CT Health Notes Blog

Health care prices in Connecticut are higher and rising more quickly than the US average, according to the Healthy Marketplace Index. The Index is a map-based tool from the Health Care Cost Institute that compares local prices for inpatient, outpatient and physician services across the US for 2012, 2013 and 2014. The researchers found significant price variation between communities, especially in outpatient care. Among the four CT communities included in the tool, none have prices in any category below the US average. Bridgeport leads the state in both inpatient and outpatient prices; physician costs are highest in New Haven. Compared to neighboring states, CT health care prices are lower than New York City (except physicians) but higher across all three categories than in Providence.

2014 health cost ratios relative to US average	Inpatient	Outpatient	Physician services
Bridgeport – Stamford – Norwalk	1.27	1.09	1.16
New Haven – Milford	1.17	1.03	1.24
Hartford – West Hartford – East Hartford	1.15	1.02	1.18
Norwich – New London	1.18	1.08	1.04
New York – Newark – Jersey City	1.31	1.16	1.1
Providence – Warwick	1.04	0.94	0.94
US average	1.0	1.0	1.0

Yesterday, the Council of State Governments’ Eastern Regional Conference (CSG/ERC) sent a letter calling on Congressional leaders to protect and support the 50-year, successful state-federal Medicaid partnership. CSG/ERC is comprised of state policymaker members from eleven Northeastern states from Maine to Maryland as well as the U.S. Virgin Islands, Puerto Rico and five eastern Canadian provinces. Signed by ERC Co-Chairs Sen. Terry Gerratana and Rep. Kevin Ryan (CT) the letter notes that state legislators represent the same constituents as members of Congress. As the letter points out, “For over fifty years, Medicaid has been a beacon of effective state and federal collaboration. The program delivers critical preventive and acute care services to one in five residents of our region. Medicaid serves the needs of the most fragile Americans, provides financial security for families, and is a cornerstone of state health systems and economies.” The letter follows an ERC Resolution passed last December also supporting the Medicaid state-federal partnership. 

From Saturday’s Hartford Courant, “These are lean times and we need our government to be smart about where it puts its resources. We don't need our limited taxpayer dollars spent "fixing" things in our Medicaid program that aren't broken.” The article points out the state’s backward plan, PCMH +, to apply a risky experiment, meant to slow health care growth, to the only part of Connecticut’s health system that doesn’t need it, our Medicaid program. Just because they can.

Last week’s meeting of the FDA’s Antimicrobial Drugs Advisory Committee was unusual. We didn’t address the merits of a single new drug the FDA is considering for approval but how to fairly assess drugs that target a single bacterial species causing very serious and deadly infections but that affect small populations. Getting sufficient numbers of appropriate patients for drug trials is challenging in many ways. Often there isn’t time to assess which species of bacteria is the problem, and not treating people as quickly as possible is not an option. As usual, there are no easy answers but the committee provided feedback on the options from diverse perspectives. Many members also thanked the FDA for being proactive in identifying a problem early, and working with companies to help them design meaningful but feasible studies of effectiveness and safety. More regulatory agencies, both federal and state, should take this constructive approach.

An OP-ED today in CT News Junkie describes the sorry level of mistrust in CT health policymaking. “Mistrust is pervasive in Connecticut policymaking and it’s blocking progress.” Luckily we know how to fix it – if only we have the sense. Read the piece

A new study published in Health Affairs raises doubts about the effectiveness of Accountable Care Organizations (ACOs) to both improve the quality of American health care while controlling costs. The study found very high physician turnover rates at a large Medicare ACO and that high cost patients were concentrated among a small minority of physicians. As patients are included in the ACO, and therefore the savings calculation, based on which physician they see – there is great potential for gaming the system. The study found that high cost patients were even more likely to stick with their physician leaving the ACO than healthier patients. If physicians with less lucrative patients leave the ACO, their patients leave with them, and the ACO can increase their “savings” calculation artificially by segmenting the patient population without either improving quality or controlling costs. As the authors conclude, “ACOs’ ability to deliberately select participating physicians year to year, however, creates a relatively simple mechanism to ‘game’ the risk pool . . . . The presence of this mechanism and the ease of its use, especially compared to the more difficult task of redesigning care, could result in an undesirable but powerful temptation for ACOs, particularly those facing financial constraints or pressing financial motivations.”

ACOs are networks of health care providers that, generally, bear some or all financial risk for the care of their attributed members. The latest trendy payment reform models rely on ACOs to control health care costs by sharing both savings and losses with the payer. ACOs are very new and experimental. Results to date have been underwhelming, both in improving the quality of care as well as controlling costs. The new study offers an explanation for that failure.

Recently, Connecticut Medicaid has moved 137,000 members into ACOs as of January 1^st and intends to move another 200,000 in next January 1 without a meaningful evaluation of the experiment. The ACO gaming of shared savings payments detected in the study was anticipated by advocates in development of the model, but proposed protections were rejected.