Hispanic Health Council unveils new website

Visit the Hispanic Health Council’s re-designed website. The Hispanic Health Council’s mission is to improve the health and social wellbeing of Latinos and other diverse communities. Programs include substance abuse and recovery, nutrition assistance, farm workers health, HIV/AIDS, breastfeeding, diabetes, cancer and parenting support. Join the Hispanic Health Council for their 30th Anniversary on October 21st from 5 to 8 pm at their offices at 175 Main Street in Hartford.

Judge denies parts of nursing home lawsuit

A federal judge has denied an injunction in the CT Association of Health Care Facilities’ lawsuit against the state, but the lawsuit is moving forward. The nursing homes had asked for an injunction to stop $300 million in cuts scheduled over the next two years; the state asked the court to throw out the entire suit. The nursing homes argue that the state’s system of payments underfunds them by $100 million, considers only finances and ignores the quality of care, and violates federal law. About two thirds of nursing home revenues are paid by Medicaid program with payment levels set by the state. In total, nursing homes cost CT $2.5 billion/year; 22 homes have closed since 2002, in part because of low Medicaid reimbursements. The judge also removed Governor Rell as a named defendant in the suit leaving only Commissioner Mike Starkowski. The association contended that the Governor has an important role in setting the state budget and, consequently, for underfunding nursing homes.
A recent study found that CT relies more heavily on nursing home care for fragile seniors and people with disabilities than other states, costing an additional $900 million/year. Other state Medicaid program regulations and administration make accessing care in the community easier. Almost 80% of CT residents would prefer to receive care in the community rather than a nursing home.
Ellen Andrews

Medicaid Managed Care Council update

Friday’s Council meeting focused mainly on plans for the $50 million temporary high risk pool opportunity created by national health reform. DSS joined the CT Insurance Dept. and the Health Reinsurance Association (HRA) to describe their plans. They intend to piggyback on the current high risk pool administered by HRA which was created in 1976 to provide coverage to CT residents with pre-existing conditions denied individual insurance. Insurance coverage will be provided through United Healthcare. After more than three decades HRA enrollment is only 2,529. HRA was criticized at the meeting for very high premiums, high deductibles, and a very confusing website. There will be at least three call centers for the various stakeholders involved in the program, including DSS, CID, ACS, HRA and United Healthcare. Concerns were raised about fragmentation, that consumers would be left with no clear point of contact, and the risk of very high administrative costs, especially given the limited federal resources available. Concerns were also raised about benefits and cost sharing under the plan. DSS admitted that the plan does not comply with state law, but doesn’t have to under federal law. Even more controversial, DSS intends to seek legislative approval to shift any eligible Charter Oak members with pre-existing conditions to this new plan; consumers moving from Charter Oak to the new plan would face significantly higher costs, potentially reaching over $1,000 more per month. DSS refused to outline how they would use the savings in the Charter Oak plan; suggestions from Council members included reducing premiums, lifting benefit caps, raising the pharmacy cap or eliminating the requirement that applicants be uninsured for six months.

In other updates, DSS described the increases in copayments and premiums in Charter Oak and HUSKY Part B. ACS will track cost sharing for families and alert both the HMOs and families when they have reached the federal limits and will no longer be charged copays. DSS is still pursuing the conversion of SAGA into Medicaid with CMS. For the first time since its inception and despite stubbornly high unemployment rates, enrollment in Charter Oak dropped in May when members were notified of the increase in premiums.
Ellen Andrews

Patients asked to leave medical practice after filing complaints for excessive billing

Two Hartford Medical Group patients have been told they are no longer welcome at the practice for complaining about fees charged to them above the payments by their insurers for routine physicals, which are 100% covered. Three complaints have been filed with the Attorney General’s office for excessive and unjustified billing; one patient was told that she could come back to the practice if she withdrew her complaint with the AG. The AG’s office is investigating the allegations which they characterized as “potentially unjustified charges added to consumer bills for services that should have been included in the physical or were never provided.” The practice claims that one patient was belligerent and “nasty” about the extra bill. According to their online policies and procedures, Hartford Medical Group charges $35 to patients who don’t show up for appointments and $45 for “administrative fees” related to nonpayment and collections costs.
There is a small but growing national trend of doctors tacking on extra fees to patients, but for services insurance does not pay for including filling out school and camp forms, no-shows, and flat “non-covered benefits” fees.
Ellen Andrews

Risk adjusting rates webinar slides and video posted

you missed Wednesday’s webinar with Diane Laurent and David Williams of Milliman, the slides and video are now online. Diane and David described the methodologies to adjust rates based on each patient’s utilization history and diagnoses. Some models can predict future utilization and events, such as hospitalizations, for each patient providing an important tool to care managers in patient-centered medical homes.
Ellen Andrews

Immediate impact of national health reform for CT

The White House has developed a list of the benefits of the Affordable Care Act to CT this year. The list includes small business tax credits, closing the Medicare donut hole, funding for early retirees, no lifetime limits on coverage, no rescissions, no pre-existing condition exclusions for children, all children to age 26 can stay on their parents’ policies (and parents don’t have to pay taxes on those benefits), Medicaid coverage (and matching funds) for SAGA, $50 million for a high risk pool, funding for community health centers, and to train more providers. And that’s just part of the list.
Ellen Andrews

CT hospitals left out of Medicare bonuses

No CT hospitals are among hospitals nationally receiving Medicare bonuses under the new national health reform act. The bonuses were designed to equalize payments between high and low cost hospitals – none of CT’s 30 hospitals qualified as lower cost. The provision was prompted by research led by Dartmouth Atlas showing no link between high cost areas of the US and hospitals with quality.In fact Dartmouth researchers have evidence that higher cost areas are associated with lower care. That research is very controversial and other researchers disagree with Dartmouth’s findings.
Ellen Andrews

New report outlines long term cost of fully funding state retiree health benefits, Gov. Rell aggressively pursuing funding opportunities in national h

An early estimate to the state’s Post Employment Benefits Commission estimated that fully funding health benefits for the state’s 42,000 retired workers would average $1.9 billion over the next 28 years. The state now pays these bills as they arise; just over $490 million is budgeted for these costs in the fiscal year that starts next month. While full funding would cost more now, it would reduce future costs. The Commission includes representatives from the Comptroller’s and Treasurer’s Offices, the administration, and labor and is charged with analyzing long term funding of the state’s health and pension benefits system. The report was prepared by Milliman.

Governor Rell’s administration is aggressively pursuing federal funding opportunities in the new national health reform act, despite criticizing the reforms. The state will not be pursuing any new opportunities to cover Connecticut’s 343,000 uninsured under the act, but is only considering options to replace current state funding including $53 million to move current SAGA recipients into Medicaid and another $50 million to fund our high risk pool. The Comptroller’s Office has also applied for $100 million over the next four years to support coverage for state employee early retirees not yet eligible for Medicare. As funds for early retiree benefits are limited, the Comptroller’s Office responded to the opportunity quickly to apply early.
Ellen Andrews

Are hospitals more dangerous in July?

Anyone who has worked around hospitals has heard the warning to stay away in July when new residents start. But is it true? The Wall Street Journal examines the evidence, which is mixed. The bottom line is that it’s always wise to be an informed consumer. For tips on making your hospital stay safer and more go to the monthly columns by Carolyn Clancy of AHRQ. And for more on patient safety click here.
Ellen Andrews

CT Health Information Exchange meeting

DPH, DSS, and eHealthCT are hosting a CT Health Information Exchange Leadership Meeting June 10th from 8:30am to 12:30pm at the CT Hospital Assoc. Offices in Wallingford. Anyone interested in health IT and how CT is progressing toward creating a network is welcome. Attendees will hear updates on the DSS Medicaid HIE pilot project, eHealthCT’s Regional Extension Center program and DPH’s strategic and operational planning. Following the updates will be a town-hall style meeting to answer questions and collect input. To register go to http://www.ct.train.org/ for course #1022441 or email lynn.townshend@ct.gov.

Test your knowledge of CT’s individual insurance market

June’s CT Health Policy Webquiz tests your knowledge of CT’s non-group insurance market.

Obesity tools: CT middle of the pack in physical education report; improved home ec classes described

25.7 % of CT children are overweight or obese and policymakers are looking to the quality of physical education as one tool to address it. A new report by the National Association for Sport and Physical Education finds that CT’s state policies are better than some states and worse than others – we require physical education in elementary and high school, but not middle school. CT does not collect height and weight data on students making policy decisions, targeting resources, and evaluation of initiatives more difficult.

The Wall Street Journal Blog reports on what is needed in effective PE classes as well as other pieces of the solution to obesity including healthy eating. The authors argue that schools should require revamped home economics classes as well as physical education. The blog quotes a JAMA commentary describing improved home ec classes as giving students “the basic principles they will need to feed themselves and their families within the current food environment,” including “basic cooking techniques; caloric requirements; sources of food, from farm to table; budget principles; food safety; nutrient information, where to find it and how to use it; and effects of food on well-being and risk for chronic disease.”
Ellen Andrews

Report finds one in five CT residents have pre-existing conditions and risk of insurance denial

A new report by Families USA finds that 593,000 CT residents have been diagnosed with one or more condition that could result in denial of insurance coverage. In September, under the new national health reform act, insurers will be prohibited from denying coverage to the 44,200 CT children with pre-existing conditions, but the other half million adults in our state will have to wait until 2014 for protection. Every income group is affected but low income residents are at higher risk. Whites, African-Americans and Hispanics are about equally likely to be affected. Near elderly residents (ages 55 to 64) are the most likely to be at risk. Pre-existing conditions that often cause coverage denials include any diagnosis of cancer, diabetes, arthritis, obesity, heart disease, or sickle cell disease.
Ellen Andrews

$266 million in Medicaid funding at risk

Congress is considering a bill that extends the badly needed enhanced Medicaid matching rates to states for another six months. Without the legislation, the extra funding is set to expire at the end of this year. CT stands to lose $266 million in federal funds. Along with thirty other states, CT has assumed receipt of those funds in the state budget that passed this spring. The version that passed the House Friday did not include the extra Medicaid funding; an earlier version in the Senate does include the funding. The Council of State Governments/Eastern Region and other groups are urging Congress to continue this vital lifeline to states struggling with declining revenues and surging enrollments in these critical safety net programs.
Ellen Andrews

SustiNet 60 day report released

Yesterday the SustiNet Board released their report to the General Assembly on how Connecticut’s 2009 health reform law fits with recently passed national reform. The report outlines significant new resources available to support SustiNet and three steps for the state to take advantage. In all, SustiNet tracks closely with the parameters of national reform.
Ellen Andrews

New webinar on risk adjustment models

The success of health care payment reforms rests on the ability to fairly adjust provider rates to reflect the expected health costs of each patient. Accurate risk adjustment can reduce incentives to over treat or avoid high cost patients. The science of risk adjustment has evolved significantly. Hear from experts about the methodologies and models to ensure that resources go to the patients who most need them. Register for our webinar June 9th at 2pm at https://www1.gotomeeting.com/register/441699025

Patient-Centered Medical Home updates

There are several opportunities in the new federal health reform act for CT to embrace, and fund, patient-centered medical homes. Currently, CT has no (zero) medical homes certified by NCQA, the national accrediting body. The SustiNet patient-centered medical home committee is considering the options and how they fit with Connecticut’s unique health care environment. At this week’s meeting, the committee heard from Ron Preston, formerly Regional Administrator at CMS in Boston, about an exciting collaborative of New England states to apply for a Medicare waiver allowing a multi-payer medical home initiative. Unfortunately CT is the only New England state not participating; it is unclear how the current administration made that decision. In addition to accessing Medicare funding, the collaborative is also working to set common standards for data collection and evaluation across patient-centered medical homes in the region to identify best practices and share resources. The committee was very interested in engaging CT with that collaborative, accessing new federal resources for our state, and learning from others about successful practice transformation to benefit every CT resident. The committee meets again this coming Wed. May 26th at 10am in the LOB.
Ellen Andrews

Only CT and DC take early expansion option

To date only CT and the District of Columbia have submitted early option applications to expand Medicaid under the new federal health reform law. CT applied April 15th and DC submitted their application May 13th. CT plans to cover our 45,000 SAGA members under Medicaid, providing expanded coverage and eliminating the SAGA asset test, while bringing in $53 million in new federal matching funds over the next fifteen months. DC expects to save $56 million over the next four years. Twenty nine states, including CT, are also taking advantage of the new federal option to create a temporary high risk pool; eighteen states are going to use the federal high risk program rather than creating their own pool.
Ellen Andrews

Medicaid Managed Care Council update

We ran out of time at Friday’s Council meeting, so we will devote the entire June meeting to discussing how the state plans to implement the new budget provision to self-insure the HUSKY/SAGA/Charter Oak program. Some of the decision points are whether to keep the program capitated but without financial risk (not sure how that works), whether we can continue to allow some providers to be paid more than others, whether to re-bid the contracts for one or more ASOs (or just keep the current HUSKY HMOs as happened last time), and whether we can have (or need) more than one ASO. Other HMOs are interested in applying now that the program does not carry financial risk. Apparently, responses from the current HUSKY HMOs to the RFP to provide non-risk care management services to the current Medicaid fee-for-service population were not cost effective.

In other reports, the Council heard about important work being done by the Women’s Health Subcommittee and Community Health Center, Inc to prevent low birth weight babies and improve breastfeeding rates by getting pregnant women into prenatal care early, ensuring access to dental care, smoking cessation and identifying and treating depression during pregnancy. The committee is planning a prenatal care summit in the fall.

Mercer gave their usual, glowing evaluation of the HMOs. Under questioning, it became clear that their evaluation is only of processes, and does not reflect actual access to care for members. Performance studies were not promising; at best, there was little progress on any health outcome or process measures. The CT Dental Health Partnership continues its impressive progress to enroll more providers and expand access to oral health care. And PCCM enrollment is up to 388 as of May 1st; up from 359 a month before.

And the Council’s name changed to the Council on Medicaid Care Management Oversight.
Ellen Andrews

Health care reform training session

The Universal Health Care Foundation of CT will hold Building Public Awareness: Building Public Will, a training session for community leaders and advocates to help us get the truth out about health reform, at the state and federal levels, and how to counter the myths and misinformation about health care. The session will be June 5th from 9am to 2pm at Middlesex Community College. If you are interested in getting involved, contact info@healthcare4every1.org or call (203) 639-0550 X320. For more on myths and truths about the federal health care reform bill, check our latest brief.

The Pill turns 50, CT took a little longer

Today, Mother’s Day, marks the 50th anniversary of the birth control pill’s approval by the FDA. Today one in five American women between the ages of 15 and 44 use the pill, spending $3.5 billion in 2008. The pill’s development hinged on the discovery of the Barbasco root, a type of wild yam that Mexican women had been chewing to prevent pregnancy for generations. It was the first US drug developed for use by healthy people. Controversial throughout its history, the pill neither destroyed nor perfected American society and family life as was predicted fifty years ago. Because of health concerns associated with the pill, the FDA changed their approval process including more extensive clinical trials, referrals to outside experts, and ongoing assessment of medication safety. The pill also led the FDA to communicate directly with patients rather than relying only on physicians to relay safety information.
Connecticut has a long history in women’s access to contraceptives. Attempts to shut down a New Haven family planning clinic led the US Supreme Court in 1965 to toss out a state anti-contraceptive law from 1879. The Court ruled that contraceptive use is a private issue. The decision made use of the pill in CT legal, as in the rest of the US.
Happy Mother’s Day.
Ellen Andrews

Fewer physicians accepting visits from drug reps in the office

The Wall Street Journal blog reports on a new survey of US physicians that found the number who are “rep-accessible”, or willing to meet with drug company sales rep.s in the office, is down 18% from last year. However, still 58% of doctors take meetings with at least 70% of the reps who call and only 9% see fewer than 30% of calling salespeople. Drug companies have significantly reduced their sales forces in recent years. By 2012 it is expected that the number of drug reps will be down to 70,000; that is still one for every ten practicing US physicians.
Ellen Andrews

Sen and Mrs. Dodd to host food allergy forum

Sen. Christopher and Mrs. Jackie Clegg Dodd will host a forum on managing food allergies at home, in school, away at college and in restaurants. The forum will feature Dr. Hugh Sampson of Mt. Sinai Medical Center, Eva Bunnell, parent of a child with a food allergy, Cheryl Resha, RN from the CT Dept of Education’s Bureau of Health and Nutrition, Dr. Jeffery Factor, Timothy Larew, a college student with food allergies, and Gary Crowder, from Resort Operations at the Mohegan Sun. The forum will be Sat. May 15th from 10am to noon at Founders Hall, CCSU, 1615 Stanley St., New Britain CT. Parking is available in Welte Garage. To RSVP email foodallergy@dodd.senate.gov or call (860) 258-6940.

Budget agreement reached

The Governor and General Assembly have reportedly reached an agreement on changes to next year’s budget, beginning July 1st, to cover a $2 billion deficit. The agreement includes converting HUSKY to a self-insured ASO model saving $77 million and increases in copays and premiums for HUSKY Part B families, saving $576,000. The legislature is expected to vote on the package today – the last day of the regular session.
Ellen Andrews

CT woman files one of first actions under federal genetic anti-discrimination law

Pamela Fink, a Fairfield resident, filed complaints last week with the US Equal Opportunity Commission and the CT Commission on Human Rights and Opportunities under the new Genetic Information Nondiscrimination Act. Ms. Fink argues that her employer, MXenergy of Stamford, eliminated her job after learning that she carries a genetic risk for breast cancer. Ms. Fink stated that she received excellent job evaluations, merit increases and bonuses for years until she told them of the genetic test results when she was targeted, demoted and eventually fired. President Bush signed the bill into law in 2008, but the employment provisions only became effective last November. The bill had been debated in Congress for 13 years. The law prohibits discrimination in health coverage and employment based on genetic information. Coverage nondiscrimination provisions of the law began taking effect last May and will be fully effective this month.
Ellen Andrews

Rell administration will not challenge national health reform law

At yesterday’s Health Reform Cabinet meeting, the Rell administration announced that they will not join twelve other states in a lawsuit challenging the Patient Protection and Affordable Care Act. All twelve Republican state senators signed onto a letter urging the state to join the suit. The senators argue that the federal law usurps states’ rights in regulating health care delivery and individual freedoms including the individual mandate. So far the administration has signaled that they will be pursing two opportunities under the new law – the Medicaid early expansion option to bring 43,000 SAGA recipients into Medicaid saving the state over $50 million and another $50 million or more available for CT’s high risk pool to cover people with pre-existing conditions.
Ellen Andrews

Governor interested in creating a CT high risk pool

Among other things, national health reform gives states an opportunity to create an insurance pool for people with pre-existing conditions. The law gives CT up to $50 million, possibly more, to implement a high-risk pool through 2014. At that point the law prohibits insurers from denying coverage to adults based on pre-existing conditions and it is expected that people with prior health problems will be able to secure affordable coverage in the private market and public exchange. Insurers are prohibited from excluding coverage for children with pre-existing conditions this year. CT has had a high risk pool since 1975 operated by the Health Reinsurance Association, however it has provided relief to few CT consumers due to very high costs. In a letter to HHS yesterday, Gov. Rell indicated that CT is interested in providing the new pool coverage through the existing HRA administration but offered by DSS. DSS does not have a promising record of promoting or administering health coverage programs. The Governor made clear that CT is not willing to devote any state funding to the pool due to the budget crisis and is not making a commitment to developing a program.
Ellen Andrews

$50 million health coverage opportunity for CT from national health reform

CT can access $50 million in federal funds to cover state residents with pre-existing conditions until 2014 when insurers will no longer be able to exclude adults from coverage because they have health problems. Under the law, insurers are prohibited from excluding children with pre-existing conditions from coverage this year. Since 1975, CT has had a high risk pool to cover state residents who cannot get coverage in the private market, but premiums are very high and it has provided relief to only a small number of consumers. The new federal funding comes with several options for delivering the temporary coverage including starting a new program, building on the current program, or if we do nothing, defaulting to the national pool which is being developed in Washington. Governor Rell has until the end of this week to signal CT’s intentions.
Ellen Andrews

SustiNet medical home committee making progress

At last week’s SustiNet Patient-Centered Medical Home committee meeting we heard about medical home initiatives in the two programs that will form the basis of SustiNet, the state employee plan and Medicaid/HUSKY. Tom Woodruff of the Comptroller’s Office presented on the state employee plan’s medical home initiative. The state will be moving to a self-insured ASO model as of July 1st and will include a very large pilot medical home program to start early next year; the state has chosen Anthem and United as administrators for the plan. They will partner with ProHealth Physicians to provide NCQA Level II or higher medical homes to their all 350,000 patients, including at least 40,000 state employee plan members, early next year. ProHealth Physicians is a large primary care practice with over 250 providers at 74 sites across the state. The Committee then heard about PCCM, the HUSKY medical home initiative, and the barriers placed by DSS on consumers and providers struggling to access care in the program. The committee then began considering questions and potential recommendations. The consensus of the group was to be as inclusive as possible in defining medical homes, but that payment must be tied to concrete standards. NCQA certification was identified as the goal and payment standard, with recognition for practices reaching milestones on the road to certification. The committee recognized the need for significant support to help practices reach that goal. Recognizing the lack of Medicaid providers, lower payment levels, and approximately 150,000 new CT Medicaid members in 2014 under federal health reform, that the committee does not want to jeopardize or undermine those providers in transitioning to a new system of care in which every state resident has access to a medical home. The committee will continue the discussion, focusing on national health reform, at our next meeting this Wednesday April 28th 10am to noon. The committee will be meeting at the Dept. of Transportation, Conference Room B, 2800 Berlin Turnpike in Newington.
Ellen Andrews

Predictably Irrational author comes to CT

Dan Ariely, author of Predictably Irrational: The Hidden Forces That Shape our Decisions, spoke at Wednesday’s Donaghue Foundation annual meeting in Farmington. How choices are framed has a lot to do with how we respond. For example, a group of people were asked to name either 3 or 10 reasons they love their significant other. They were then asked to rate how much they love that person. You’d think the people who came up with 10 reasons would be more in love, but you’d be wrong. Apparently, it is hard to come up with 10 reasons you love someone, according to Ariely. People reason that if they have so much trouble coming up with 10 reasons, how much could they love them. Today’s Predictably Irrational blog relates the link between people in powerful positions and hypocrisy – judging subordinates more harshly than themselves in moral situations. However that hypocrisy evaporates, even reverses, when the powerful regard their position as illegitimate or undeserved – in that case, they hold themselves to higher standards than others. He related the research back to lessons for policymakers who want to improve people’s health – don’t overwhelm with information, provide aid, consider how you present alternatives, and understand the role of emotion. Fascinating stuff.
Ellen Andrews

The Treatment Trap author visits CT

I had already ordered her book online after reading a review in Health Affairs when I got an invitation to hear Rosemary Gibson, author of the Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health and What You Can Do to Prevent It. Her visit yesterday was hosted by AARP-CT and the CT Center for Patient Safety. Ms. Gibson highlighted the problem of medical overtreatment and how it harms our health. 32% of Americans report getting treatment they didn’t need. She related at least a dozen stories of patients whose health was compromised by getting too much care. An accountant received joint replacement surgery in his toe for arthritis, but his pain got worse until he was eventually restricted to a wheelchair. He had the joint replacement removed saying he could live with arthritis, but not with the replacement. A healthy woman was told she needed heart surgery and overheard the doctor say to a nurse, “We’re under pressure to get more patients. We’re only at 9 a day now and we need to get to 14 to make this place pay for itself.” She got a second opinion and avoided surgery. A RAND study found that 1 in 3 angiograms were unnecessary. Ms. Gibson asserts that avoiding overtreatment and its costs would more than fund all the care needed by America’s uninsured.
Ellen Andrews

Smoking bans slowly move to private clubs

The 2003 state law prohibiting smoking in restaurants and bars exempted private clubs. In 2007 the Supreme Court upheld the law in a challenge filed by a few bar owners. When the law passed, many believed that private clubs would become more popular as sanctuaries for smokers. However, according to yesterday’s Hartford Courant, a growing number of clubs, in CT and nationally, have voluntarily implemented smoking bans. The clubs are responding to members’ preferences.
Ellen Andrews

Myths and truths in national health reform

There has been a lot of misinformation about the new national health reform bill and what it will mean for Connecticut. Rumors include 16,500 new armed IRS agents to enforce the individual mandate, Medicare cuts, skyrocketing premiums and budget deficits. We’ve collected twenty of them, some true and some false, from calls to CT’s Congressional delegation and to us. We’ve checked the facts in our latest policymaker issue brief.

BHP initiative reduces hospital delay days by 22% in two years

At Wednesday’s Behavioral Health Partnership Oversight Council meeting, Value Options, DCF, DSS and eight hospitals announced remarkable progress in reducing the number of HUSKY children in discharge delay at hospitals, ready to leave but waiting for appropriate outpatient behavioral health care. The initiative aligned performance incentives across providers and administrators. During 2007, before the initiative, there were 43,493 child-days in delay. By 2009 delay days were down 22% to 33,744. During those same years, enrollment in the program grew by 8% and total admissions rose by 19%. Over the two years the percent of discharges that were delayed dropped by 32% and the average length of delay dropped by 58%. Delay status is not the only indicator that improved, acute length of stay was down 14%. Value Options credited staff at all the agencies and hospitals with focusing attention and hard work on ensuring that every child has an appropriate place to get care. The reductions in delay status were not accompanied by any change in readmission rates suggesting that the movement to outpatient care was effective and permanent for most cases. Congratulations to all involved for their dedication to make the system work for kids.
Ellen Andrews

House passes budget mitigation plan

Yesterday the House approved a plan to address the $371 million deficit in this year’s state budget. The Senate will vote on the plan today and the Governor is expected to sign it. The bill includes freezing subsidized enrollments in the Charter Oak program at the end of this month; consumers paying full cost will still be enrolled and people enrolled before May 1st will continue to receive premium subsidies. The bill also increases copays on children in the HUSKY Part B program, cuts over the counter drugs, and limits eyeglasses to one per year for all programs. The bill also makes changes to the definition of medical necessity for services in all programs.
Ellen Andrews

Foundation working to get health reform truth out

The Universal Health Care Foundation of CT announced yesterday a public awareness campaign to help people in CT understand the benefits of national and state health care reforms and to counter substantial misinformation efforts by opponents of reform. Speakers pointed out that 150 volunteers have been working for months researching and designing CT’s health system redesign as part of the state’s SustiNet program planning. Speakers at the announcement included Stan Dorn of the Urban Institute, Kathy Lewis, Executive Director of the CT Public Health Policy Institute, John Olson, AFL-CIO President, Brenda Kelley, state AARP Director, John McNally a consumer with a pre-existing condition, Fred McKinney President of the Greater New England Minority Supplier Development Council, and Frances Padilla, Acting Director of the Foundation. For coverage of the event, click here and here.
Ellen Andrews

eHealthCT wins federal grant for health IT training

This week eHealthConnecticut announced their application for $5.7 million in federal stimulus money was approved. The funding is to create a training center for CT health care providers implementing electronic health records. eHealthCT joins a network of sixty similar training centers across the nation. Electronic health records are a long overdue innovation in medicine that will improve patient safety and the quality of care while reducing costs and paperwork. But it is critical that systems are used effectively and that requires training. Most practices in CT are small and don’t have the resources to implement electronic health records. eHealthCT’s initial training will focus on CT primary care providers starting later this spring, but eventually will expand to other specialties.
Ellen Andrews

Medicaid Managed Care Council update

Friday’s Council meeting was relatively uneventful. We started with a wonderful outreach video by CT’s Healthy Start programs describing the important work they do supporting at-risk pregnant women and connecting them to the care they need to ensure healthy births. (Advocates think it would be a good idea to start every Council meeting with babies – it makes it hard to be grumpy.) We then heard about the challenges of keeping families enrolled in HUSKY. A study by CT Voices for Children found that 141,000 people came into HUSKY in 2006 and 2007, but total enrollment grew by only 11,000. However they were unable to determine if people left because they found other coverage or if they became uninsured. DSS noted that they have implemented several improvements to the eligibility system since 2007. PCCM/HSUKY Primary Care enrollment is up to 359 clients and 237 providers. DSS has also agreed with advocates’ concerns and will ask CMS for permission to delay the PCCM evaluation until 2011 when it is hoped enrollment will be high enough to make the study meaningful. DSS described their plans to move all SAGA recipients into Medicaid (as of April 1st) under a new option passed in the recent national health reform act. It is expected that the option will save CT $53 million over the next 15 months. CT is the first in the nation to apply under this provision. However we are eligible because the state never acted on multiple directives from the General Assembly to apply for a waiver to cover SAGA – most other New England states have been covering childless adults under a Medicaid waiver for years. New enrollment numbers from ACS show that about half of all Charter Oak members are over age 50 and that older members have higher incomes than younger members – over half of members paying the full, unsubsidized Charter Oak premium are over age 50.
Ellen Andrews

Federal health reform and CT small businesses seminar

The Universal Health Care Foundation of CT is hosting a free seminar for small businesses on national health care reform Monday, April 12th 7:45 to 9:30am in Meriden. A panel of experts will describe the new federal law and CT’s SustiNet plan and how they will impact small businesses in CT including how to get tax credits, employer contributions, health insurance exchanges and benefits for self-employed business owners. Space is limited so reservations are required. Click here to sign up.

High risk pools in federal health reform

Questions are surfacing about the federal reform bill’s provision to create a high risk pool will be implemented. The pool is meant to provide temporary coverage for people locked out of the insurance market until the bill’s pre-existing condition ban for adults becomes effective in 2014. People who need high risk pools include those timing out of COBRA, those turned down for individual coverage, people who don’t have access to COBRA because their former employer went out of business, among others. CT has had a high risk pool since 1975 but it is very small (2,336 as of 12/31/08). We have explored the pool as an option for many clients who call our helpline, but it has never been an affordable option. CT state law sets the rates charged in the pool to between 150 and 200% of standard market rates, which are already too high for many. Thirty five states have high risk pools, most of which also don’t meet the growing need. But MN’s high risk pool has much higher enrollment for a variety of reasons. One of the most important is that MN’s pool rates are between 101 and 125% of standard market rates by law. A recent blog from Health Affairs outlines other important provisions that need to be included in the federal pool if it will be useful to more than a handful of people. Building the high risk pool is only one of many devils in the details of health reform. Advocates from ME, MA and VT have been through this and emphasize that passing reform is only step 1A; the hard work starts now.
Ellen Andrews

New OLR report finds PCCM succeeds, saves money in other states

A new report by the legislative Office of Legislative Research outlines enrollment, savings and impact on hospital visits in states that have implemented Primary Care Case Management (PCCM). PCCM is a different way of running Medicaid managed care plans (HUSKY in CT) used in thirty states. PCCM does not involve HMOs, but rather rests on the medical home model. Consumers choose a primary care provider to deliver and coordinate their care. Researchers found that PCCM enrollment is growing in all but one state. They also found that, if implemented thoughtfully, PCCM can generate significant savings for states. A study found that the cost of PA’s PCCM program was almost half the cost of the HMO program operating in the same counties. Impact on hospital care has been mixed. Researchers offer that successful states target assistance to people with health risks such as asthma, diabetes and congestive heart failure. Implementation of CT’s PCCM program has struggled; DSS in the current administration has not been supportive of the program.
Ellen Andrews

April Webquiz – CT preventable hospitalizations

Test your knowledge of CT hospitalizations that could have been prevented with access to primary care. Take the April CT Health Policy Webquiz.

Webinar: National Health Reform and What it Means for CT

The video and slides from today’s webinar with Rep. Joe Courtney, Congressman from CT’s 2nd district, are posted at http://www.cthealthpolicy.org/webinars.

New Webinar: Congressman Joe Courtney on national health reform

Join CT Congressman Joe Courtney from CT’s 2nd district, and CT Health Policy Project Board Member, describe national health reform, how we got here, and what it means for CT in a webinar next Wednesday March 31st at 3:15pm. To register, go to https://www1.gotomeeting.com/register/169103624

Collaboration works – housing conference

This morning was the third in a series of conferences on housing in CT, but with a twist. The organizers emphasized the need to collaborate across issue areas – to include people who care about transportation, education, workforce, the economy, government, the environment, and health care. The conference was a collaborative effort of non-profits with government. They brought in speakers to talk about model programs in other states like Louisiana, North Carolina, Ohio, Pennsylvania and Texas (yes, Texas). They brought useful ideas that could be adopted here to improve on the housing successes CT has already achieved through collaboration. There was a lot of very productive talk about breaking down silos around housing. I left wishing we could do the same for health care in CT.
Ellen Andrews

Why is getting healthy so hard? Find out April 21st

The Donaghue Foundation’s annual meeting will focus on behavioral and cultural perspectives on taking responsibility for our health. The meeting will be Wednesday, April 21st from 7:30 am to 12:30 pm at the Hartford Marriott Farmington. Registration is free. For more information click here.

Federal health reform – what it means to the real world, how to prepare now

The Wall Street Journal has a nice article outlining what people in the real world can do to prepare for national health reform. The NY Times has a great site describing what reform will mean for you, depending on your status now.

CT Medicaid wins in health reform reconciliation bill

The reconciliation bill scheduled to be considered this weekend by Congress benefits CT’s Medicaid program, and the state bottom line, in significant ways.

The bill would expand Medicaid coverage to all state residents (except undocumented immigrants) up to 133% of the federal poverty level (FPL) -- $14,620.50 for individuals and $19,669.50 for a family of two – in 2014. CT would receive full funding for all newly eligible residents in 2014, tapering down to 90% after 2019. In 2007/2008 CT had 110,200 uninsured residents living below 133% FPL. In January of this year there were 43,549 members of our state-funded SAGA program; those members would become eligible for Medicaid and, because we do not have a waiver to cover them, they should be eligible for federal funding saving the state $133 million. Because CT does not have a Medicaid SAGA waiver, coverage of SAGA members would qualify for federal funding under the reform bill (sometimes it pays to procrastinate). It is also likely that many of the 6,077 Charter Oak residents in the lowest income band (0 to 150% FPL) as of March 1st will become eligible for Medicaid and full federal funding, saving the state what we spend on their subsidies.

Medicaid primary care providers will benefit under the reconciliation bill which increases their rates to Medicare levels in 2013. In 2008, CT primary care Medicaid rates averaged 0.78 of Medicare levels, according to the Kaiser Family Foundation. The incremental cost will be paid fully by the federal government from 2013 through 2014. In 2008, CT’s rates were better than most other states (weighted average of 1.44 compared to other state’s rates). CT would receive more if our provider rates were closer to the national average, but we will be getting more than we did in the past.

In January, the CT Health Policy Project outlined a list of questions CT’s Medicaid program needs to answer in implementing national health reform.
Ellen Andrews

CT nursing school graduate survey results

The CT League for Nursing fielded a survey of 2010 nursing school graduates for the SustiNet Health Care Workforce Task Force; the CT Health Policy Project analyzed the data. The survey found that virtually all the graduates plan to stay in CT, and most intend to work full time. Two out of three are graduating with debt, most totaling between $10,000 and $30,000. Most expect to work in a hospital, but a large number of LPN graduates are seeking positions in nursing homes. Factors affecting their decision include distance, location, work environment, and finances, in that order.
Ellen Andrews

Rising uninsured in CT falls hardest on middle income families; How national health reform would help

A new report by the Robert Wood Johnson Foundation finds that between 1999/2000 and 2007/2008 the rise in the number of uninsured CT residents was concentrated among people living in households between two and four times the poverty level (now between $36,620 and 73,240/year for a family of three). The number of CT residents with incomes in that range rose by 7.2 percentage points; below that income, the percentage of uninsured dropped by 5.7 and above those incomes the rate barely changed (up 0.3). Also during those years, CT workers’ contributions to employer health insurance rose by 45% for single coverage and 53% for families; median incomes only rose 2.5%.
But in good news, the US House Committee on Energy & Commerce has posted online fact sheets outlining the district-by-district benefits of national health reform. The reports include the numbers of families and small businesses in each Congressional district that would receive tax credits to help pay for insurance, how many families would be protected from bankruptcy, how many residents with pre-existing conditions would get coverage, funding for community health centers, and how many uninsured residents would be covered.
Ellen Andrews

PCCM Subcommittee update

At today’s PCCM subcommittee of the Medicaid Managed Care Council, DSS unveiled their plans for the Mercer evaluation of the program to be completed by July 1st. Advocates raised many concerns including:
· The inability to get any meaningful information on health outcomes with only 200 members on average over the last year
· A survey of those few consumers and providers in the program is valuable, but misses exactly the population we need to be reaching out to – the far larger population of consumers and providers who have decided not to sign up – we need to know why, and adjust the program accordingly
· It is likely that consumers will say that they have not noticed a change since moving from HMOs to PCCM – does that mean the program has failed? A provider with 100 PCCM patients has received only $9,000 this year – not enough to hire a care coordinator or even to change policies significantly
· There is a lot in the evaluation about testing providers’ compliance with the contracts, but nothing to evaluate whether DSS has done any of the things they promised to do
· No evaluation of PCCM marketing (or lack of it)
· Strong concerns about measuring health outcomes at this very early stage – among 200 kids, on average only about half would have had a well-child visit this year, and of that number how many had health care needs that required coordination to even be evaluated?
· How can you test readmissions to hospitals (a relatively infrequent event) in such a small population over only a year
· Holding providers accountable for patients’ ER visits is unfair if DSS still hasn’t set up a system to notify providers when their patient visits an ER – how are they supposed to know?
· These are fairly intrusive questions that touch on sensitive areas for practices, the documentation burden will take time from overburdened administrative staff and serve as yet another barrier to signing up with the program
· Asking about EHR implementation is premature, and the contract also allows electronic disease registries – a mention was made to providers by DSS staff at one meeting that an Excel spreadsheet would work – it is completely unfair to change the rules at this point
· It is unfortunate that so far in this program DSS has spent less than $19,000 on care coordination (and zero on marketing) but is willing to shell out four times that amount for an evaluation that appears set up to label the program a failure
The Committee reviewed information from DSS that suggests that PCCM is more costly than the current HMOs; however DSS cautioned strongly that with such small numbers it is not a valid comparison. It was also noted that there is anecdotal evidence that because it is so small, the program is attracting disproportionately more medically needy and complex members than the rest of the HUSKY program. If true, this would serve to benefit the HMOs financially by removing more expensive patients from their roles. The Committee also discussed options to allow more willing pediatricians to participate and to recruit more adult medicine providers. The Committee discussed what should be included, and what should be prohibited, in an ASO contract to run the PCCM program; the Committee agreed to solicit input from other stakeholders before the next meeting. The Committee will draft a letter to DSS and CMS with our suggestions for improvements to the program.
Ellen Andrews

Medicaid Managed Care Council meeting update

Friday’s Council meeting was uneventful. After a year, there are 342 people in PCCM/HUSKY Primary Care; legislation requires at least 1,000. Despite that, DSS is steaming ahead on plans to evaluate the program by July 1st. It is fascinating that they are just now deciding to comply with deadlines in this program – they have blown through every reporting and start date in legislation until now, but they appear to be eager to get an evaluation of the program done as soon as possible. Despite promises to consult with the PCCM Subcommittee, DSS has already negotiated an agreement with Mercer on the scope of the study. They stated that it was a draft agreement, but noted the aggressive time frame for the work and did not commit to making changes in response to the Committee’s input at next week’s meeting. Advocates and legislators raised concerns about a premature evaluation that will not provide a valid assessment of such a small program and could be used to unfairly label the program a “failure” and be used to shut it down before it has had a chance to succeed. Advocates have also raised concerns about hiring Mercer for the evaluation given that Mercer receives much of its revenue from HMOs and Mercer signed off on the 24% rate increase DSS gave the HMOs two years ago, overpaying the HMOs by $50 million/year. Advocates also raised concerns over the $75,000 cost of the evaluation, especially given the growing budget deficit and proposed cuts to essential services for HUSKY families.
Other reports from the Council meeting include good news from the CT Dental Health Partnership – the number of providers and sites continues to grow and prior authorizations are being processed in under 11 business days. Concerns were raised that, while there has been progress, there are still serious problems with access to care. DSS and the Partnership are working hard to address them, reaching out to providers, consumers and advocates to improve the program. The HMOs described their Quality Improvement Projects, required under their contracts, and stated that they will be reporting on their findings, planned interventions to address concerns, and progress toward quality improvement. Concerns were raised about whether patients in the study sample are notified that their records are pulled and subjected to increased scrutiny. The HMOs will check and get back to us at next month’s meeting. INFOLINE reported on the calls and cases they receive on their helpline. Last year they received 66,200 calls for assistance – the three top problem areas were help finding a dental or primary care provider and access to prescriptions. They noted that the carve outs of dental and pharmacy benefits dramatically decreased calls to their office about those services.
Ellen Andrews

Thousands line up for free dental care

People began lining up outside this year’s Mission of Mercy clinic at 3am Friday morning. The CT Dental Association sponsors the clinics annually to provide free dental care to CT residents in need. This year’s clinic ran Friday and Saturday in Middletown but could only care for 1,000 patients each day. Almost 1,700 people, clinicians and non-clinicians, volunteered at the clinic. Over the last three years, clinic organizers have seen demand for their services increase, but because of improvements in HUSKY dental care, the number of children needing care is down. In 2004, 35% of US adults had no dental coverage; people who are poor or low-income are more than twice as likely to be uninsured than those with high incomes. Average dental expenses per American rose 68% from 1996 to 2006.
Ellen Andrews

Council of State Governments/Eastern Region state/provincial updates

The latest health policy update from CSG/ERC the Northeastern US states and Canadian provinces is online. The CT Health Policy Project has worked with CSG/ERC on health policy issues for over four years – providing policy analysis and support while shamelessly stealing great ideas to bring back to CT.

From the helpline

An uninsured consumer called our office looking for help paying bills to two hospitals. He had been placed into collections but he had received no information about financial assistance. He made $17,000 last year; not wealthy by any means but ineligible for SAGA. He has no children, so doesn’t qualify for HUSKY. I called Milford Hospital first on his behalf. The billing person I spoke to was not helpful, stating that information on their financial assistance program was printed on the back of the bill – a provision that she feels complies with CT laws requiring notification. When I pushed the issue, she wanted my name, organization and title. She read the notice from the back of the bill that my client would have received – it was the CT General Statute word-for-word. Anyone who has read CT state law knows that they are not even close to understandable. She informed me that it is hospital policy that they cannot even send a financial assistance application until the patient has applied for HUSKY and SAGA, been denied, and presented the hospital with a denial letter – something that was not explained in the notice she read me. I explained that my client is clearly not eligible for either program and this policy only creates a needless hurdle for him and senseless paperwork for DSS workers who have better uses for their time. She just kept saying that it was hospital policy and that they would have told him the policies if he had called them. I asked her to call him and later got a call back from her to let me know that she’d left him a message. (I’d already called to tell him what he needed to do.) Next I called the Hospital of St. Raphael; they just asked for his address and will send him an application packet right away.
Ellen Andrews

New plan for Dempsey hospital

The Governor and UConn unveiled their newest plan to revive John Dempsey Hospital at the UConn Health Center in Farmington. The $352 million plan will be funded with $100 million from national health reform, assuming it passes, and by re-directing $227 million from already-approved projects elsewhere. The cost is down from previous plans costing $430 million; this initiative includes partnerships with five area hospitals rather than only Hartford Hospital as in the original plan. The plan includes a new cancer center, simulation training program, bioscience zone, and primary care, clinical research translation, and health disparities institutes.
Ellen Andrews

Report finds CT long term care skewed toward nursing homes

A new report by the CT Regional Institute finds that the way we pay for long term care costs us an additional $900 million/year in Medicaid costs. Currently, CT spends 47% of our long term care funding on expensive nursing home care; we are 34th in the nation in the proportion spent on home and community based care. The study finds that current Medicaid rules and regulations make it easier to access care in nursing homes than in the community. Almost 80% of CT residents would prefer to receive care in their home than a nursing home. Over the next 15 years the number of CT residents over age 65 will increase by 40%, driving the need for long term care, but the number of residents ages 18 to 64, potential caregivers, will decrease by 5%.
Ellen Andrews

Nancy Pelosi visits New Haven to talk about health care reform

US Speaker of the House Nancy Pelosi spoke to about 100 advocates, providers, and policymakers yesterday at the Graduate Club in New Haven about women’s health and the benefits of the health reform bills being considered in Congress. She was hosted by US Rep. Rosa DeLauro and US Rep. John Larson and joined by Dr. Carolyn Mazure, Director of Women’s Health Research at Yale. Melissa Marottoli, a cancer survivor, noted that when she was diagnosed, two and a half years ago, doctors estimated that she had only six months to live. She stated that she cannot change jobs because she now has a pre-existing condition and is concerned that she would not be able to get health coverage in a new job unless the reform bill passes. The Speaker talked passionately about the millions of Americans who have no coverage and the health and financial consequences that all of us. She noted that when it passes, health reform will prohibit insurers from denying coverage due to pre-existing conditions such as women who’ve been the victim of domestic violence, stabilize the Medicare program and eliminate the doughnut hole in prescription coverage, and improve the American economy by eliminating job lock – people Like Melissa who can’t leave their jobs for health coverage. She emphasized that the bill makes no changes to women’s access to abortion services and is confident that reform will pass this Congress.
Ellen Andrews

Buying insurance can be confusing

When I was at a friend’s house recently, his parents were in the process of choosing a health plan because his mother had just gotten a new job, and they were finally going to have health insurance through her employer. There were several plans to choose from, and all of them looked similar, except that one had a significantly lower deductible. None of us could figure out why that would be, but obviously, he and his parents were ready to choose that option because the lower deductible made it much cheaper. At the very bottom of the page, however, I noticed the row listing the annual benefit limit for each option. For the plan with the lower deductible, the annual benefit limit, or the amount up to which insurance will pay per year, was only $30,000. That amount sounds like a fair amount of money for a healthy family, but I knew from my work here at the Project, that one surgery or emergency could easily use up that amount. I mentioned that to them, and after a lot of discussion and googling the price of various emergency surgeries, they decided to go with one of the options with a higher annual benefit limit. I was glad I was able to help them, but it also made me realize how difficult navigating the world of health insurance is, especially for those who have it for the first time or who come from countries with nationalized health care. Medical care costs more than most people realize, and health insurance plans and their terminology can be confusing, which often leaves people feeling lost when they make decisions concerning their health insurance.
Sabina Klein, CTHPP Fellow

PCCM bill public hearing

Tuesday the Human Services Committee heard HB-5297, An Act Concerning Statewide Expansion of the Primary Care Case Management Pilot Program. The bill would, as the title says, expand PCCM statewide as of October 1st and delay the planned evaluation of the program until next year. Advocates have raised concerns about DSS’ plans to evaluate the program prematurely, worried that it could incorrectly label the program a “failure” and serve as an excuse to shut it down. PCCM has only 322 members; legislation requires at least 1,000. DSS plans to hire Mercer for the evaluation; Mercer receives much of its revenue from HMOs.
At the hearing, legislators peppered the commissioner with questions about why DSS has not been supportive of PCCM especially marketing restrictions such as requiring providers to print their own brochures or restricting providers from talking to their patients about PCCM but allowed to answer questions if asked. Legislators noted that they have heard very positive feedback from PCCM providers and were concerned that physicians in parts of the state beyond DSS’ current four towns who want to join the program (a remarkable and wonderful thing) are being told that they can’t participate. Legislators were particularly interested in what happened to $5 million appropriated in the last two years to support PCCM. DSS answered that they used the money to cover their deficit, which includes the $50 million overpayments to the HMOs uncovered by the Comptroller’s audit.
Ellen Andrews

Governor proposes more cuts to health care

To address the growing budget deficit, the Governor’s mitigation plan includes $13.7 million in new cuts to health care programs. The cuts include higher copays and premiums for HUSKY Part B and Charter Oak families, cuts to community and school-based health centers, cuts to Medicaid providers, reductions in hospital DSH payments for the uninsured, new cost sharing for Medicaid clients, and cuts to vision, transportation, dental care and outreach. Something for everyone.
Ellen Andrews

Hearing on hospital error reporting proposal

Yesterday the Public Health Committee heard SB-248, An Act Concerning Adverse Events at Hospitals and Outpatient Surgical Facilities. Proponents argue that the bill would close important loopholes in the current weak hospital system reporting including public reporting of errors -- so consumers could use the information in their medical decisions and put pressure on hospitals to improve patient safety. There is no evidence that secret reporting has improved patient safety. The bill would also require random audits of hospital safety, protect employees who report errors, and imposes penalties on hospitals that don’t comply. The CT Hospital Association opposes the bill claiming that the current law allowing reports to remain secret encourages hospitals to report errors.
Ellen Andrews

A fresh perspective

At the beginning of February the National Association of Free Clinics ran a free clinic in Hartford, and for the entire afternoon, the sense of good will and community was a pleasure to be a part of. I had the opportunity to be a Spanish translator, and although the demand for translators had tapered off by the time I arrived at 2:45, I was able to help a couple of people and eventually switched to accompanying patients through the process regardless of language needs. Because they kept the translators in one area while we waited for patients who needed us, I was able to talk a lot with the other translators and watch the waiting areas. One thing that overwhelmed and impressed me in both my conversations and the interactions between people was the positive attitude and friendliness that marked almost every interaction. So often, we spend a lot of time griping about health care in this country and how unwilling some politicians and people are to fix the system, but at the clinic, everyone was just very excited to come together and help people. Challenges definitely existed in getting people the full care they needed, but overall, doctors, nurses, and volunteers were obviously there to help in any way possible. This sense of good will was reaffirmed when I received, as did all the other volunteers, an email that relayed a message from one of the patients who received care at the clinic. When she arrived at the clinic, doctors realized that this woman was in cardiac distress and rushed her to the hospital. There, she spent a week being treated for hypertensive crisis and congestive heart failure. She called the director of the National Association of Free Clinics when she was released from the hospital to thank her for the care that saved her life. I knew good work had been done when I left the clinic that day, but it was even more inspiring and affirming to hear that the free clinic had a lasting positive effect.
Sabina Klein, CTHPP Fellow

National gridlock on health reform misses the point

A new report by Families USA estimates that 2,100 residents of Connecticut have died because they were uninsured since the last time Congress considered health reform but did not act. The report predicts that without reform another 1,700 will die by 2019. The report used methodology from an Institute of Medicine study with updated numbers.

“The findings in this report are truly shocking and underscore the urgent need for health insurance reform. We cannot afford to stand idle as individuals and families in Connecticut and across our nation continue to suffer and even die because they don’t have health insurance. I thank the Connecticut Health Policy Project and Families USA for bringing this issue to light and for their work on behalf of the uninsured,” said U.S. Rep. John Larson, D-1st District “We are closer than ever to bringing real reform to the health insurance industry – reform that will end discrimination based on pre-existing conditions, lower health insurance costs for all Americans and strengthen Medicare for the long term. Just this week, the House passed important legislation that would force the health insurance industry to compete fairly and honestly like every other industry in America, ending the health insurance industry’s anti-trust exemption. I also applaud President Obama for bringing together Republicans and Democrats for today’s health care summit. Health care reform is not a Republican or a Democratic issue, as this report proves it is an American issue and one we must confront.”

“For many, the health care reform debate is a matter of life and death,” U.S. Rep. Joseph Courtney, D-2nd District, said. “ This debate is about providing coverage to those who are without and controlling skyrocketing costs for small businesses and families whose health is threatened by a dysfunctional system.”

U.S. Rep. Rosa DeLauro, D-3rd District, said, “It is simply appalling that in my own state of Connecticut, 2,100 adults have died due to lack of health insurance since the last attempt to pass health care reform legislation—and another 1,700 will die in the next 10 years if we fail to act. For far too long, the American people have waited for Congress to act, and this report makes it starkly clear: the cost of inaction is too high. We must continue the work we have done over the past year and work to pass legislation that will ensure every American has access to quality, affordable health insurance reform. It is literally a matter of life and death.”

Pressure is building to improve health insurance premium regulation

Calls are increasing from advocates, legislators and public officials to better regulate health insurance rates in CT. A bill being heard today in the Insurance and Real Estate Committee, SB-194 An Act Concerning Rate Approvals for Individual Health Insurance Policies, would tighten the CT Insurance Dept. procedure for approving insurers’ proposed rate hikes. A recent report by the Office of Legislative Research found that the Dept. rarely denies insurer requests. The US Dept. of Health and Human Services released a report last week highlighting CT among states with very large insurer rate requests and predicts 20 to 40% rate increases into the future. The President’s recent health reform plan proposes to regulate premiums at the federal level rather than the states.
Ellen Andrews

CT a leader in children’s oral health

Some good news for a change – CT is recognized as a national leader in getting dental care to children in a new report by the Pew Center for the States. The proportion of children on Medicaid receiving dental care has been rising since 2005 up to 41.4%. It’s true that is low, well below the rate for children with private insurance at 58% (and far below 100%, every child deserves decent health care) but it is above the US Medicaid average of 38.1%. We met six of eight benchmark oral health policies, so we are far ahead of most states. Oral health advocates (current and former) at the CT Oral Health Initiative, Greater Hartford Legal Assistance, and champions in the General Assembly deserve all the credit.
Ellen Andrews

Why is getting healthy so hard? Find out April 21st

The Donaghue Foundation’s annual meeting will focus on behavioral and cultural perspectives on taking responsibility for our health. The meeting will be Wednesday, April 21st from 7:30 am to 12:30 pm at the Hartford Marriott Farmington. Registration is free. For more information click here.

What if news was run like health care?

Building on the idea of running an airline the way we run the US health care system, yesterday’s NY Times column by Nicholas Kritof, I Cost More But I’m a Specialist, envisions news delivery like health care delivery. Very funny.

CT state retiree health and benefit system underfunded by $26 billion

A new report by the Pew Center on the States finds that while all but four states have underfunded retiree benefits, CT is among the worst. We are one of eight states with over one third of our liability unfunded. In 2008 CT’s pension liabilities totaled $41.3 billion, but we had only $25.45 billion in assets and health care and other benefits are 62% of the retirement funding shortfall. This doesn’t count last year’s early retirements which have significantly added to that liability. Pew has rated our health care and benefits fund as needing improvement but our pension fund earned their lowest rating – serious concerns.
Ellen Andrews

Webinar on DPH health care workforce programs, addition to medical home webinar

Thursday, Feb. 25th at 3pm, speakers from DPH will join the SustiNet Health Care Workforce Task Force on a webinar to describe their health care workforce programs. Kristin Sullivan will discuss the public health workforce, Jennifer Filippone will describe J-1 Visas and online licensure, and Johanna David will present on the National Health Service Corp. To join the webinar, register at https://www1.gotomeeting.com/register/402604745

Jim Hester, Director of Vermont’s Health Care Reform Commission has agreed to join the SustiNet Medical Home Committee webinar scheduled for Tuesday, Feb. 23rd. We will begin at noon with Jim; Ann Torregrossa of the Pennsylvania Governor’s Office of Health Care Reform will join us at 1 pm. To register, go to https://www1.gotomeeting.com/register/596582016

For a list of upcoming webinars and materials from prior talks, go to the CT Health Policy Project’s Webinar page.

Tolland is healthiest CT county, Windham least healthy

A new study ranking US counties based on health finds Tolland county is CT’s healthiest for outcomes and Middlesex for health factors. Windham is the least healthy for both outcomes and health factors. Outcomes measured include premature death, fair or poor health status, and low birthweight. Health factors include smoking, uninsurance and liquor store density. The study was released by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute; they plan to repeat the rankings annually.

Free Dental Clinic March 12 and 13

The CT State Dental Association will be sponsoring a Mission of Mercy free dental clinic again this year on March 12th and 13th at the Aetna Building on Industrial Park Rd. in Middletown. The clinic will start at 8am each day. There are no eligibility or income requirements; both children and adults are welcome. Patients will be seen on a first-come-first-served basis – no appointments. Services include fillings, cleanings, extractions, root canals, and interim partial dentures on a limited basis. Sign up to volunteer through February 21st – both dental/medical professionals and community volunteers are needed. For more information, call 866-539-9372.

Another webinar

Wednesday, February 24 at noon the SustiNet Patient Centered Medical Home Committee will hear from Lee Partridge of the National Partnership for Women and Families. Lee is a national consumer advocate and expert on patient-centered medical homes. To register for the webinar, go to https://www1.gotomeeting.com/register/524374993
For more on the Partnership’s medical home project, click here.

For information on our other webinars, click here.

New webinar – Medical homes and payment reform in PA

On February 23rd at 1pm, the SustiNet Patient Centered Medical Home and Health Care Quality and Provider Committees will hear from Ann Torregrossa, director of the PA Governor’s Office of Health Care Reform, about her state’s progress implementing medical homes and payment reform. To register, go to https://www1.gotomeeting.com/register/596582016

February 22nd at 3pm the SustiNet Health Care Workforce Task Force will hear from Tanya Court of the Fairfield County Business Council, Margaret Flinter from the Primary Care Authority and Alice Pritchard and Mary Ann Hanley of the Allied Health Workforce Policy Board. To register, go to https://www2.gotomeeting.com/register/795515106

Videos and slides from our first two webinars are on-line. The first included Mina Hawkins from NCQA about patient-centered medical home certification; the second was with CT provider professional organizations about the future of CT’s health care workforce.

Check this page for upcoming webinars and archives.

New Britain dentists providing children with free care this Friday

The New Britain Herald is reporting on several New Britain dental offices opening their offices this Friday to children who cannot afford care including screenings, cleanings and fillings. The “Give Kids a Smile” program was started by the American Dental Association in 2003 as part of National Children’s Dental Health Month. For information on participating offices, call (860) 347-6971 X3701.

New addition to the Book Club

What would happen if there was an earthquake in an American community, the Red Cross came into town and provided disaster relief, but a couple of months later everyone got a bill for those services, marked up tenfold, and people who couldn’t pay were sued? There would be outrage; it wouldn’t be tolerated. But that is what happens to the uninsured at nonprofit hospitals every day. Do No Harm is the story of a doctor and an accountant who brought attention to the finances of their local Georgia hospital. For a review of this movie and other works, at least marginally about health policy, check out the CT Health Policy Project Book Club.

PCCM forum highlights DSS barriers to implementation

Friday the Appropriations Committee heard about DSS’ lack of progress in implementing the PCCM option for HUSKY passed into law three years ago. The panel included Dr. Patrick Alvino, a pediatrician practicing in Branford, who would like to participate but because PCCM is not statewide he and his 2,000 patients do not have the option. The committee also heard from Tawana Bourne, a HUSKY mom from Middletown who has struggled to access care for her family and would also like the option of receiving care though PCCM’s medical home model but it is not available in her town. Christine Bianchi of Staywell Health Center in Waterbury, a participating provider, talked about the lack of support or guidance she has received from DSS in trying to implement the program that started in Waterbury a year ago. Sabina Klein, a Yale senior and CT Health Policy Project Fellow, outlined to the committee the provider recruitment and public education activities she and other students/volunteers working with the Project and New Haven Legal Assistance have been providing in the absence of DSS efforts including phoning and visiting provider offices, putting up posters in schools, churches and health care sites, manning tables at community events, holding provider forums, and providing mass mailings to consumers and provider groups. Because DSS marketing guidelines prohibit providers from telling their patients about the PCCM option, but can answer questions if asked, the CT Health Policy Project purchased “Ask Me About PCCM” pins that the students/volunteers have distributed to hundreds of PCCM providers. The committee also heard from this advocate about PCCM experience in other states including OK where the shift from HMOs to PCCM saved $85.5 million in medical costs in the first full fiscal year, participating providers increased over 40%, outpatient visits went up, and ER visits went down. DSS responded that they believe the program is reaching its goals and they have no plan to improve enrollment or provider recruitment beyond what they are doing. The committee discussed advocate recommendations to hire an Administrative Services Organization to run the program for DSS and to appoint a Special Master to take over the program if DSS does not improve their efforts and performance.
Ellen Andrews

Why we need patient centered medical homes

Government is taking over health care

Sometime next year government will overtake all other payers and fund more than half of all US health care, according to actuaries at CMS. Last year health care consumed 17.3% of our economy, the largest one year climb since 1960. We spent $282 million per hour last year on health care. Just government’s share of US health care spending last year was equal to all health care spending – government plus private payers -- in Britain and Italy. How long can we keep this up?
Ellen Andrews

Governor’s budget proposal – lots of cuts and a plan to reform HUSKY HMOs

In her budget proposal released yesterday, the Governor proposed shifting the current HUSKY HMOs away from capitation back to a non-risk arrangement. For a few months in early 2008, the Governor ordered a similar switch from capitation to an Administrative Services Organization (ASO)-model, in which the HMOs administered the program for DSS but passed all the medical bills onto the state. There is evidence that the state saved money under that non-risk arrangement. At the time, the HMOs were paid $18.18 per member per month (pmpm) for those services; a back of the envelope calculation suggests that the state expects to pay about $15 pmpm this time. Under PCCM, a new alternative to HUSKY HMOs, providers are paid only $7.50 pmpm for services that include care coordination. The 2008 switch resulted from advocacy efforts for transparency and accountability in the program. This year’s switch is prompted by cost pressures. An audit by the Comptroller last year found that HUSKY was overpaying the HMOs by $50 million/year. The Governor estimates that switching HUSKY to an ASO model will save the state $29 million next year.
Unfortunately, the Governor’s proposal also includes copays on Medicaid services, eliminating coverage for non-prescription drugs, vision services for adults, cuts to subsidies and increased premiums in the Charter Oak Health Plan, increased premiums and copays in HUSKY Part B, vision and transportation cuts to SAGA, and cuts HUSKY outreach. Those cuts total $53 million. None of these cuts is necessary; we have thirteen ways to save money in CT’s state budget that improve health.
Ellen Andrews

Free clinic makes a difference

Yesterday’s massive free health clinic at the CT Convention Center in Hartford had provided care to 700 uninsured people in just the first three hours. Almost 1,100 people signed up to volunteer. The clinic was run by the National Association of Free Clinics; CT has over a dozen free clinics providing care to the uninsured. I was an exam room runner – getting patients where they needed to be, getting supplies and answers to questions, and generally filling in. I spent a lot of time talking with patients – most were working, some at more than one job. Most had been uninsured for a long time and hadn’t seen a doctor in over a year. Unfortunately, I saw three people whose problems were so serious that ambulances needed to be called. Volunteers came from all walks of life; I met doctors, nurses, medical administrators, PAs, social workers, students, an investor, community organizers, retirees, some people who are unemployed, and a computer programmer. Services provided included physician services, seventeen specialties, lab tests, help with prescriptions, counseling, HIV testing, immunizations, dental and vision testing. Everyone was connected with follow up care, appropriate public and private medical and social programs at check out. The organization involved was mind-boggling and carried off with professionalism and good humor. It was a tremendous treat to be involved, a nice break from policy analysis and advocacy, but it was exhausting.
Ellen Andrews

February webquiz – PCCM/HUSKY Primary Care

Test your knowledge about CT’s PCCM program -- HUSKY Primary Care. Take the February CT Health Policy Webquiz.
This month’s quiz was developed by Sabina Klein, CTHPP Student Fellow and soon-to-graduate Yale senior. Sabina is one of the “army” of students/volunteers working to get out the word about this exciting new option for HUSKY families. (Sabina is second from the right in the picture).

PCCM update for Appropriations Committee

Friday from 10am to 1pm at the Legislative Office Building the Appropriations Committee will receive a report from DSS about their progress in implementing PCCM/HUSKY Primary Care. Following the department’s report will be a panel including physicians, a consumer, and this advocate about the program.
Ellen Andrews

Quality and Valerie Jarrett at Families

Regions of the US with higher health care spending actually have worse health outcomes, according to Elliott Fisher from Dartmouth. Friday’s Families conference started with a fascinating plenary about the disconnect between what we spend on health care and what we get, followed by concrete guidance for providers who want to improve the quality of care they deliver. As a state based advocate, I found the workshops on exchanges, subsidies, benefit packages, and states’ roles in reform were very useful. At lunch, Valerie Jarrett, White House Senior Advisor, came to thank us for our advocacy and to urge us on.
Ellen Andrews

Nursing homes file suit against state over rates

The CT Association of Health Care Facilities yesterday filed suit in federal court arguing that the rates paid by the state to nursing homes violate federal laws that require consistence with efficiency, economy, quality and equality of access to care and that there is no evidence that rates are set on an objective, reasonable and principled basis. "This lawsuit is a last resort. After years of underfunding, Connecticut's nursing homes are stretched to the limit trying to provide high quality care to 28,000 frail and elderly residents without adequate funding," CAHCF Executive Vice President, Matt Barrett said. The suit names only Governor Rell and alleges that she has established a policy where budget decisions are the main priority in rate setting, excluding the costs of providing care or federal law. The suit cites several state-sponsored studies to back up their claims.
Ellen Andrews

Sen. Frankin stars at Families conference

In describing opponents of health care reform, Minnesota Senator Al Frankin reminded advocates at yesterday’s Families USA conference of a quote by former Speaker Sam Rayburn, “Any jackass can kick down a barn, but it takes a carpenter to build one.” He characterized the opponents as having bumper stickers with only one word – No. Our bumper sticker has way too many words, and ends “continued on next bumper sticker.” He closed by reminding us how close we are to providing relief to struggling consumers with affordable, quality options for coverage. He says we should pass what we have, and not let the perfect be the enemy of the merely very good.
Our CT delegation agrees, in my visits. I spoke with Rep. Chris Murphy’s staff yesterday and they are also determined to see that reform moves forward.
Ellen Andrews

Second wind for health care reform

My second day of visiting Capitol offices found mainly optimism and people really taking a breather. The President’s State of the Union speech last night helped. The Houses and the White House are talking although no one expects this to happen anytime soon. I heard about the seven stages of grieving from more than one staffer, and different people are at different places, but everyone was clear on one point – we can’t not do this. Reform has to happen; the alternative is unacceptable. And everyone stated their willingness, eagerness in some cases, to get back to work (and get it over with). I visited Rosa DeLauro’s, Lieberman’s, and Dodd’s HELP committee staff. The House and Senate were very close before the MA election and most expect much of that agreement to end up in the final agreement. But “it’s a process”.
Ellen Andrews

Capitol Hill visit – What about reform?

I’m spending this week at the Families USA pre-conference meeting of advocates from across the states. We thought we’d be talking about how to implement health care reforms (and we still are talking about that), but politics got in the way. We have also been fanning out across Capitol Hill, reminding our legislators that the need for reform hasn’t changed; our broken health care system wasn’t fixed by MA’s very special election last week. We’ve been hearing a lot about reconciliation, rules, and deep distrust between the House and Senate. We are luckier in CT than advocates from some other states; our delegation knows how important this is. Yesterday we met with Cong. Joe Courtney, who knows more about health care than anyone I know. He is working hard to move this forward and make sure it works and is fair to everyone.
Ellen Andrews

SustiNet workforce and medical home webinars scheduled

Three SustiNet webinars have been scheduled to date; all are available to the public to participate.
The first is February 2nd at 11am. We will be hearing from Mina Harkins, Assistant Vice President at NCQA about their patient centered medical home certification program. To register for that webinar, go to https://www2.gotomeeting.com/register/618793754

The second will be February 8th at 1pm. We will hear from Marcia Proto of the CT League for Nursing, Matt Katz Executive Director of the CT State Medical Society and Scott Selig and Rashad Collins from the Community Health Center Association of CT. Register for this webinar at https://www2.gotomeeting.com/register/649452571

The third will be February 22nd at 3pm. We will hear from Tanya Court of the Fairfield County Business Council, Margaret Flinter from the Primary Care Authority and Alice Pritchard and Mary Ann Hanley of the Allied Health Workforce Policy Board. To register, go to https://www2.gotomeeting.com/register/795515106

Cheshire/ Wallingford LWV health care forum features Congressman Murphy

There were concerns that Saturday’s forum on health care might get ugly, but thankfully everyone stuck to the issues – what should Congress do now about health care reform. Congressman Murphy said that health care is a very personal, hot button issue and it should be. We have to look very hard at what we are spending and what value we get for all of it. Congress needs to “take a breath” and consider how to move forward. Speakers noted that the need for reform hasn’t changed because the political landscape has shifted. In the last ten years, CT families’ premiums rose 7.4 times faster than our incomes. One in ten CT residents is uninsured; three CT residents die every week because they aren’t covered. The US spends far more than any other country on health care but we lag on most measures of quality. All speakers agreed that doing nothing is not a viable option.
Speakers included Cynthia Russo of Midstate Medical Center, Dr. Phil Brewer of Quinnipiac University Student Health Services, Daniel Diaz Del Valle of Innovative Partners and me. Slides are online.
Ellen Andrews