Posts by Ellen Andrews
Disability advocates register serious concerns with SIM primary care capitation plan
On Friday, thirty consumers and advocates for people with disabilities sent a letter to Vicki Veltri and Mark Schaefer, CT’s SIM officials, expressing their concerns with SIM’s proposal to capitate primary care for everyone in CT. The signers are concerned about the potential to deny needed care, especially for people with complex medical conditions. Capitation…
Read MorePCMH+ quality reports surprisingly underwhelming
At the MAPOC and Care Management committee meetings we finally received the promised quality evaluation of PCMH +’s first year. PCMH+ is DSS’s experimental new payment program that now covers 165,432 HUSKY members. We only received information on the 13 mainly process measures. These measures were chosen as basis for shared savings payments, not for…
Read MoreCT hospitals report $1.6 billion in community benefits, but most of that is claims of Medicaid underpayment
Yesterday’s Healthcare Cabinet meeting focused on CT nonprofit hospital community benefit reports to the IRS. Last year, CT hospitals claimed $1.6 billion in community benefits, but over half of that (57%) are claims of Medicaid underpayment. Charity care provided to patients unable to pay for their services constituted 21% of total charity care; health professional…
Read MoreAdvocates get no answers to questions about HUSKY experiment
Last month, a group of independent consumer advocates, the Medicaid Study Group, sent questions to DSS about the impact of PCMH Plus, their new $10.8 million experimental program of shared savings in HUSKY. Advocates have been concerned about PCMH Plus’s potential to deny needed care, raise costs in the program, and erase hard-won progress. Questions…
Read MoreAnthem keeps lion’s share of CT insurance market
The best-kept secret in CT healthcare – the Insurance Department’s Consumer Report Card on Managed Care Plans – is out again this year covering 2017. Once again, Anthem has the lion’s share of the market at 46%. ConnectiCare lost almost 55,000 members between 2016 and 2017. About two out of three insured people in Connecticut…
Read MoreEmployer health benefit costs hit lowest wage workers hardest
The latest Kaiser Employer Health Benefits Survey found that nationally last year premiums for employer-sponsored health benefits rose by 3% for single coverage and 5% for family coverage. In comparison, wages rose 2.6% and inflation was 2.5%. As in previous surveys, premiums were highest in the Northeast. But in a really unfair twist (which also…
Read MoreMedicaid update: LTSS working to keep people out of nursing homes, hospitals
Friday’s Medicaid Council meeting focused on rebalancing long term services and supports allowing more members to stay at home, if they choose, and improve quality of life. Recipients of LTSS services comprise 6% of Medicaid members but 43% of costs. On average community-based care is less costly. The comprehensive strategy that began with a 2013…
Read MoreCTNJ: CT uninsured rate up, especially for higher income households
New Census data on the uninsured is always a big event for policy types. This year most expected the numbers to rise, but the data had a surprise. Read more
Read MoreAnother reason to be glad HUSKY fired managed care
New favorite quote – “If you have a dumb incentive system, you get dumb outcomes.” Charlie Munger, quoted by 46brooklyn A new analysis by 46brooklyn highlights the extra costs to Medicaid managed care programs of drug industry middlemen. Ohio’s Medicaid program pays $224 extra in markups to Pharmacy Benefit Managers (PBMs) hired by managed care…
Read MoreCT hospital readmission penalties up for next year
Next year, Medicare will penalize CT hospitals by an average of 0.74% in readmission penalties and all CT hospitals will pay a penalty, according to an analysis by Kaiser Health News. Nationally hospital penalties averaged less at 0.57%, and 574 US hospitals will have no penalty. Since 2012 hospitals have been penalized if they have…
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