CT providers won’t benefit as much from Medicaid rate increase as other states

Effective January 1st, the Affordable Care Act includes a payment increase for Medicaid primary care providers bringing rates up to Medicare levels. The federal government is reimbursing states 100% of the cost of the rate increase for two years. While nationally that averages a 73% rate increase, CT providers will see only 41% increases in primary care rates, according to estimates. A survey by the Kaiser Family Foundation found that CT physician Medicaid rates are already close to Medicare levels. This confirms previous studies which also found that CT Medicaid rates are among the highest in the US. Despite these higher rates, CT is forth lowest among states in physician Medicaid participation. A study by the CT Health Policy Project found that a 2008 significant rate increase had no impact on CT physicians’ likelihood to participate in Medicaid. Barriers included billing issues, delayed reimbursement, administrative hassles, poor communications and poor provider relations. Fortunately, since that study was published last year, DSS has systematically worked to address all the recommendations.

Exchange staff back off eroding essential health benefits

At yesterday’s CT Health Insurance Exchange meeting we learned about an attempt by Exchange staff and the Insurance Dept. to reduce the Essential Health Benefit Package that had been agreed to earlier this year in a contentious but inclusive and public process. Like the last process that rejected active purchasing, this process happened in evening conference calls not open to the public in a very short time frame. This time, however, providers and advocates on the committees voted down the benefit package erosion (active purchasing was not part of the reconsideration) and the staff finally agreed to pull the proposal from the Board committee agenda yesterday. However at the meeting, staff stated that they plan to lobby the fed.s to let them re-consider, and lower, the agreed-upon essential benefit package. The issue is CT mandates for coverage in state law – whether they cost or save money in premiums and how much. A public commenter noted that affordability is very important, but eroding mandates may not work to keep costs down. Active purchasing is proven to reduce costs, but the Board and staff have rejected that proven tool and have indicated no interest in re-visiting that decision. Other news included a strong theme of affordability in the Healthy Chat public events. Staff noted that many people were new faces to health care, not traditional activists. They also noted that people had “done their homework” and were very sophisticated in their understanding of active purchasing and its potential for affordability. The staff is still working on the details of the health plan benefit standards and benefit design, how plans will be rated for innovation and plans for quality monitoring. Advocates will be watching this process carefully for further standards that erode consumer protections, if there is any transparency or opportunities for meaningful public input.

31 Ways to Save Money in CT’s Health Care Budget

The state budget is facing a billion deficit next fiscal year. We have 31 ways to both save money and improve quality and access to care. The options focus on payment reform, re-engineering care delivery, engaging consumers, quality reforms and prevention, learning from experience, removing waste and excessive administration. In 2010 we only had fifteen ways to save. One of those, shifting HUSKY from capitated managed care to self-insured, coordinated care. We recently learned that the shift is saving the state millions.

Evidence of ancient health care

A story in today’s NY Times describes mounting evidence of compassion and dedication to caring for the ill among human communities living thousands of years ago. Multiple burials provide evidence of years of care, in some cases it would have likely been around the clock care, for people with disabilities and illnesses. The provision of that care would likely have cost the community dearly in scarce resources. One woman buried on the Arabian Peninsula probably suffering from polio and unable to walk, showed evidence of severe dental disease, unusual for someone of her age. Experts believe she may have been fed many sweet dates to make her happy. It’s nice to know we are hard wired to care for those who need it.

Medicaid Council meeting clears up misinformation on HUSKY parents fate under ACA

The CT Health Insurance Exchange staff’s presentation to the Medicaid Council Friday described the “opportunity” under the Affordable Care Act for significant state savings by shifting HUSKY parents into the exchange. They described subsidized premiums ($45 to $243/month), some caps on out of pocket costs, and a list of covered services. However, with questioning from legislators, providers and advocates, the rest of the story emerged. Now those low-income, working HUSKY families (this year $31,809 to $42,643 for a family of four) pay no premiums and benefit from a comprehensive benefit package covering important services that the exchange does not cover or charges more for. A legislator confirmed that the ACA does not require the state to cut HUSKY parents off the program and that the state always had that “opportunity”. It was also noted by a questioner that, many low-income working families are just getting by on what they make and paying even subsidized premiums is not realistic; their alternative, if HUSKY is cut, is to pay a $95 tax penalty the next April that will be very difficult to implement in any case. So for policymakers the “opportunity” is to cut people off HUSKY, save the state some funds, but force tens of thousands of CT working parents into paying much higher costs or into uninsurance.

Luckily there is another ACA option – the Basic Health Plan -- that saves the state millions and gives those families, and thousands more, comprehensive coverage with little or no cost. Several economists have crunched the numbers and found that available federal subsidies would more than cover the costs of care for the population with funds left over to raise provider rates. When asked about the BHP option they had not included in their presentation, exchange staff answered that the feds have not yet released regulations on the option and that they have heard that some other states are not planning to use the option.

In other news, we learned that some primary care Medicaid providers who do not work under the direct supervision of a physician may not qualify for the ACA increase in rates to Medicare levels, to become effective Jan. 1, 2013. We were also given information on January 1st increases in Charter Oak and unsubsidized HUSKY B premiums. Charter Oak rates are increasing 32% for all -- to $589/month for people who enrolled after June 2010. HUSKY B rates are increasing 16% from $270.36 to $314/month for families who do not receive subsidies (over 300% FPL). We will receive new enrollment numbers next month to know how many people these rates affect.

We also heard from Commissioner Bremby about strong measures his office has taken about problems in processing applications and voter registrations at the Hartford DSS office. He described plans to upgrade enrollment and other systems as well as enhanced monitoring that will help ensure this never happens again.

HUSKY B saves $4 million in switch from HMOs

As advocates predicted, it appears the shift from capitated managed care to self-insurance saved the HUSKY Part B program $4 million in lower medical costs in the first six months. (The numbers are still tentative, as there may be some outstanding claims from the first half of the year, but they are not expected to be large). January 1st of this year the state moved the entire HUSKY program out of capitated HMOs and into a self-funded model with care coordination. At this week’s PCMH committee of the Medicaid Council, DSS reported that spending in the HUSKY B program was down significantly after the switch. The switch was only effective for six months of the latest fiscal year (FY12) but even so, medical service spending was down by $4 million over the previous year. HUSKY B spending in FY 11 was $35 million. If the $4 million savings continues for the rest of 2012, savings would be 23%. Enrollment varied by only 2% between the years. HUSKY Part A savings from the switch were not available as that spending is included in the much larger Medicaid line item.

HHS approves CT insurance exchange plan

Along with six other states, CT’s health insurance exchange received approval yesterday from the federal agency providing funding. CT was among the first six states to apply to HHS for approval – 14 states have applied to date. No state’s application has been denied. CT’s exchange has been criticized for their plan to accept any willing plan and refusing to negotiate with insurers to control costs and reduce consumer premiums. CT’s exchange also voted not to conduct a secret shopper survey to monitor whether people who purchase their insurance plans can find a provider. The exchange has also been criticized for having no independent consumer Board members, having Board members with close ties to the insurance industry and for members with insurance company investments.

NY ex-con shoplifts to get prison health care

Frank Morocco, a Buffalo area ex-convict, intentionally got himself arrested for shoplifting two weeks ago. He stole $23 worth of miscellaneous items, making sure he was seen by store employees and other customers. He stated that he was desperate and saw no other way to get treatment for his cancer. He suffers from a rare form of leukemia for which he received great care while in prison. But since his release last December he has been unable to afford private insurance and his employer does not offer benefits. With assistance from his probation officer he applied for Medicaid and disability coverage, but was denied. He has incurred $5,000 in medical debt in the last year. The Buffalo Times article notes other cases of ex-convicts getting arrested for health care.

CEPAC meeting in CT – effective sleep apnea treatment

Yesterday’s New England Comparative Effectiveness Public Advisory Council (CEPAC) meeting centered on sleep apnea. Too many new (and expensive) treatments and technologies are adopted and gain wide use without a careful analysis of their effectiveness in treating the condition and/or cost effectiveness compared to other options. CEPAC’s mission is to produce actionable information to aid regional policymakers in the medical policy decision-making process. CEPAC includes researchers, clinicians and patient advocates from across the New England states who, twice a year, drill down into the research around treatment options for a condition, evaluate effectiveness and costs, and vote on whether there is sufficient evidence to recommend each treatment’s use. About 10 to 20% of middle-age and older adults suffer from sleep apnea, with regular bouts of difficulty breathing through the night. And rates of the condition are rising, driven in part by rising obesity rates. Studies have found that sleep apnea patients have higher rates of health care use, including more and longer hospital stays, and higher health care costs before diagnosis than after. Sleep apnea has been linked to lower productivity among workers, higher motor vehicle crash rates, and cardiovascular disease. After long discussion of the research and impact in the real world, the group voted on effective treatments (home sleep studies) and treatments (urging more research on weight loss support). Studies like these are critical to the double goal of both improving the quality of care and controlling costs. We have to find more opportunities like this if we are going to fix our broken health care system.

December webquiz – CT spending on medical assistance programs

Test your knowledge of DSS spending on medical assistance programs, most notably Medicaid. Take the December CT Health Policy Project webquiz.

Medicaid outreach recommendations

Small grants, engaging an army of trusted community messengers, ubiquitous marketing, and robust monitoring will be critical to enrolling the estimated 130,000 newly eligible CT Medicaid members in January 2014, according to a report by the CT Health Policy Project. Best opportunities for outreach include providers, current HUSKY members, faith-based communities, connecting with employers and other state programs, targeting life transitions, improving application and enrollment processes, and thanking outreach partners. It will require strong, concerted efforts to overcome the program’s stigma and other barriers to enrollment. The report draws on the experience of community organizers, consumer advocates who worked on HUSKY outreach, providers that care for CT’s uninsured patients, and lessons from other states. While aimed at Medicaid, many of the report’s findings also apply to the new CT Health Insurance Exchange.

Exchange Board and staff water down already watered-down affordability and access provisions

In a surprise to advisory committee co-chairs, CT Health Insurance Exchange staff submitted four alternative policy proposals at today’s Board meeting – they were adopted virtually intact by the Board. The staff alternatives were contrary to the recommendations adopted Tuesday by the Consumer and Qualified Health Plan Advisory Committees, with Exchange staff at every meeting. One staff change increased the number of options insurers can offer (in response to insurance industry comments); research shows that consumers prefer and make better choices with a limited number of well-vetted options. Another eliminated a secret shopper survey to ensure that the plan’s provider panels are accurate; in a Mercer study of HUSKY plans, shoppers were only able to get appointments with one in four providers on those HMO panels. Staff stated that accountability in secret shopper surveys seem “too adversarial” with insurers. Another proposal reduced the number of essential community providers that plans have to include in their networks, such as community health centers. The last one eliminated even the guidance that the Exchange will develop a plan of some undefined type to eventually, someday move along a continuum toward an active purchasing model. Active purchasing now saves MA exchange consumers millions in premiums by fostering competition and negotiating rates with insurers.

Staff reviewed comments to the draft health plan solicitation. Ten of the 22 comments mentioned were from insurers – half were accepted in the staff proposals, two were not, and three others were not relevant. Five comments came from NCQA, two from unknown sources, four from this consumer advocate (none were reflected in proposals) and one from a provider (was reflected in joint committee proposal).

The Exchange staff also announced they have hired Pappas Macdonnell, a Westport marketing firm with experience in selling corporate insurance and financial products. When asked if they have any experience in marketing to low-income, uninsured populations, one representative noted that he has worked on Democratic political campaigns.

In other news, they have settled on a new name for the Exchange – Access Health. They also have submitted an application for $2.6 million in federal funding for application assisters. They expect to award about 300 grants of about $6,000 each to community organizations to publicize the exchange, help people figure out what assistance they are eligible for, and help them enroll. They have hired three new Exchange staff this month.

Governor’s initial budget cuts

Yesterday the administration announced an initial list of $170 million in cuts to address the growing state budget deficit. The cuts include AIDS services, breast & cervical cancer detection and treatment, home care, Healthy Start, and DSH payments to hospitals. The cuts also include $1.5 million from HUSKY B, but expenses were down significantly in that program last year. As predicted, the switch from capitated HMOs to the ASO model may be responsible for those savings.

Joint exchange committees voting down active purchasing, cost control

While the votes are reportedly still coming in, it appears that the Consumer and QHP Insurance Exchange committees have voted against active purchasing. With active purchasing, other state exchanges are using the power of numbers, as large employers do, to negotiate better premiums, lower costs and better coverage for their members. MA has saved millions for consumers in their state with active purchasing. While the committees’ language includes a symbolic nod to possible future negotiation, it is far weaker than current state law. Reportedly, through a procedural maneuver, Exchange staff and committee co-chairs agreed to link all the proposals in one vote. Providers on the committees were picked off by adding back requirements that their organizations be included in network standards. Reportedly consumers lost votes we would have had if active purchasing had had a fair vote. All meetings this week and negotiations over language were conducted in secret. A critical negotiation session happened by conference call, but the public was not allowed to listen in. (The public was told to come to the LOB, from 6 to 7pm Monday to hear the call. However the building closes at 5:30.) This secrecy would not be allowed if the Exchange was part of state government – there are laws about that. But as a quasi-public entity, they can make their own rules. It is ironic as 50% of the Board members are public officials (71% if you count spouses and retirees), and all their millions in funding come from taxpayers. Exchange staff also incorrectly argued that they had to have this issue decided in time to release the health plan solicitation next month. However, state RFPs rarely release specifics on how they will score bids with the RFP release. Why would you? Now the HMOs know that as they prepare their premium bids, that the sky is the limit.

Official vote tally from Exchange staff: Note -- a vote to reject was a vote FOR active purchasing Below lists the results of the votes cast by the Consumer Experience and Outreach and Health Plans Benefits and Qualifications Exchange Advisory Committees with concern to the certification of Qualified Health Plans within the Exchange. Results:
Twenty (20) – Approve Two (2) – Reject Approve
-- Sheldon Toubman Vicki Veltri
Gerard O’Sullivan Anne Melissa Dowling Deb Polun
Marcia Petrillo
Steve Frayne
J. Erlingheuser
Mark Espinosa
Gloria Powell Margherita Giuliano Tanya Barrett
Bonnie Roswig
Mary Fox
Alta Lash
Arlene Murphy
Sarah Frankel
Cee Cee Woods
Dr. Robert McLean Dr. Robert Scalettar Reject
-- Kevin Galvin Deirdre Hardrick

Just 6 days to comment on exchange health plan solicitation

Stakeholders had only six days to comment on the 40 page health plan solicitation from the CT Health Insurance Exchange – and it’s already over. Stakeholders in CA and MD had months to comment, with multiple drafts, meetings and opportunities to craft better proposals. The CT Health Policy Project’s initial comments centered on active purchasing, network adequacy, and the proposed “iterative process”. MA’s Connector has used active purchasing to save consumers millions in premiums – CT should do the same. When consumers are required to purchase coverage in the exchange, they must be able to get an appointment with a provider. HUSKY secret shoppers were only able to get appointments with 1 in 4 providers on the health plan lists. Using the standards from HUSKY contracts, thoroughly vetted in CT, and intensely monitoring compliance is key. The exchange’s proposal to initially implement a weak exchange and implement some standards later will sound eerily familiar to CT advocates – with a very poor history. Other comments include better cost sharing structures, standardize rating options so differences are meaningful, wellness programs that aren’t a screen for cherry-picking, constructive connections to the Medicaid program, accreditation standards, quality improvement plans (at least have one), and CID rate reviews as a floor. Perhaps the most troubling thing about the proposal is how much is taken on faith in attestations from insurers. Will anyone be monitoring to see if the promises are real?

Exchange advisory committees reject “any-willing insurer”

Today in a joint meeting of the Health Plan Benefits/Qualifications and Consumer Experience/Outreach committees of the CT Health Insurance Exchange voted against the staff recommendation “that the Exchange not deny any carrier QHP certification on the basis of its approved rates”. The only votes for the staff’s any willing insurer proposal were from Aetna and CT Insurance Dept. representatives. The committees asked staff to come back with a new proposal that includes rate negotiation.

Who is coming into LIA?

Today’s CT Mirror asks the question – who are the 37,000 new enrollees in the Low Income Adult Program? LIA was created just over a year ago as an option under the Affordable Care Act. CT shifted our fully-state-funded SAGA program into Medicaid, getting a 50% federal match, and re-named it LIA. When the program switched, the SAGA $1,000 asset limit on eligibility was lifted. As more people have signed up for the program than intended (fuzzy policy estimates are hardly new) and costs are higher than expected, the state has asked the feds for permission to re-impose an asset limit of $10,000 for eligibility. The administration has suggested that many new LIA members are able to pay for insurance, but are choosing coverage in a public program. The article notes that we really don’t know who is enrolling, because the state doesn’t ask about assets in applications and no one has surveyed the population. But the reporter spoke to providers who say that’s not what they are seeing in the real world. The article also includes interviews with two new enrollees that do not fit the administration’s picture. Make sure and read down to both stories – important lessons about people working hard doing everything they should and are unlucky enough to have health problems – exactly who safety net programs are built for. In a down economy, it shouldn’t be surprising that numbers are up.

CT Insurance Exchange holding public events

In response to concerns about the lack of public input, CT’s Health Insurance Exchange will be holding seven “Healthy Chat” events in the next month. Similar to Consumer Conversations last month but sponsored by the exchange this time, they will be reporting on their activities but will also be taking questions. We will be asking why they aren’t willing to negotiate with insurers to keep premiums affordable. The events will all be 5:30 to 7:00pm with registration at 5:00. The events will be in Hartford on November 27th, Waterbury on November 29th, New London on December 4th, New Haven on December 6th, New Britain on December 11th, Stamford on December 13th, ending with Bridgeport on December18th. For more details, click here.

Where are the consumers on the consumer committee?

Kevin Galvin of Small Business for Healthy CT reflects on the recent CT Health Insurance Exchange’s Consumer Committee meeting. A lack of consumers on the consumer committee explains a lot.

November webquiz – substance use rates in CT

Test your knowledge of substance abuse in CT. Take the November CT Health Policy Webquiz.

Why CT’s health insurance exchange needs to negotiate

CT’s health insurance exchange is not planning to negotiate with insurers to improve value and control costs for consumers. As of January 2014, consumers will be mandated to secure coverage. Consumers eligible for affordability assistance must purchase in the still developing exchange to get the subsidies. Massachusetts’s exchange (the Connector) negotiates, termed active purchasing, with insurers saving consumers $16 to $20 million annually. In contrast, Utah’s exchange does not negotiate with insurers but includes any qualified insurer, as the CT exchange is planning, and premiums are HIGHER inside the exchange than in the outside market. There is some disagreement about whether the Board and the Qualified Health Plan Committee have already made the decision. No public comment was solicited on the issue and the decision memo was posted a day after the QHP committee meeting. For more on the issue, go our Policymaker Brief.

Consumer questions to CT insurance exchange

Some initial questions from consumers for the exchange were collected for last Friday’s Consumer Conversations. Among the 43 early questions -- Will you standardize benefit limits, exclusions, and substitutions to the Essential Health Benefit package? and How will you monitor that there are enough of the right kinds of doctors, and other providers taking new patients in each plan close to where people live?

CT health reform progress up to 16.7%

CT inched up only 0.3% in progress toward health reform last month. We have completed 16.7% of the tasks needed to be ready for January 1, 2014 when individuals will be legally required to secure health coverage. Highlights remain Medicaid and patient-centered medical homes. Unfortunately, problem areas continue to be the insurance exchange and insurance review. Last month, CT health care thoughtleaders gave CT a C+ grade for reform progress. For more, visit the CT Health Reform Dashboard at www.cthealthreform.org.

Consumers raise concerns with CT insurance exchange

Consumers and small businesses had a rare opportunity to share their concerns with CT’s health insurance exchange Friday. A standing room only crowd met with the exchange’s CEO, Kevin Counihan at a restaurant in Glastonbury. Christie Hager, HHS Regional Director, also attended. Comments focused on the lack of consumer and small business input to the exchange, inappropriate influence of insurance interests, and the exchange staff’s decision not to negotiate with insurers to get the best value for customers. Through negotiation, MA’s exchange has been able to keep the rate of premium increases to half what it is outside their exchange. However prices in Utah’s exchange, which does not negotiate with insurers as CT’s exchange is planning, are actually higher than prices outside the exchange. CT’s exchange is being set up by the state, with millions in federal grants, to help consumers get decent, affordable coverage and is expected to purchase on behalf of one in ten state residents. As of Jan. 1, 2014, everyone in CT will be required to have coverage. Residents who qualify for federal affordability subsidies will have to buy their insurance through the exchange. Check back at the CT Health Policy Project’s site soon for a brief on the benefits for CT consumers, promoting value and affordability, through negotiation on CT’s exchange.

CT health reform update

The CT Health Policy Project has posted a summary of updates and context on CT’s progress toward health reform.

PCMH workforce conference offers lessons for CT

Yesterday’s conference on patient-centered medical homes and workforce brought speakers from other RI, MA and Pittsburg together with CT programs to share best practices and lessons learned. Take aways included baking training into all activities and for every member of the team. It is also critical to begin training well before NCQA recognition. And training is not over with recognition; CHC, Inc. retrains all team members every year. The speakers emphasized that the patient-centered vision is the responsibility of everyone – including clinician, administrators, IT staff and receptionists. Teams are not one-size fits all; they have to fit into their community. Sustainable funding in a multi-payer initiative was cited by several states as critical, from the beginning. It is critical to use data – process and population health – to target interventions. Kyle Crawford from the Pittsburgh Regional Health Initiative noted that we have to create a “better relationship with our data.” Other lessons included the importance of behavioral health integration and engaged, committed leadership both at the practice level and among policymakers.

Additions to candidate briefing book

New briefs have been added to our CT Health Policy Project briefing book for Connecticut candidates. New briefs include wellness programs, patient-centered medical homes in CT, comparative effectiveness research, and CT’s health care workforce. The candidate briefing book is part of cthealthbook.org, our site for CT health care system resources. Check often for more updates.

CT exchange staff won’t negotiate with insurers on behalf of consumers

Staff of the CT Health Insurance Exchange have “opted to utilize an ‘any qualified plan’ approach” for determining which plans can be offered in the exchange. Proposed qualifications are minimal and generally only what is required by the Affordable Care Act. This decision is counter to the CT exchange’s own research. According to the market consultants, “One of the most attractive aspects of the Exchange is that the big insurance companies compete for their business. The feature evoked references to Lending Tree’s slogan ‘When banks compete you win.’” Utah’s health insurance exchange has pursued an “any qualified plan” approach, similar to CT’s staff proposal, and has attracted little enrollment with no evidence of cost control. Massachusetts’s Connector, on the other hand, operates with an active purchasing approach – negotiating with insurers to get the best price and quality for consumers. Annual premium increases for plans in Massachusetts’s exchange have been half the increase of plans outside the exchange. Starting in 2014, every CT resident will be required to secure health coverage. Over 150,000 state residents will have to buy it in the exchange to get federal affordability subsidies. According to the staff memo, the decision not to negotiate on behalf of consumers has been made and they are only taking comment on how to implement that policy. The memo was delivered Monday to the Qualified Health Plan Committee that no longer includes a consumer representative due to the unfortunate loss of Jennifer Jaff.

Medicaid Council update

Lots of good news at Friday’s MAPOC meeting. DSS has significantly improved their redetermination process in response to huge backlogs that prompted a legal aid lawsuit. The dual eligible Health Neighborhood proposal’s behavioral health component has been improved by shifting from the controversial, administratively complex and fragmented co-lead proposal to a partnership. This is what it always should be – partnerships across health care silos into an integrated neighborhood. People don’t come in silos, only the health system does, and further codifying that in policy is a very bad idea. The state is still currently pursuing a limited health home option only for people with serious mental illness. Health homes are an ACA provision reimbursing states 90% of care coordination costs for people with chronic conditions but only for two years. At the meeting, agency staff noted that CMS has issued guidance that states will retain the ability to access the 90% match for other populations in the future, but speakers noted the uncertainty of future federal funding due to sequestration and the imminent fiscal cliff. The state was urged to move swiftly to ensure that every eligible person be covered by the option as soon as possible.

PCMH workforce conference Oct. 23rd

Patient centered medical homes offer exciting potential to both improve the quality of care and control costs. But this transformation of care delivery will require new skills and roles in CT’s health care workforce. A conference to explore these issues and CT’s readiness for delivery reform will be held October 23rd from 8am to 3pm at Wilde Auditorium at the University of Hartford. Speakers include academic experts, working professionals and consumer advocates from CT and other states. The conference is sponsored by the Universal Health Care Foundation of CT together with the Allied Health Workforce Policy Board and the University of Hartford Center for Public Health and Education Policy. To register, click here.

State innovation application posted

The state’s application to CMS for a $3 million State Innovation Models Grant is now online. If awarded, the grant would fund health care planning activities including hiring staff at state agencies and consultants. The project will work to align incentives among stakeholders to reform delivery and payment systems. The initiatives include coordinating data across payers, supporting providers in practice transformation, and expanding primary care capacity. The role of consumers and the Cabinet is unclear. The project was developed by state agencies; the activities would be coordinated by the Office of Health Care Reform and Innovation.

CT still earns a C+ on reform

Once again, CT health care thoughtleaders give our state a C+ on health reform. From the beginning of the CT Health Thoughtleaders Survey in February, CT has varied between C and C+. CT has always received a B for effort. In good news, grades for the CT Health Insurance Exchange improved since June with fewer D’s and some A’s in this survey. Unfortunately, grades for Engaging Consumers in Policymaking and Data-based Policymaking have fallen. The former was the most common recommendation from thoughtleaders to improve progress toward reform. The overwhelming response was to engage consumers in policymaking – increase consumer voices, greater public engagement in the process, and engage advocates. Other suggestions included smarter policymaking (data, best practices), improve communications and transparency, convene stakeholders to build trust, and guard against conflicting financial and special interests. New questions in this survey found that almost all thoughtleaders are somewhat or very engaged in the process of reform, however all but four cite barriers to engagement. Understanding how critical stakeholder engagement will be to success, policymakers should work to improve effective, meaningful access to the process. A disturbing number of respondents have not been asked, or have tried but found few ways to participate. The Thoughtleader Survey is part of the CT Health Policy Project’s Health Reform Dashboard project at www.cthealthreform.org.

Join us for Consumer Conversations: the CT Health Insurance Exchange

January 1, 2014 every CT resident will be required to secure health coverage. The CT Health Insurance Exchange is being developed under the Affordable Care Act to be a fair, user-friendly marketplace for consumers and small businesses to buy decent coverage, hopefully at an affordable price. The Exchange has not heard consumer voices, does not include any independent consumer Board members, and is dominated by insurance interests. Small Business for Healthy CT and the CT Health Policy Project have invited Kevin Counihan, CEO of the exchange, to meet with consumers and small businesses to learn what consumers need and how to make the exchange a success. We will also be joined by Christine Hager, Regional Director of HHS, the federal agency funding the exchange. The meeting will be October 26th from 8:30m to 11am at the Pond House Grille in Glastonbury. To register, click here.

Aetna announces layoffs, blames ACA, puzzling

Aetna has announced they will soon be laying off 80 CT workers, 160 nationwide. The company cited competitive pressures from the Affordable Care Act (ACA) in their decision, which is puzzling. The ACA legally requires Americans to buy their product, which should substantially improve their bottom line. Significant lobbying from the insurance industry into the law ensured that we would not have a competing public option to help reduce costs. It is also interesting that Aetna laid off more employees (100 in CT, 625 in the US) a month before the ACA passed. The economic downturn has hit CT hard, and the 80 innovation, technology, and customer service workers will be joining a growing number of unemployed CT residents. The laid off employees will receive nine weeks of pay and some are eligible for a severance package.

Fascinating UConn medication management conference

UConn’s School of Pharmacy invited some stellar speakers to yesterday’s 2012 Hewitt Symposium on Medication Management. Medication management is an important new tool to both lower health care costs and improve care. The tool pairs patients with complex conditions and many medications with a pharmacist to ensure they are taking the right medications, eliminate conflicts, address side effects, prevent errors, and help them adhere to the care plan. Speakers came from successful programs in Boston, Pittsburg, Minneapolis, North Carolina, Iowa, and Connecticut. A CT Medicaid program, highlighted in Health Affairs, saved $1,123 per patient per year in medication costs and $472 in medical care – saving $2.50 for every dollar spent on the program. Another CT program serving Cambodian refugees saved even more -- $3,032.44 per patient per year – returning $5.60 for every dollar of program spending. The speakers shared important lessons learned. Opportunities to both save money and improve care are rare -- every CT payer should be looking at medication management.

Midwifery conference

Mary Breckinridge, one of the foremothers of nurse-midwifery in the United States, famously said, “Our goal is to see ourselves surpassed.” Nearly a century later, there is still much room for improvement in maternity care. As new tools and resources become available, what will it take to transform maternity care, and how can midwives and other maternity care professionals be part of that transformation? Join us for the ACNM Region 1 Annual Meeting: Quality Improvement in Maternity Care. Network with providers from across New England, earn CEUs, and get inspired to improve quality and patient safety. Saturday, November 10 8:30am – 3pm New Haven Lawn Club 193 Whitney Avenue, New Haven

October webquiz – pre-exisiting conditions

Test your knowledge of CT residents with pre-exisiting conditions. Take the October CT Health Policy Webquiz.

Exchange Board approves Essential Health Benefits standard – false choice between benefits and cost

Yesterday the CT Health Insurance Exchange Board approved CT’s version of the Essential Health Benefit (EHB) package under the Affordable Care Act (ACA). As of January 1, 2014 individual and small group plans will have to cover at least the EHB services. The ACA required that the EHB include at least ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse care, prescriptions, rehab and habilitation services, lab services, preventive and wellness care including chronic disease management, and pediatric care including vision and dental care. States have several plan EHB options including large commercial plans, federal and state employee plans. After long, contentious deliberations, two exchange committees of experts and stakeholders agreed on a moderate, compromise choice based on ConnectiCare’s HMO plan that includes all state mandates. The committees recommended that compromise to the Exchange Board. While the Board eventually approved the committees’ recommendation, there was a great deal of discussion about reducing the “richness” of the plan in the interest of “affordability”. Board members noted that the recommended plan is “richer” than what is offered now in CT. They failed to note that one of the main points of reform was to improve the “value” of health insurance so it truly covers what people need. If what is available now was sufficient, we wouldn’t have needed reform. The Board wants the legislature to “revisit” legislatively mandated benefits next year, eliciting groans from lobbyist and advocate observers in the room. Unfortunately there was no meaningful discussion about the potential for ongoing payment and delivery innovations successful in many other states, to provide flexibility that improve quality, access, patient satisfaction while controlling costs. The Board includes no independent consumer advocates and several insurance industry representatives. Consequently the Board is locked in the narrow false choice between mandated benefits and affordable premiums. That very old, very simplistic dialogue only spirals downward into worse care and upward into skyrocketing costs. The Board is missing a massive opportunity to learn from innovators and truly reform CT’s health care landscape.

Join us for Consumer Conversations: the CT Health Insurance Exchange

January 1, 2014 every CT resident will be required to secure health coverage. The CT Health Insurance Exchange is being developed under the Affordable Care Act to be a fair, user-friendly marketplace for consumers and small businesses to buy decent coverage, hopefully at an affordable price. The Exchange has not heard consumer voices, does not include any independent consumer Board members, and is dominated by insurance interests. Small Business for Healthy CT and the CT Health Policy Project have invited Kevin Counihan, CEO of the exchange, to meet with consumers and small businesses to learn what consumers need and how to make the exchange a success. We will also be joined by Christine Hager, Regional Director of HHS, the federal agency funding the exchange. The meeting will be October 26th from 8:30m to 11am at the Pond House Grille in Glastonbury. To register, click here.

Resources on PCMHs and health equity

Care coordination is only one aspect of patient-centered medical homes (PCMHs) that can have a large impact in promoting health equity. PCMHs are primary care practices that create partnerships among a team of providers that serve and support consumers in improving their own health. In addition to care coordination, PCMHs track the population health needs of their patients, offer enhanced hours, and provide culturally appropriate care and services. The CT Health Foundation has published a brief, references, and a chart on the subject.

Candidate briefing book posted

The CT Health Policy Project’s 2012 candidate briefing book on CT’s health is posted. This year’s book includes briefs on thirteen timely issues including health care cost drivers, CT’s health insurance exchange and CT & national health reform. The briefing book is part of www.cthealthbook.org our resource library on health care issues and solutions facing CT.

Health Justice Town Hall

Health Justice Town Hall Meeting 2012, a statewide discussion on creating solutions for a healthy and equitable Connecticut, will be held October 23rd from 5:30 to 7:30 pm. Meetings will be held that evening in three locations – the Legislative Office Building, and two Community Health Center Inc locations -- 675 Main St., Middletown and 1 Shaws Cove, New London. More details are coming soon at www.HealthJusticeTownHall.org.

No CT hospitals make top quality list

The national experts who are responsible for accrediting US hospitals, the Joint Commission, has just released their list of 620 hospitals, Top Performers on Key Quality Measures. The 620 hospitals were recognized for providing “evidence-based clinical processes that are shown to be the best treatments for certain conditions, including heart attack, heart failure, pneumonia, surgical care, children’s asthma, inpatient psychiatric services, stroke and venous thromboembolism.” Unfortunately, no CT hospitals earned a spot on the list. Among our surrounding states, New York had 16 hospitals on the list, Massachusetts had 10, and one Rhode Island hospital met the standards.

State Employee wellness program working

Preliminary results from the new Health Enhancement Program (HEP) for state employees show decreasing use of specialists and increasing use of primary care. HEP is a wellness program that gives state employees incentives to manage chronic conditions and prevent new problems. HEP grew out of last year’s labor negotiations designed to both reduce costs and improve the quality of care – and it appears to be working. Emergency Room visits are down significantly and people with chronic conditions like heart disease, high blood pressure, high cholesterol and diabetes, are doing a better job taking their medications. The HEP results follow some very interesting FY12fiscal numbers in this presentation by the Comptroller’s Office. Once again, Medicaid dwarfs other line items in the budget at $4.7 billion. Even accounting for federal matching funds, it exceeds the next largest line item – salaries and wages. And rising Medicaid caseloads are a significant driver of the rising state budget. This is all the more reason to expand good ideas, like the HEP, to all state health spending and leverage the state’s success to improve the rest of the market.

New uninsured brief posted

Check our newest Policymaker Issue Brief for more information on the drop in uninsured CT residents last year. See where the gains came from, where residents get coverage, why it matters, and why we need to continue the important work of reform.

Census finds 94,000 more CT residents had health coverage last year

New US Census numbers found that the number of uninsured CT residents dropped to 303,000 last year from 397,000 in 2010, to 8.6% of all state residents from 11.6%. The rate of uninsurance in CT has been rising since 2005. The Affordable Care Act deserves much of the credit for the drop, especially for the estimated 23,000 young CT adults now able to stay on their parents’ policies to age 26. Employer-sponsored coverage accounted for 24,000 of the increase, but the majority was due to increases in Medicaid (43,000) and Medicare (38,000). However, it remains true that the majority (66%) of CT residents receive coverage through an employer.

Kaiser taking guesses on uninsured number

New Census figures on the number of Americans without health coverage last year are due out Wednesday morning. Experts expect the number to be up slightly as unemployment remains high. Kaiser Health News is taking guesses on their blog. The closest guess gets recognition. Any guesses for CT’s number? Go to our brief from last year to study up.

RFI for state employee Health Enhancement Program support

The Office of State Comptroller has released a Request for Information for data, support, chronic care coordination and monitoring services to support the new Health Enhancement Program. The RFI includes questions about medical management, care management, call center, physician support, data exchange, quality management, privacy & security, information technology, outcomes, and wellness support. Please share with anyone who might be interested.

CEPAC coming to CT December 6th

The New England Comparative Effectiveness Public Advisory Council (CEPAC) will hold our next meeting here in CT -- December 6th from 10am to 4pm at the Legislative Office Building. Too many new (and expensive) treatments and technologies are adopted and gain wide use before a careful analysis of their effectiveness in treating the condition and/or cost effectiveness compared to other options. CEPAC’s mission is to produce actionable information to aid regional policymakers in the medical policy decision-making process. CEPAC includes researchers, clinicians and patient advocates from all New England states who, twice a year, drill down into the research around treatment options for a condition, evaluate effectiveness and costs, and vote on whether there is sufficient evidence to recommend each treatment’s use. Both Medicare and Anthem have cited previous CEPAC votes in deciding which treatments to fund. June’s meeting in New Hampshire focused on treatments for ADHD. December’s meeting will focus on treatments for obstructive sleep apnea (OSA) in adults. Studies estimate that between 10 and 20 percent of middle-age and older adults suffer from OSA and the rate is rising as obesity rates rise. The meeting is open to the public and the public is invited to testify and/or submit written testimony.

LHP takeover of Waterbury hospitals may be off

News outlets are reporting that LHP Hospital Group, the for-profit Texas company planning to purchase both Waterbury and St. Mary’s Hospitals, has sent a letter threatening to pull out of the deal unless the three sides came to agreement by last Friday. The plan was to merge the two hospitals in a new facility. One potential area of disagreement may be delivery of abortion services and other women’s health care. The Mayor is concerned the deal will fall apart; the hospitals are saying discussions continue.