Capitol Hill visit

It was an exciting time to be in DC yesterday. Our health policy class was able to attend the House press conference on the West Steps of the Capitol releasing their health reform bill that is expected to go to the floor next week. We heard from a panel of very tired health policy staffers from across the spectrum including Sarah Dash from Congresswoman Rosa DeLauro’s office, who I spoke with at length later about the bill. In the afternoon I visited all the offices of CT’s delegation. CTHPP Board member Congressman Joe Courtney and his health staffer, Maija Welton, were very gracious. Joe had just left the House Caucus and full of details about the bill. Senate staff in Sen. Dodd’s HELP committee were less sanguine about the chances of getting 60 votes for many of the House bill’s best provisions but very helpful in explaining where they are. Asked what we can do to help them, Joe asked that advocates work to clear up the myths being sold to seniors that health reform will harm Medicare. In fact, the House bill reduces and eventually eliminates the donut hole in prescription coverage, adds coverage for more preventive services, includes demonstrations for important initiatives that could vastly improve access to care, care coordination, and would help stabilize the program’s financial stability (which without reform is tenuous). My visit was energizing and exciting – I haven’t said that about a visit to DC in a very long time. It is very possible that something historic is about to happen.
Ellen Andrews

Last day of policy training classes

Yesterday was our last day of classroom federal health policy training. Our “classroom” has been the Kaiser Family Foundation’s Barbara Jordan conference center in downtown DC – a fantastic facility. We had an intriguing breakfast discussion with a registered lobbyist who has worked for Academy Health, the health research think tank that is running the training, and GAO. We had backgrounders on Medicare and state health policy and a session on how to communicate with policy leaders. Not surprisingly, advocacy at the federal level is a lot like the states – same motivations, same dynamics – but slower and more deliberative. This training is primarily for health services researchers; my classmates are very frustrated that research isn’t the only factor that drives health policymaking. It’s far worse at the state level. Today we go to the Hill for our last day of training.
Ellen Andrews

More health policy training in DC

Yesterday we heard about polling, federal budgeting, the role of the judiciary in health policy and a capstone panel with an overview of policymaking from beginning to end using regulation and rule making for electronic health information breach notification in the federal stimulus bill as a case study. The panel on the role of the judiciary was fascinating. We heard the differences (courts don’t care about data or statistics, it is all driven by individual cases or anecdotes) and similarities (politics decides alot) with policymaking in other branches. The bioethics underlying the law came up repeatedly – medical marijuana and assisted suicide cases. But the one that fascinated me most was a hospital in rural Maine that sued recently claiming that the requirement that hospitals treat everyone who enters their doors (at least to stabilize them) regardless of ability to pay was an unreimbursed “taking.” Something like when government takes your home to build a highway, they have to pay you a fair price. The hospital claimed that the government was requiring them to provide uncompensated care and not reimbursing them. This hospital provided only a very small amount of uncompensated care – 0.5% of revenue -- the national average is ten times that. The Courts found against them, but the reasoning was that the hospital’s trustees didn’t have to run a hospital. They could have chosen to convert it to another purpose (a hotel maybe?) and then nothing would be “taken”. I can’t wait to see what we’ll learn today.
Ellen Andrews

DC health policy training

This week I am learning about how health policy gets made at the federal level, thanks to funding from the Council of State Governments/Eastern Region. Yesterday we heard the basics – White House offices and staff dynamics, how Congress works, then how it really works, agencies and their roles in developing policy, and how it all interacts. My head still hurts from the complexity, but the parallels to state policymaking help. Everything is framed in the context of the current health reform debate. It is an extremely exciting time to be here.
Ellen Andrews

CT Voices re-opens search for budget analyst position

CT Voices for Children is seeking a budget analyst to research family economic security issues and state fiscal analysis. CT Voices is a New Haven-based nonprofit advocacy organization working on behalf of children and families.

Another PCCM/HUSKY Primary Care outreach tool

A brochure for consumers about the PCCM/HUSKY Primary Care option is available on the CT Health Policy Project website.

From the Consumer Helpline

On Wednesday, the New Haven Adult Education Center held their Community Resource Day. This was my first consumer outreach event, and it was a great introduction. The fair was extremely well-attended, and the organization of the event and how smoothly it ran really impressed me. Different groups and classes from the Center came in at staggered intervals, so it was always busy but never too crowded. Because of the variety of programs the Center offers, there were people of all ages, and we handed out a ton of tip sheets, in both English and Spanish, and applications for HUSKY and Charter Oak. Many people also asked us specific questions about their own health care experiences, options, and situations, and one person has already called us to find out more about the information we gave him at the fair. Lots of the people we spoke to were interested in finding alternative insurance programs because they had recently lost their jobs and, therefore, their health insurance. We also heard from a young woman who has Charter Oak and who cannot find a doctor who will see her, which, as this blog has written about, is a common complaint about the program. In general, the younger students at the Adult Education Center had less interest in our table, which I initially assumed was because of the stereotype of the young invincible who believes s/he can’t get sick. Once I talked to a few of them, though, it turned out that most of them had HUSKY or other insurance from their parents already, so they didn’t need to worry about health care yet.

I also very much enjoyed seeing the other organizations at the fair and learning more about the resources available to the New Haven community. Yale can be very isolated from the rest of the community, so I had only a vague idea about the number of community organizations in the area. Everyone was very friendly, and a couple of youth and community groups took tip sheets and signed up for our newsletter. Overall, it was a very successful and enjoyable event, and I am looking forward to doing more of them.

Sabina Klein, CTHPP Fellow

New PCCM/HUSKY Primary Care outreach tools

New outreach materials for use by advocates recruiting providers and consumers into PCCM – now named HUSKY Primary Care – are available on the CT Health Policy Project website. The tools include a updated FAQs for providers and for consumers. Our new consumer newsletter is also posted in English and Spanish.

Michigan Medicaid dental cuts cause woman’s death

A Northern Michigan’s woman’s death last week is being blamed on her inability to access oral health care in Medicaid. Her untreated infection could have been prevented; she was scheduled for surgery just days after her coverage was cancelled. Her dental clinic was willing to donate the surgery but Medicaid refused to pay for hospital costs. Because of budget cuts, only emergency dental care is covered for adults in Michigan’s Medicaid program, as of July 1st.

“This woman had a chronic dental infection that ultimately killed her. If the
infection had been but a dental infection, Medicaid would have paid for
treatment, including hospitalization,” said Thomas Veryser, Executive Director
of Dental Clinics North. “We predicted cuts to the Adult Dental Medicaid Benefit
would cost lives and now it has.”

Ellen Andrews

October CT Health Policy Web Quiz

How much do you know about the CT Health Policy Project? To celebrate our Tenth Anniversary, this month’s online web quiz, the CT Health Policy Project By the Numbers, marks our accomplishments.

Courant editorial calls for DSS Commissioner search

Yesterday’s Hartford Courant editorial calls for a broad search for the next Commissioner of DSS. This echoes other voices, including ours. State health care programs have struggled in recent years. National health reforms offer Connecticut exciting new opportunities but also immense challenges that will make the last decade seem easy. The choice of a new Commissioner is critical and cannot wait.
Ellen Andrews

From the Consumer Helpline

A consumer called our helpline because she needs help paying for her daughter’s medical bills. Even with insurance, the co-pays and deductibles are adding up. Her daughter is 4 years old and has cystic fibrosis; she was in the hospital, which had a $500 co-pay and the mom has to pay for her prescriptions before she can pick them up, totaling another $1,500. It is a little more difficult to find resources for people who are insured but still having trouble paying for the care they need. There were some resources for people with cystic fibrosis and others for children with chronic illnesses. Each program has a separate intake screening and application process. The mom is already applying for HUSKY so she can try to get help through the hospital for that bill. On the phone, she sounded discouraged and exhausted. In addition to taking care of a child with a chronic illness, she has to make a lot of phone calls and fill out all sorts of paperwork to try and get her daughter the medical care she needs.
Jen Ramirez

New report estimates 28,100 new uninsured in CT this year

Based on rising unemployment rates, a new study by Families USA estimates that 28,100 more CT residents are uninsured this year than last. Unemployment in CT as of Aug. 1st was 8.1%, up from 6.1% last August. This places CT 40th in the nation in rates of uninsured; in 2008 we were 45th according to the US Census. People without health coverage are more likely to delay seeking needed care until problems are more difficult and more expensive to treat. Sixty two percent of bankruptcies nationally are caused by medical bills.
Ellen Andrews

SustiNet meeting today cancelled

Today’s SustiNet meeting at the Capitol is cancelled due to illness.
We’ll let you know when it’s rescheduled.

New resource for CT physicians on quality of care

eHealthCT together with a long list of partners is providing physicians with quality measures for their practices across payers through a new iniative, CT Health Quality Cooperative (CHQC). CHQC is the first of its kind tool in Connecticut and one of only a handful nationally to aggregate data across health plans and Medicare to provide physicians with a comprehensive set of data on eight quality measures for their practice in comparison to other physicians across the state. Partners include Aetna, Anthem Blue Cross and Blue Shield, Bridges to Excellence, ConnectiCare, the CT State Medical Society-IPA, HealthNet, UnitedHealthcare and Qualidgm. Previously physicians could only access information about their quality performance for patients from each payer separately; the new report aggregates patients to provide more meaningful information that providers can use to improve care. CHQC covers approximately 95% of insured CT residents. Initially the CHQC indicators focus on diabetes, coronary heart disease, asthma, childhood respiratory infections and several preventive measures such as testing for cervical and breast cancer, and cholesterol testing. Funding was provided by the partner organizations and from the UConn Foundation for a physician continuing medical education module to help assess and use the information to improve care in their practices.
Ellen Andrews

Medical home panel at NASHP conference

Today’s medical home panel at the NASHP conference in Long Beach focused on partnering with the private sector. RI has coordinated all the payers to make incentives salient and set common standards. OK has 420,000 enrolled in their Medicaid medical home/PCCM program and is saving millions. Most are using NCQA accreditation of medical homes. PA has 1.2 million in their chronic care model medical homes. Payments to providers can reach $95,000/year. Technical assistance, learning collaborative and other support for providers is key in all three states. The common theme is that states have to take a leadership role, as a payer, convener, and regulator; when states convene the stakeholders, payers can coordinate without worrying about anti-trust issues.
Ellen Andrews

NASHP pre-conference on payment reform

Today’s pre-conference meeting to the National Academy of State Health Policy’s annual conference took on the elephant in the health policy room – how to align incentives among payers, providers and consumers to reward quality and efficiency. Health care is a very fragmented, very large business and it doesn’t turn on a dime. But a number of states have had success in reforming payment systems both in the care the state directly purchases (Medicaid, state employees, etc.) and using its bully pulpit to move other payers. States have a unique role as a major payer and the primary regulator of health care. Models vary from pay for performance that most states have implemented (but not CT yet) to global capitation payments (proposed in MA). Spending per person varies significantly between and, in some cases, within states and there is no evidence that better quality of care or outcomes follow higher spending. States have identified significant savings and improvements in quality. There was a lot of discussion about how to develop Accountable Care Organizations, integrated health systems that can be held accountable for value across the care continuum. CT is unique in that we have alot of small physician practices that are not formally linked to hospitals or other institutions so creating ACOs here will take more organization and more time. PA has an extensive medical home program covering 1.2 million patients that is helping reform payment systems and improving coordination of care for state residents. Minnesota described their reforms that include “baskets” of bundling payments for care to promote transparency, P4P, public health improvements including obesity and tobacco prevention, medical homes, health information technology, and health care cost measurement. We also heard from Washington State legislative and administration staff, cooperating across branches of government, about their success in integrating evidence based science into payment decisions that has saved the state between $40 and 60 million in pharmacy costs alone. Fascinating stuff.
Ellen Andrews

Medical home conference

Saint Francis Health Care Partners is holding a very comprehensive Medical Home Symposium Thursday November 5th at the Hartford Marriott Farmington. If you are considering this important practice innovation or just want to know more, you will learn all you need to know. Session 1 from 1:00 to 5:00 pm includes Paul Grundy of the Patient-Centered Primary Care Collaborative, Ken Sacks from the CT State Medical Society, Robert Fortini of the Queens Long Island Medical Group, Barbara McCann of Interim Health, Mary Allegra of Masonic Care, Sandra Nichols of AmeriChoice and myself. Session 2 from 5:00 to 8:00pm includes Paul Grundy, Terry McGeeney of TransforMED, Robert Hockmuth of CIGNA, and Suneel Parikh of the Queens Long Island Medical Group. Registration is $50 for one session or $90 for both. Click here to register. For questions, contact Rose Stamilio (860) 714-6162 or rstamili@stfranciscare.org.
Ellen Andrews

SustiNet Board meeting

The Board made progress on workplans and committees at yesterday’s meeting. They added a health disparities and equity committee, and asked for input on membership for the others. The workplans for the committees and the Board we adopted with some minor revisions. Workplans and membership lists are online. All meetings will be public and subject to Freedom of Information laws.

In other news, the health care workforce task force will be holding its first, organizational meeting October 15th at 4:30 pm in Room 1C of the Legislative Office Building.
Ellen Andrews

Families report on how national health reform will benefit CT consumers

A new report by Families USA outlines how national health reform proposals will improve health care for CT consumers from current law. Issues include coverage for pre-existing conditions, premiums based on gender and health status, expanding options for coverage, affordable premiums and out of pocket costs for families and small businesses, annual and lifetime caps on coverage, limiting administrative and profit overhead, maintaining coverage when consumers become sick, covering the uninsured and low income consumers, and Medicare improvements.
Ellen Andrews