CT Health Notes Blog

DSS asks CMS for a HUSKY delay

2008-09-30T10:03:00.001-04:00

The administration has asked the federal government for a four month delay for moving HUSKY families into the new HMOs. DSS and the two new HMOs, AmeriChoice (United Health Care) and Aetna Better Health, have been criticized for having inadequate provider networks and for not devoting enough time to building those networks. The third HMO participating in HUSKY, Community Health Network, is based on CT’s community health centers and has served HUSKY clients for over a decade. DSS still expects to be able to meet the deadline of defaulting families into the HMOs on December 1st, but asked for the extension to March 31st just in case. DSS is still fully committed to moving all families into managed care but has promised not to force anyone into an inadequate network. Previously, Anthem, who left the program last fall, agreed to continue serving HUSKY families indefinitely with their larger provider network. HUSKY covers approximately 340,000 CT residents, including one out of five children and one in four births in the state.
Ellen Andrews

Drug company Cephalon will pay CT $6 million fine

2008-09-30T07:24:00.000-04:00

CT’s Attorney General announced yesterday that Cephalon, Inc. will pay $425 million nationally and $6.13 million to CT for illegally marketing three drugs causing serious complications in some patients including seizures, respiratory depression, addiction and death. The off-label marketing of the drugs for uses not approved by the FDA caused sales of the drugs to increase by as much as 1,000 percent. The agreement resulted from a four year investigation finding that Cephalon engaged a strategy of buying overlooked drugs with narrow approved uses and aggressively marketing them for non-approved uses to boost profits. The settlement subjects Cephalon to broad corporate integrity and financial transparency standards.
Ellen Andrews

Critical Condition documentary showing tomorrow night

2008-09-29T11:41:00.002-04:00

PBS’ POV series tomorrow night at 9pm will be, Critical Condition, describeing the barriers to accessing care for America’s uninsured. A streaming version of the film will be online until Nov. 11th. Directly following at 10:30 pm will be RX for Change, a MacNeil/Lehrer Special, a discussion of Americans’ top health insurance concerns. June 5th CPTV aired a CT version, Critical Condition: Focus on CT.

Legislature and Comptroller announce audit of DSS

2008-09-24T18:18:00.000-04:00

Legislative leaders and Comptroller Nancy Wyman announced today that the Comptroller’s office will conduct an audit of DSS to eliminate waste and over-budgeting. Specific concerns include difficulties tracking expenses, over $100 million in DSS carry-forward requests, turmoil in the HUSKY program, start up costs of the Charter Oak Health Plan, and funds appropriated for programs that are not implemented or partially implemented such as delays in securing disease management, PCCM and medical interpreting services. The Appropriations and Finance Committees will hold a joint fiscal accountability meeting on November 18th.
Ellen Andrews

PCCM public hearing and RFA out

2008-09-24T17:48:00.001-04:00

The Appropriations and Human Services Committees held a public hearing today on DSS’ proposal for a PCCM pilot for HUSKY. Over thirty legislators came to hear Commissioner Mike Starkowski and Director of Medical Administration David Parrella outline their plans for the program. Legislators universally expressed enthusiasm for the plan and commended DSS for faithfully implementing the program. DSS is planning to hold forums around the state to introduce the program to providers and to collect feedback. They intend to hire a contractor to evaluate the program and a nurse advice line for patients. Legislators expressed concern that the implementation of PCCM be timed to fairly compete for members with the current plans to default HUSKY families into HMOs December 1st. PCCM isn’t slated to start until January 1st. The committees then heard from provider representatives, an IPA, advocates and consumers all in favor of the plan and urged the committees to approve it. Advocates commended DSS for an inclusive process to design the program, including advocates at every step and incorporating most of our input. Improving access to care for families and reducing burdens on providers were the highest priority and every design decision was tested against that standard. The collaboration created not only a strong proposal, but also deepened trust and respect between the agency and stakeholder groups which will continue into the future. While the vote was left open, voting at the meeting was unanimously to approve the plan.
The application and draft agreement for providers interested in PCCM is posted on DSS’ website.
Ellen Andrews

CTHPP is seeking a Program Director

2008-09-22T15:26:00.001-04:00

The CT Health Policy Project is hiring a Director of Programs. The position involves coordinating consumer assistance and educational programming for the Project. There are opportunities for policy analysis and advocacy as well. Qualifications include organizational and interpersonal skills, resourcefulness, ability to work independently and take initiative, and most important – enthusiasm and commitment to our mission to improve access to quality, affordable health care for every CT resident. Knowledge of CT’s health care system is not necessary. Bilingual English/Spanish is preferred. Hours and salary are negotiable and based on experience. For more information, click here.

DSS answers Medicaid Managed Care Council on HUSKY and Charter Oak costs

2008-09-20T07:45:00.000-04:00

Yesterday’s Medicaid Managed Care Council was standing room only for what is generally a dry actuarial discussion about rate setting. Questions from legislators and advocates were pointed but answers were fuzzy.
First, representatives from Shramm and Raleigh, DSS’ no-bid financial contractors, described how Charter Oak’s costs and benefit package were arrived at. The original bids for the original package promised by the administration from the only three HMOs to apply -- Community Health Network, Aetna Better Health, and AmeriChoice – was $335 per member per month, higher than the $250 premiums the Governor had promised. So they asked the HMOs how they could tweak the package to save 24% and keep the Governor’s promise. They arrived at the $100,000 annual limit on benefits. The auditors acknowledged that this provision will cause a number of very ill patients every year to incur significant medical debt as a planful part of the program’s design – they didn’t know how many, but they will get back to us. They also revealed that the actual premiums for members at lower income levels are higher than the $256 paid by un-subsidized members. While this doesn’t matter to those members, their maximum contributions are set in statute, DSS acknowledged that this increases the state’s financial risk, especially given that so far the large majority of enrolling members are in those subsidized income ranges. Many concerns were raised about the state’s financial risk and the sustainability of Charter Oak. There was no answer to the question posed by Kevin Lembo, the State Health Care Advocate, about when we will know if the costs are in a death spiral and what will be done about it.
Council members also had serious concerns about Mercer’s presentation on how the 24% increases in the HUSKY HMO rates were arrived at. Questions focused on the 8.2% increase to bring provider rates under the HMOs up to the fee-for-service floor. Sen. Harp, Co-Chair of Appropriations, stated that the legislature’s understanding was the HMOs were using the 4 to 4.5% increases they have received every year for over a decade to raise provider rates and last year’s fee-for-service increases were just to catch up. She was very concerned to learn that we were paying the HMOs yet again to raise rates. Members also questioned why price increases were included in the 8.2% item as well as in the 5.6% trend adjustment raising concerns that price increases were being counted twice. Significant concerns were raised about the 5.3% increase (over $30 million) allotted for “Change in MCO financial position.” This appears to be money to cover HMO profits and for “negotiations.” We can only imagine those negotiation sessions, when DSS needed three HMOs to run the program and only got three bids.
When asked about the Governor’s dismissive response to the Council’s unanimous resolution advising DSS to slow implementation of the HUSKY transition and until the HMOs have adequate provider panels (as required under federal law), the Commissioner stated that a handful of members are receiving care now.
The meeting then turned to those inadequate provider networks which continue to grow very slowly. Despite that DSS intends to begin enrollment in New Haven, Tolland and Litchfield counties October 1st and the rest of the state November 1st. Middlesex County began enrollment the first of this month, but thankfully less than 7% of consumers have switched into the skeletal plans. The large majority of those have chosen CHN, the already existing HMO based on the state’s community health centers. All HUSKY families will have to choose one of the three HMOs by November 25th or they will be randomly defaulted into a plan on December 1st.
The next Council meeting will be October 10th at 9:30am and will discuss revenues and expenses for HUSKY during the last year and progress on the dental carve out. Can’t wait.
Ellen Andrews

Behavioral Health Partnership/HUSKY update

2008-09-12T11:44:00.001-04:00

At Wednesday’s BHP Oversight Council meeting, DSS reported HUSKY MCO enrollment numbers in Middlesex County, the first to go “on-line” back to managed care plans. Voluntary enrollment in the MCOs started Sept. 1st; at the end of November it will be mandatory. Of Blue Care members, 170 (41%) chose Aetna Better Health, 28 chose AmeriChoice (7%) and 218 (52%) chose CHN. Of traditional Medicaid members, 18 (25%) chose Aetna, 1 (1%) chose AmeriChoice and 54 (74%) chose CHN. It is important to remember these are very early numbers and provider networks are still skeletal.

DSS and DCF also reported on BHP finances ($109 million in FY 08), and access numbers. Access was broken out by children vs. adults, and by outpatient services, intermediate care, home-based services (which have increased significantly) and emergency mobile psychiatric services. We also received detailed information on inpatient care – the numbers of admissions is up but length of stay is down. While we have far to go, inpatient days in discharge delay for children (children ready to leave the hospital, waiting for an appropriate treatment setting) is down from 37% in the last quarter of 2007 to 26% in the second quarter of 08, coming closer to national averages. The Council is reviewing DSS’ plans for using targeted new funding to reduce length of stays in psychiatric residential treatment facilities, with more focused treatment and reducing delay days.

Significant concerns were raised about DSS’ plans for mental health and substance abuse services under Charter Oak. Services are limited and costs to consumers could be substantial. The effect of medical debt on patients’ financial health, serving as a disincentive to needed follow up care, and that Charter Oak could be ineligible for free bed assistance because they have insurance, in some cases, they may be worse off with Charter Oak than uninsured.
Ellen Andrews

PCCM hearing date set

2008-09-11T05:45:00.000-04:00

The mandated public hearing on DSS’ Primary Care Case Management proposal has been set. The hearing of the Human Services and Appropriations Committees will be September 25th at 11am at the Legislative Office Building. If you cannot come and would like to submit comments, the Chairs of the Committees are Representative Peter Villano, Senator Jonathan Harris, Senator Toni Harp and Representative Denise Merrill. Mail to any legislator can be addressed simply to the Legislative Office Building, Hartford CT 06106; email addresses can be found at www.cga.ct.gov.

Authorities holding public hearings

2008-09-06T07:14:00.000-04:00

The Health First and Primary Care Authorities will hold public hearings on their mandates to develop options for health coverage of all CT residents and to assess the capacity of CT’s primary care system. All are 6:30 to 8:30 pm.
9/17 Putnam Middle School
9/18 Norwalk City Hall
9/23 Torrington City Hall Auditorium
9/24 CHA building, Wallingford
9/25 Norwich Town Hall Chambers
9/29 Danbury Town Hall Chambers
10/1 Waterbury Arts Magnet School
10/2 Legislative Office Building, Hartford
TBA Manchester

The Project turns nine !!!

2008-09-02T13:20:00.001-04:00

Yesterday marked the ninth anniversary of the CT Health Policy Project. We took the day off.

To celebrate, we are moving our offices (actually just Ellen’s office). Our address will be not change. As of next week all the staff will be in the same part of the building. Our phones and internet won’t be working on Friday, but hopefully everything will be back up and running again on Saturday. Many thanks to Brian Roccapriore, former Director of Programs, who will be sharing his weekend with us, fixing the inevitable computer glitches.

PCCM concept paper out

2008-08-28T12:20:00.000-04:00

The concept paper for the state’s planned PCCM pilot has finally been delivered to the legislature. The Appropriations and Human Services Committees now have 30 days to hold a public hearing and approve, deny or make changes to the plan. PCCM is a way of running HUSKY without HMOs and will serve as another option for consumers and the state to run the program. Under PCCM, consumers will choose a primary care provider (PCP) – a physician, APRN, nurse midwife, or Physician Assistant – who serves as their first contact for health care. Their PCP is responsible for providing routine checkups and health care, arranging for tests, specialists and other needed care and coordinating everything. Consumers will need referrals from their PCP for specialty and other care; PCPs will only need prior authorization from DSS for some hospital services. The state will provide access to an off-hours nurse advice line. PCPs will need to have or get an electronic medical record or electronic disease management data registry within a year. PCPs will be held accountable for the care and coordination they provide.

The goals of the program include improving outcomes, expanding access to primary and preventive care, improving doctor-patient relationships, lowering expenses, and empowering providers and consumers in guiding the HUSKY program. An advisory committee of providers will be convened and charged with developing a proposal for accountability and all other aspects of the program.

DSS plans to implement the program on Jan. 1st and to pay PCPs $7.50 per member per month for care management costs in addition to the usual fee-for-service payments for visits and procedures. Plans for outreach include regional forums for providers and consumers. We will let you know when those and the legislature’s public hearing have been scheduled.
Any providers who are interested in participating can call the CT Health Policy Project at (203) 562-1636.
Ellen Andrews

Sad news

2008-08-27T08:57:00.003-04:00

From Gary Spinner, COO of the Hill Health Center:

“It is with great sadness that I let you know of the passing away of Cornell Scott, Hill Health Corporation's Chief Executive Officer. Scotty passed away at noon today in Yale New Haven Hospital. He had been ill for a great deal of time, and the past year has been one of frequent hospitalizations. Scotty has been the CEO of Hill Health Corporation since its founding in 1968. HHC was his love, his life, and his passion, and even until the end, he took great pleasure and joy in hearing about the work and mission of the Center.”

Scotty will be dearly missed here in New Haven, in Connecticut and across the US as one of the first and most prominent leaders in the movement to bring health care to those who need it the most.
Ellen Andrews

New Census numbers find uninsured largely unchanged in CT; many more buying insurance directly

2008-08-26T15:43:00.001-04:00

In 2007, there were 326,000 uninsured CT residents, or one in eleven of us had no coverage – not significantly different from the 2006 numbers according to Census numbers released today. We had a good decrease in uninsured from 2005 to 2006 which has been stable. CT has the eighth best (lowest) uninsured rate in the US. HUSKY enrollment grew by 2% from 2006 to 2007. While this is all good news, there are still far too many CT residents living without coverage, risking both their physical and financial health. Click here for the CT Health Policy brief on the numbers.
Amongst all the stability is an interesting trend – the rising number of CT residents who directly purchase health insurance. That number rose significantly in 2007 to now equal the number of people without any insurance coverage. Anyone who has shopped lately for insurance, especially here in CT, knows how expensive it is. The state could do more for those direct purchasers to improve affordability and availability. Purchasers in CT’s small group market have several protections under state law including modified community rating (spreading costs over a larger group), guaranteed issue and renewability and the Insurance Dept. has to approve rate increases in the small group market. None of these protections apply in the individual market but they could. As part of their health care reforms, Massachusetts is merging their individual and small group markets, a reform that is expected to save individual purchasers 15 % (and only costing the small group market 1 to 1.5% more). MA also requires employers to allow workers to buy insurance with pre-tax dollars, saving direct purchasers even more. CT should look at these reforms at a minimum as more residents are relying on our largely unregulated individual insurance market.
Ellen Andrews

COHI seeking Executive Director

2008-08-26T08:45:00.001-04:00

The CT Oral Health Initiative needs to hire a new Executive Director. For five years COHI has been advocating for better oral health for everyone. They have focused on access to dental care for CT’s underserved and education about the importance of oral health. COHI is seeking an experienced nonprofit leader who shares the organization’s mission and values. Speaking personally, I enjoyed my term working with COHI, learned a lot about the importance of oral health, and have rarely met a group of advocates as dedicated and nice to work with. For more info, go to www.ctoralhealth.org.
Ellen Andrews

eHealthCT designated as a Chartered Value Exchange

2008-08-22T09:58:00.000-04:00

Connecticut is entering the e-health big leagues! Yesterday, our own eHealthCT was designated as a Chartered Value Exchange by the Agency for Healthcare Research and Quality. eHealthConnecticut is a not for profit entity incorporated in January 2006 and represents a collaborative approach to meeting the challenges of health information technology adoption and interoperability for the entire State. It is Connecticut’s single organization focused on statewide HIE, with the combined governance and resources of the public and private sectors and the flexibility of a private corporation. A Board of Directors representing physicians, providers, consumers (including the CT Health Policy Project), purchasers, payers, academia, and quality organizations governs eHealthConnecticut, with State agency officials providing direction on an ex-officio basis. Chartered Value Exchange status allows eHealthCT to bring critical resources back to our state, allowing CT health care consumers and payers to benefit from the benefits of health information technology sharing. Congratulations to eHealthCT for their hard work so far and good luck with the hard work yet to come.
Ellen Andrews

Drama at the Medicaid Managed Care Council

2008-08-21T10:35:00.000-04:00

Yesterday, the Council passed a resolution to recommend a delay in transitioning HUSKY families into the new HMOs and to freeze enrollment in Charter Oak until July 1st, 2009. The council was concerned that only a handful of providers have signed up with the two new plans, AmeriChoice and Aetna Better Health, and that patients won’t be able to access care. The motion was offered by Rep. Peter Villano and passed unanimously.
Unfortunately, DSS wasn’t there to hear Council members’ concerns. The Commissioner was not able to attend due to a family illness, but other staff were prepared to present and were in the room distributing handouts when they were abruptly called back to 25 Sigourney Street just before the meeting started.
The Council and visitors, including seven legislators, had a lively discussion with the three HMOs, the CT State Medical Society and the CT Hospital Association. Concerns beyond the inadequate provider networks about the program included provider rates and whether they will be made public under Freedom of Information law, inclusion of retail clinics, higher rates paid to some providers, whether the plans were contracting with providers for all three programs (HUSKY Parts A and B with Charter Oak), linkage of HUSKY with Charter Oak and the impact on families, the state’s liability for behavioral health and prescription costs, and why providers are being offered lower rates when the MCOs received a 24% increase in their rates from the state? (We were promised an answer to that question at the next meeting – Sept. 19th at 9:30am).
According to news reports, the Governor has dismissed the Council’s concerns suggesting that the legislators favor universal health care. There was no discussion of universal health care at the meeting. She says the HUSKY transition and launch of Charter Oak will go ahead unchanged.
It’s August; aren’t we supposed to be taking it easy?
Ellen Andrews

Retail Medical Clinics and Primary Care panels

2008-08-12T13:23:00.000-04:00

Today’s panels at the CSG/ERC annual meeting explored retail clinics – opportunities and concerns – and primary care shortages. The clinic panel included Kim Rhodes from Take Care Clinics (owned by Walgreens) and Ken Ferrucci from the CT medical society. There are about 1000 retail clinics in the US, providing affordable access, including evenings and weekends, to basic services for conditions such as immunizations, colds, and ear infections. Ninety percent of patients who have used clinics are satisfied with the quality of care they received. Take Care Clinics have strong quality standards and work to connect patients to appropriate community services. Demand for clinic services is strong and growing, especially for people who cannot reach their doctor’s office during business hours and don’t need an emergency room. Ken emphasized that the medical society is not advocating to prohibit the clinics, but to ensure that they are regulated to protect patient safety. Other concerns include providing health care in stores that sell tobacco, offering lower copays to patients for visiting a clinic over a physician’s office, and the effect of clinics on the rest of the health care market.
The second panel focused on the shortage of primary care services and included Sen. Lisa Marrache (ME), Dr. Mario Motta, President-Elect of the MA Medical Society, and Dr David Stevens, of the National Association of Community Health Centers. Sen. Marrache, who is also a practicing primary care physician, created a legislative Commission to Study Primary Care Medical Practice. The Commission found that primary care physicians are leaving practice in record numbers primarily due to low reimbursement rates. The Commission recommended increasing and equalizing Medicaid rates, streamlining prescribing processes, investments in health information technology, and creating a medical home pilot project. Dr. Motta described the medical society’s recent study that found serious and growing physician workforce shortages, particularly in primary care fields. Half of MA physicians reported that they would not choose to practice medicine again as their profession. Waiting times for primary care appointments are increasing in MA which has serious implications for the success of MA’s health care reforms to cover all state residents. Insurance coverage is only part of the answer, being able to find a provider is just as important. Dr. Stevens focused on the critical role of community health centers in filling primary care gaps for underserved patients. He also highlighted the “medical home” model of care as a potential solution. In a medical home, patients have one place to access and coordinate comprehensive care in a culturally competent, compassionate setting. The medical home uses a team of providers including physicians, nurse practitioners, nurses and others to deliver appropriate, patient-centered care.
CT’s Governor Rell and Senator Harp attended both panels and actively participated in the discussions.
Ellen Andrews

State reform updates

2008-08-11T18:13:00.002-04:00

I’ve been staffing the annual meeting of the Council of State Governments/Eastern Regional Conference health policy track meetings in Atlantic City, NJ. Today we heard updates from states at varying stages of reforming their health care systems – Maine, Massachusetts, Vermont and New Jersey.
Sen. Joseph Vitale described New Jersey’s comprehensive plan to cover all 1.2 million uninsured residents. Phase I was just signed into law expanding SCHIP for parents. They are starting an insurance mandate for children, but there are no penalties attached to it yet. Policymakers decided against any employer contribution. They allow families with higher income children to buy into the program at full cost – similar to HUSKY Band 3 – at a cost of about $137 per child per month (twice that for two children and three times that for three or more children in a family). The law increased the minimum allowed medical loss ratio for managed care companies from 75% to 80% -- CT has no standards for medical loss ratios. Phase II will include coverage for everyone not eligible for existing programs, will be self-funded, provide a benefit package similar to the most popular small group market product, and will reimburse providers at commercial rates.
Sen. Richard Moore updated the conference on Massachusetts’ reforms. The rate of uninsurance has dropped from 13% two years ago when Chapter 58 passed to at least 7% and possibly as low as 4% now – over 355,000 people have found health insurance. Not only has Massachusetts found no evidence of crowd out (employers dropping coverage assuming workers can join the new public programs), in fact employer sponsored insurance rates have increased since Chapter 58 passed two years ago. Uncompensated care spending is down 34%. Fewer state residents report not being able to access care due to cost, and medical debt is down. Public support for the reforms is strong and growing. Reforms of the non-group market have made insurance far more affordable and enrollment is up 50%. Despite this rosy picture, challenges remain. Residents who have chosen to remain uninsured may be difficult to convince, covering the underinsured, workforce shortages, and containing health care costs. To contain costs, a new law just signed by the Governor addresses price transparency, health information technology adoption, regulation of drug company gifts to providers, prohibits billing for “never events”, CON reforms, and a medical home demonstration project.
Jim Hester, Director of Vermont’s legislative Health Care Reform Commission, described Catamount Health which also passed in 2006. The Commission is a legislative oversight body that follows the implementation of reforms closely and is critical to the state’s success. 5,800 Vermonters have joined Catamount Health and 4,300 have newly enrolled in state programs. Vermont is having difficulty getting the federal government to honor its commitment to their global Medicaid waiver at promised funding levels. This year Vermont enhanced their reforms by expanding coverage for children on their parents’ policies to age 23 and a large increased investment in health information technology paid for with a 0.2% fee on paid claims across all payers. Vermont is also expanding their successful Blueprint for Health plan to reduce the prevalence and provide chronic care management for diabetes. ER use is down by 40% for patients in the self-management program.
Phil Saucier, from Maine’s Governor’s Office of Health Policy & Finance, talked about progress covering the uninsured. Their Dirigo health plan passed in 2003 and now covers about 18,000 Mainers. The state has taken the federal government to court arguing that they are owed financial support for the program. The state repealed the contentious savings offset payment mechanism to fund the program in favor of a flat fee on all payers, including self-funded plans, of 1.8% of claims as well as taxes on alcohol, tobacco and soda. The soft drink industry has mounted a referendum on the November ballot to repeal the tax on soda – a “people’s veto”. The state also increased the age children can stay on their parents’ policies to 25, prohibited billing for “never events”, created medical home pilots, and are addressing overtreatment inefficiencies.
Ellen Andrews

Charter Oak/HUSKY troubles in the news

2008-08-05T13:04:00.005-04:00

The current problems getting providers to participate in the new Charter Oak/HUSKY plans have been hot news lately. A sampling:
The Day
ctnewsjunkie.com
Hartford Courant
Journal Inquirer
New Haven Register
Waterbury Republican American
Kaiser Daily Health Reports
Medical News Today
CT Post
WTIC News Talk 1080
Fox News 61
News Channel 3
Norwich Bulletin

According to DSS, as of Friday there were only 314 total primary care providers enrolled statewide in Aetna’s plan (only 2 in Windham county) and 225 in Americhoice’s panel (5 in Middlesex County). On Friday, there was still only one hospital signed up with Aetna and none had signed on with Americhoice.
Ellen Andrews

Charter Oak/HUSKY/PCCM update

2008-07-31T11:24:00.000-04:00

DSS Comm. Mike Starkowski met with the Appropriations and Human Service Committees yesterday delivering a 72 page program update. The big news (from our perspective) is that the PCCM concept paper, drafted by a working group of DSS staff and advocates (including the CT Health Policy Project), will be submitted to the legislature next week. The committees will then hold a public hearing on the draft plan, and approve, reject or modify it. In response to a question from Rep. Villano, the Commissioner also announced that the per-member-per-month payment to Primary Care Providers in PCCM will be $7.50, not $5 as was previously reported. The working group had recommended $7.50 after animated negotiations. The bad news is that PCCM may not start until Jan. 1st. Legislators urged DSS to do everything possible to have it ready as another option at the same time that consumers have to choose between HMOs.

There was a great deal of discussion about the 24% increase in rates to the HUSKY/Charter Oak HMOs that seemed “awfully high” to Sen. Harp, with the committees asking DSS to get back to them with more detail. Sen. Harris and others asked about the lack of providers in the new HMOs’ panels. DSS says the HMOs are actively recruiting providers and the plans will pay the out-of-network costs for care to members through November. Legislators expressed concerns that if out-of-network services are not paid at reasonable levels, consumers may still have difficulty accessing care. The Commissioner emphasized that no consumers will be defaulted into any plan until November 25th and the current ASO arrangement, that by all accounts is working well and possibly saving money, will continue until at least the end of the year.

Overall, the committee members expressed a lot of frustration with DSS – in delays to implementing programs, selectively cutting legislative priorities, and numbers that “change every time we meet”. Rep. Merrill said, “We will keep having hearings until we get answers.”
Ellen Andrews

Troubling Charter Oak call

2008-07-30T09:09:00.001-04:00

We’ve received calls from many consumers about Charter Oak – and it is a good option for some. However yesterday we got a troubling call on our Consumer Helpline (888) 873-4585. Leslie Dmowski called the Charter Oak application number to find out how to apply. She was injured in a car accident and can no longer work. She has applied for disability and is now paying for COBRA – a considerable burden on her family when she is without an income. When she called Charter Oak, she was told she was not eligible because she has insurance coverage. She was told nothing about the financial hardship exception. DSS has stated that if someone is now paying 10% or more of their income for health coverage, they do not have to drop coverage for six months to qualify for Charter Oak. Leslie is paying over 20% of her family’s income for coverage. Thankfully she called us, told her about the financial hardship exception, and sent her an application.

She also waited a long time on the phone after calling Charter Oak and got lost in the phone tree before she spoke to an actual person who was rushed and not helpful. She wanted to make sure that callers know not to press any numbers at the phone prompts to get a real person.

Leslie’s troubles point out a common problem with translating policies to the real world. We at the CT Health Policy Project have been very concerned about the six month uninsured requirement for Charter Oak – we feel it is unfair to people like Leslie who are sacrificing to pay for coverage now and it is bad public policy – excluding those who need health care is an odd way to build a health care program. We advocated with DSS and the legislature to remove the six month exclusion. Policymakers decided not to change it, but assured us that there would be generous exceptions. However it really doesn’t matter how fair the policies are on paper when they don’t get translated to the real world Leslie and her family live in. Advocates have to be especially vigilant – our job is only starting when we get policies passed in Hartford. And policymakers should be realistic when designing programs.
Ellen Andrews

What would you tell her?

2008-07-24T09:20:00.002-04:00

I just returned from a wonderful trip visiting family. While I was there, I ended up in a conversation that put me in an awkward situation, given my job. I was talking with one of my sisters and some of her friends, about half of whom are uninsured. One friend, who is a self-employed 39 year old, asserted, “I don’t believe in health insurance.”

“How’s that?” I asked, preparing myself to tout the importance of health insurance and primary health care.

The friend said that certainly the cost of health insurance is prohibitive, but her main concern was that you can’t be sure of what you’re getting when you pay your premiums. If you have pre-existing conditions, insurers will likely not cover costs associated with those. If you are diagnosed with some unrelated but expensive condition, insurers will likely fight having to cover those costs. She continued. The small print may exclude a number of common events or conditions. And, you may still have an absurdly high deductible or burdensome co-pays.

I was deflated. She’s right…particularly for people who would be finding their insurance as individuals and especially for those who are unable to afford a Cadillac insurance plan on their own.

Insurance is important, but only when it really protects its clients. Too often, we get calls at the Consumer Health Action Network (toll-free in Connecticut at 888-873-4585) from people who have upheld their side of the insurance contract only to find that the insurance companies have built in loopholes that exclude their conditions or key parts of their treatments, or that their “insurance” is not insurance but simply a Medical Savings Account, which offers little in the way of negotiating power to reduce the cost and nothing in terms of offsetting the cost itself.

As I listened to my sister’s friend, I thought about the calls I’ve taken from people here in Connecticut who have seen significantly higher costs than benefits to having health coverage. In order to convince these people (and my sister’s friend) that health insurance is an important and worthy expense, there must be more meaningful standards for what’s covered, clearer explanations of coverage, and better cost controls. Short of either this kind of regulation or of a system that provides truly universal health coverage, we will always have people who forego preventive care, rely too heavily on safety-net providers, and take their chances that they’ll stay healthy enough. That approach is not good for them and it’s not good for our society.
Connie Razza

HUSKY/Charter Oak health plan rates up 24% from last year

2008-07-23T11:58:00.000-04:00

After accounting for the impact of dental and prescription drug carve outs, the capitated rates paid to the three HUSKY HMOs – Aetna, AmeriChoice (United) and CHN – are 24% higher than the capitated rates paid to the plans last year before November. This is according to an analysis done July 17th for DSS by Mercer obtained by the CT Health Policy Project through a Freedom of Information request. The 24% rate increase includes a 13.1% increase due to programmatic changes (coverage for HPV vaccines, routine dental exams by PCPs, eligibility expansions, etc.) that some advocates and analysts take issue with. Along with medical trend and case mix adjustments, the rate hike also includes a 5.3% or $36.7 million increase for “negotiations” with the plans. $36.7 million is significantly more than the increase in physician fee-for-service payment rates last January – the first in twenty years. It is important to note that the budget, agreed to by both the legislature and the administration, allowed for a 2% rate increase to the plans.
Ellen Andrews

Mr. Lembo goes to Washington

2008-07-18T06:10:00.001-04:00

Yesterday State Health Care Advocate Kevin Lembo testified at a Congressional hearing on health insurance company abuses -- post claims underwriting and policy rescissions. That’s when an insurance company cancels a policy after consumer has been paying premiums faithfully, sometimes for years, and they get sick. The company, when faced with mounting claims, looks back into the patient’s history for reasons to cancel. A consumer who joined Kevin on the panel was cancelled after sustaining back injuries from a mountain bike accident because her husband had previous back problems. It is amazing that this was legal in CT until Kevin’s office advocated to change the law. Unfortunately it is still legal in other states, but hopefully Congress will help change that. We are very fortunate to have our State Health Care Advocate, and now Congress knows how lucky we are as well. Read Kevin’s blog on his odyssey into the Beltway.
Ellen Andrews