Posts by Ellen Andrews
Advocates support SIM underservice, cherry picking protections
Connecticut’s SIM plan acknowledges that risks of inappropriate under-treatment and cherry-picking are higher in new shared savings payment models. Advocates were successful in getting a provision included in the SIM final plan that prohibits payment of shared savings to provider networks that systematically deny needed care or cherry pick patients to generate those savings. The…
Read MoreIssue Brief: Attribution and Why It Matters
A new brief describes attribution, a key component of payment reform. Attribution done wrong in a shared savings payment model can create incentive to cherry pick out less lucrative or difficult patients and disrupt existing provider-patient relationships. Attribution is the process of defining the population that a provider network is responsible for managing under a…
Read MoreNine SIM committee members reject weak ethics policy
In a letter sent yesterday, nine members of various SIM committees rejected the weak ethics policy promoted by SIM leaders. The weak policy does little to limit conflicts of interest, such as those that tainted the awards of SIM’s first grants. Instead they urged SIM to limit conflicts of interest and adopt the State Code…
Read MoreSeptember web quiz on Medicare hospital readmissions in Connecticut
Test your knowledge of Medicare hospital readmissions in Connecticut. Take the September CT Health Policy Webquiz.
Read MoreCT health reform progress down again
Unfortunately CT’s progress toward health reform dropped again this month to 26.2% this month, adding to last month’s dip. Growing ethics and transparency problems at SIM led the concerns. CT hospital’s continuing poor performance on Medicare readmissions, consolidation and loss of services across hospitals added to the drop. In good news, if adopted SIM’s underservice…
Read MoreCadillac tax will affect 13.6% of single premiums in CT in 2018
Under the Affordable Care Act, in 2018 high cost employer-sponsored health plans will begin paying a hefty 40% tax, termed the Cadillac tax, on the value of the plan over specified threshold levels. A new report by the Congressional Budget Office estimates that 13.6% of CT single premium plans and 11.9% of CT family plans…
Read MoreCSG ERC health panel shares innovation lessons, resources for policymakers
Today’s Health Policy panel at CSG/ERC’s Annual Meeting in Wilmington DE focused on health care innovations that build value. States shared lessons learned and resources. We heard from Heidi Louise Behforouz, MD of AnansiHealth and Brigham and Women’s Hospital about the value of including community health workers into the health team. We also heard from…
Read MoreSIM update, equity planning questions
At Thursday’s SIM steering committee meeting in public comments, SB Chaterjee raised concerns about DPH’s planning to address health equity. Important planning meetings occur in closed meetings, without public notice or minutes. (Sound familiar?) Questions were also raised about how federal funds have been spent and the required conflict of interest policy is not available.…
Read MoreCTNJ op-ed: Insurers blocking underservice protections, again
Consumer protections had a good start in Connecticut’s latest health reform plan. But, as always, the devil is in the details. Unfortunately insurers are working to sabotage those protections to benefit their bottom line. Read more
Read MoreTestimony FOI never got to hear
Last week the Freedom of Information Commission held a hearing on my request for SIM documents related to their Consumer Advisory Board’s (CAB’s) votes on appointments to SIM committees. Those committees are making very important decisions about CT’s $30 billion health care system and ethical questions have been raised about committee members receiving substantial SIM…
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