance industry among others. We expect that all members will honor the spirit of the law, regardless of background. The first meeting of the Board is scheduled for next Monday August 29th at 10am in Room 1A of the LOB.
Ellen Andrews

Regulations making insurance easier to understand; Survey finds businesses expect big increase in health costs next year

Yesterday HHS released long-awaited proposed rules for the Summary of Benefits and Coverage to be given to every consumer by March 23, 2012. The Summary is a brief document, explaining in simple, consistent language basic information about each health plan offering including what is and isn’t covered, consumer costs and how they are broken out (copays, deductibles, etc.), and the rules for out of network providers. Every insurer and employer offering coverage will have to provide the same forms and the Summary will include a standardized comparison tool allowing consumers to clearly compare options. The Summary will be accompanied by a Glossary of Terms and was tested with consumers to ensure it is understandable. The proposal was developed by the National Association of Insurance Commissioners and a working group of stakeholders.

A survey by the National Business Group on Health finds that large American employers expect health benefit costs to rise 7.2% next year and most plan to shift those costs onto workers. While that increase is lower than the 7.4% increase in health costs this year, it is still twice the rate of overall inflation. Cost shift plans including increasing employee share of premium (53%), increased deductibles (39%), increased out of network deductibles (23%), and increased out of pocket maximums (22%). 73% expect to offer at least one consumer-directed health plan option, up from 61% this year. The survey found that national health reform is having little impact on most employers’ plans for next year.
Ellen Andrews