Connecticut has explored many approaches to improving healthcare value for consumers over the past several years. The state created an all-payer claims database in 2012 and passed a comprehensive law prohibiting certain out-of-network billing practices and establishing a “certificate of need” process for insurance companies to acquire physician groups in 2015. The law also requires health insurance companies to submit an annual report to the Connecticut Health Insurance Exchange that lists the billed and allowed amounts paid to each healthcare provider in the insurer’s network for certain diagnoses and procedures, and the corresponding out-of-pocket costs. The state launched an Office of Health Strategy in 2018 to implement comprehensive, data-driven strategies that promote equal access to high-quality healthcare, control costs and ensure better health for Connecticut residents. Among other responsibilities, the office will oversee the state’s four-year State Innovation Model grant to test multi-payer healthcare payment and service delivery models to improve health system performance, increase quality of care and decrease costs.
As of 2019, Connecticut is one of the few states that has comprehensive protections from surprise medical bills. However, high drug costs remain a significant consumer concern. The state has passed several pieces of drug pricing legislation to address these concerns, including laws that require pharmaceutical companies to disclose and explain drug price hikes; force pharmacy benefit managers to report how much they collect in rebates and how much they keep; and protect pharmacists from “gag clauses” that prohibit them from disclosing specified information to people purchasing certain drugs.
The Connecticut General Assembly passed legislation that will cap the monthly cost of insulin, supplies and emergency insulin for people with insurance, according to the CT Examiner. Beginning Jan. 1, 2022, the maximum monthly out-of-pocket cost for insulin will be $25, while non-insulin medication and devices/equipment will cost $25 and $100, respectively. Additionally, anyone with diabetes will be eligible for a 30-day emergency supply of insulin at any pharmacy in the state one time per year. The law is a major win for roughly 25 percent of patients with diabetes who report rationing insulin because of cost.
A coalition of 51 states and territories, led by Connecticut’s attorney general, are suing generic drug companies for price fixing, according to a press release from the attorney general’s office. The lawsuit stems from the ongoing antitrust investigation into a widespread conspiracy by generic drug manufacturers to artificially inflate and manipulate prices, reduce competition and unreasonably restrain trade for generic drugs sold across the United States.
Connecticut's governor issued an executive order prohibiting hospitals from charging uninsured patients more than the Medicare price for their COVID-19 care, according to Modern Healthcare. The order also aligns payment for emergency and non-emergency out-of-network care by requiring insurers to pay out-of-network providers in-network prices for care during the COVID-19 public health emergency, and protects healthcare workers and facilities from lawsuits if they are “acting in good faith” to provide COVID-19 care despite shortages or capacity issues.
Connecticut’s Governor signed two executive orders to directly address healthcare costs, primary care spending and quality of care for individuals, businesses and the state government, according to Robert Wood Johnson’s State Network. The orders direct the Office of Health Strategy to establish statewide healthcare cost growth and quality benchmarks in addition to a primary care spending target, and direct the Department of Social Services to improve public transparency of Medicaid costs and quality.
While Connecticut has led national efforts in public insurance reform, research shows that significant health disparities persist between the state’s residents of color and white residents, reports the CT Mirror. Specifically, Black and Latino residents are more likely than white residents to be uninsured, to die before reaching adulthood and to report being in poor health. Latino adults, in particular, were more than twice as likely as white residents to say they went without seeing a doctor in the past 12 months because of the cost.
Connecticut’s state comptroller and Office of Health Strategy are developing a “healthcare affordability standard” to calculate how much money individuals and families in the state must earn in order to afford healthcare without compromising other basic needs, like food and housing, reports Hartford Business. According to officials, understanding the threshold at which healthcare becomes unaffordable is vital to creating sound policies. The tool is anticipated to launch in Spring of 2020.
One Connecticut hospital stands alone when it comes to pursuing patients in small claims court over unpaid medical bills, according to Hartford Business. Research from the UConn Health Disparities Institute revealed that Danbury Hospital filed nearly half of the 13,824 total medical debt cases in Connecticut in 2016. The hospital claimed $8.8 million in debt from these lawsuits, compared to $10.4 million claimed in lawsuits filed by all other Connecticut hospitals that sued patients for medical debt that year. The finding has prompted Danbury Hospital to review its debt-collection policies.
Connecticut’s “Centers of Excellence” network will enable state residents to identify which providers perform best for certain procedures, helping them make informed decisions about where to receive their care, reports The CT Mirror. By steering patients to providers who offer cost-effective treatments, the state hopes to reduce its healthcare costs by millions of dollars in the 2019 and 2020 fiscal years combined. The resource will be released in 2020 and will serve an estimated 210,000 state employees, retirees and dependents.
Connecticut is using certificate of need (CON) regulations to hold hospitals accountable for making meaningful investments in their communities’ health, according to the National Academy for State Health Policy. In a recent CON agreement, the Connecticut Office of Health Strategy mandated that merging hospitals: adopt evidence-based interventions to address community needs; explain how patient outcomes will be measured and reported to the community; and increase the total dollars spent on community benefit activities by at least one percent each year for the next five years. These activities must directly address the health and health-related social needs identified by the hospital’s Community Health Needs Assessment. While the CON conditions are time-limited, they demonstrate what is possible when states use their policy levers to maximize community benefits investments.
Connecticut’s Office of Health Strategy launched a free, online tool intended to help consumers, businesses and healthcare providers navigate the state’s vast system of care, reports The CT Mirror. The website’s two key elements–a quality scorecard and a cost estimator–will allow users to compare the quality and cost of medical care at 19 of the state’s healthcare organizations. Organizations are also evaluated on patient experience in four categories: office staff, provider communication, timely care and overall patient experience. In addition, users can compare the overall performance rating of provider networks across all quality measures. Connecticut is one of the first states to create a rating system that evaluates the performance of provider networks rather than individual providers.
State regulators approved two major hospital mergers and acquisitions under the condition that the organizations agreed to healthcare cost price caps tied to the Consumer Price Index, reports the Hartford Business Journal. This type of agreement is a first for Connecticut and one of the most stringent cost controls ever placed on hospital combinations in the state. Compared to states like Massachusetts and Rhode Island, Connecticut’s caps are relatively modest. Nevertheless, they are an important protection against rising healthcare costs, which have historically increased with consolidation
Community health workers have the potential to help improve health outcomes, reduce costs and reduce health disparities. Despite this, the role of community health workers in the healthcare system remains precarious and not widely understood. A report released by the Connecticut Health Foundation aims to shed light on the work community health workers are doing in Connecticut and their potential to bridge gaps between clinical care and patients’ lives. This report complements previous research published by the Connecticut Health Foundation, including a brief and report identifying specific ways community health worker services can produce a positive return on investment and a report detailing how 15 other states handle certification for community health workers.
Specialty care accounts for a significant and growing portion of year-over-year Medicaid cost increases. Some referrals to specialists may be avoided and managed more efficiently by using electronic consultations. A study in Health Affairs found that linking primary care providers with specialists in dermatology, endocrinology, gastroenterology and orthopedics in Connecticut using an electronic platform reduced the need for face-to-face visits, saving an average of $82 per patient per month. Researchers concluded that expanding the use of electronic consultations for Medicaid patients and reimbursing the service could result in substantial savings while improving access to and timeliness of specialty care and strengthening primary care.
Connecticut’s U.S. congressional delegation is at odds with the governor over the failure to apply for an expansion of the HUSKY program that would give low-income residents access to new telemedicine services, especially for psychiatric care and substance abuse treatment, reports The CT Mirror. Five Democrats representing Connecticut in the U.S. House of Representatives are pressing the Malloy administration to apply for the waiver, which would allow the state’s doctors and hospitals to receive Medicaid reimbursements for their services when they treat HUSKY patients through telemedicine. The Malloy administration says the process for obtaining permission to add these services is lengthy, may not achieve the desired results and is not currently a priority. Connecticut is the only state in the nation that has not requested a waiver from the Department of Health and Human Services to incorporate telemedicine into its Medicaid program.
Tens of thousands of Connecticut residents lack access to adequate healthcare, despite the state’s tremendous wealth and strong embrace of the federal Affordable Care Act, according to The Connecticut Mirror. While Connecticut once had a generous social safety net that elevated its poorest residents above their counterparts in most other states, it has since been eroded by massive budget deficits, which could get worse in the near future. Advocates worry that changes on the horizon could mean greater barriers to healthcare for many Connecticut residents – low-income individuals and families, those who rely on safety-net clinics for care, middle-class earners whose income has been squeezed by healthcare costs, and those with insurance plans that increasingly require them to pay more for care.
A survey conducted Altarum’s Healthcare Value Hub for the Universal Health Care Foundation of Connecticut revealed that residents across the political spectrum want state laws that require healthcare pricing transparency and make it easier to navigate the complex system, reports Hartfordbusiness.com. The survey found that half of survey respondents had experienced healthcare affordability burdens in the previous 12 months. Of that group, four in five said they had delayed or skipped a doctor visit, medical procedure or test, cut pills in half or skipped doses, or had trouble accessing mental healthcare due to cost. Though lower-income households had the highest reported affordability burdens, 42 percent of households making more than the state's median income reported experiencing cost burdens. Respondents supported a number of steps to remedy affordability problems, such as showing patients a "fair cost" for specific procedures, requiring medical providers and insurers to give up-front cost estimates and giving the state Attorney General the authority to prevent price gouging on prescription drugs.
The U.S. Centers for Medicare and Medicaid Services approved a significant increase in Connecticut's annual tax on hospitals—from roughly $556 million to $900 million, reports The CT Mirror. The state will redistribute much of the revenue back to its hospital industry through increased hospital payments, but the new taxing arrangement will allow Connecticut to draw an additional $150 million in federal money annually through its Medicaid program. This back-and-forth arrangement is currently employed by a number of states.
Connecticut is one of several states that have recently enacted drug cost transparency laws, designed to make drug pricing information accessible so states can eventually take action on price gouging, reports NASHP. The new Connecticut law requires drug makers, health insurers, and pharmacy benefit managers (PBM) to disclose a wide assortment of information on price increases. Drug makers must justify large increases, insurers must report them when filing rate requests and PBMs must report how much they collect in rebates and how much they keep.
A new Connecticut law requires drug companies, health insurers and pharmacy benefit managers to disclose a wide range of drug pricing information to the state, reports CT Mirror. Key provisions that go into effect on Jan. 1, 2020, include: requiring drug companies to justify potentially unwarranted drug price increases over specified periods of time; requiring insurers to identify the 25 drugs with the highest cost to the plan, the 25 with the greatest year-over-year price increases and the 25 most frequently prescribed, as well as the premium growth that is attributable to prescription drugs; and requiring PBMs to report how much they collect in rebates and the share that they keep. Insurers will also be required to report whether they use the rebates to offset premiums or pass the money down to residents at the pharmacy counter. The bill does not include a previous requirement that the majority of rebates from drug companies be passed down to consumers when they buy drugs at pharmacies.
Connecticut Voices for Children is partnering with Health Equity Solutions to propose legislation that would standardize guidelines across state agencies for collecting data related to race and ethnicity in healthcare outcomes, reports WNPR. The bill would provide better training for the healthcare professionals who collect the data and make the data easily shareable, in addition to increasing the specificity of the data collected so that outcomes for smaller ethnic groups can be more easily tracked. Advocates assert that increasing the availability of data on smaller racial and ethnic minorities will increase social justice, save money on costly disease management and get more of the state's population healthy and contributing to the economy.
Connecticut has launched a new Office of Health Strategy, designed to implement comprehensive, data-driven strategies that promote equal access to high-quality healthcare, control costs and ensure better health for state residents. The office will bring together the formerly independent State Innovation Model (SIM) Project Management Office, Health Information Technology Office, Office of Health Care Access and All Payers Claims Database to combine critical data sets and health information exchange efforts and allow for collaboration with many stakeholders, including state agency partners. “Connecticut has made strong progress on healthcare coverage and accessibility, but there is much more we need to do to address health outcomes, healthcare costs, health inequities and care delivery and payment reforms. Healthcare isn’t a partisan issue, the Office of Health Strategy will help us move forward collaboratively to address these issues with our stakeholders,” said Executive Director Vicki Veltri.
In November, Connecticut passed legislation to establish an Office of Health Strategy, which will oversee all of the state’s major health reform and planning initiatives. These include the Health Information Technology Office, the State Innovation Model Management Office, the All-Payer Claims Database and the Office of Healthcare Access. “The Office of Health Strategy is an opportunity to ensure better health outcomes, to lower costs and to create a more efficient healthcare system,” said Lt. Gov. Nancy Wyman. “This signifies important progress that must continue—and is most effectively coordinated by a single entity.”
For the past several years, healthcare costs in Connecticut have continued to rise, despite evidence suggesting that consumers are not uniformly receiving high quality care. Additionally, the state received double F’s on the Leapfrog Group’s Price Transparency and Physician Quality Report Card for its ability to help consumers find the information they want and need to compare the price and quality of their healthcare. A recent report released by Altarum examines Connecticut’s cost and quality issues, highlighting the inefficient management of hospital expenses and arguing against the continued inflation of prices irrespective of healthcare value.
A new Connecticut law will outlaw “gag clauses” in pharmacy benefit-manager contracts that now bar pharmacists from telling consumers when they could save money by paying out of pocket for generic drugs that can cost less than the co-pay for a covered brand-name drug, according to the Connecticut Mirror. The bill also would require insurers to give better notice to consumers regarding the cost of using out-of-network labs.
Many Connecticut residents struggle to understand insurance terminology and perform the financial calculations required in today’s complex insurance plan designs, according to UCONN Health. These problems are difficult to overcome, but a state-wide strategy aimed ultimately at enhancing the value of health insurance for all is needed.
A coalition of pharmacy societies has released a new framework for mapping medication therapy management services to the SNOMED CT codes used for EHR documentation, interoperability efforts, and quality reporting. Unlike ICD-10, which is primarily geared toward recording diagnoses and procedures, SNOMED CT attempts to capture a more holistic view of the patient and his or her experiences, including socioeconomic data, medication use, lifestyle behaviors and family history.
Starling Physicians will partner with Aetna to participate in an oncology medical home model designed to improve patient experience by enhancing delivery of quality and value in cancer care. The model will be centered around the whole person, with evidence-based, integrated and personalized medical care, with a focus on quality and safety; and enhanced access to care.
A new free mobile application, "FH Cost Lookup CT," enables both insured and uninsured consumers to estimate the region-specific costs of medical and dental procedures, reports Healthcare Finance. The app was launched by FAIR Health and funded by a grant from the Connecticut Health Foundation. The application is available in both English and Spanish, includes region-specific costs in neighboring states of New York, Massachusetts and Rhode Island, and provides educational articles to explain the fundamentals of health coverage. It is driven by healthcare prices from FAIR Health’s database of more than 21 billion claims for privately billed medical and dental procedures since 2002.
The Connecticut Health Policy Project released a report and training module aimed toward students, interns, and volunteers that discusses the basics of health policy. The report gives an overview of public insurance, private insurance, the uninsured, healthcare financing, healthcare reform, and the role of states.
A state-hired consulting firm presented a plan to Connecticut’s Health Care Cabinet that called for the largest reorganization and consolidation of health-related state agencies in two decades, according to The Connecticut Mirror. The proposal urged the creation of the Connecticut Health Authority, which would absorb the responsibilities of more than six state agencies and would create a quasi-independent oversight agency, the Office of Health Reform. The Office of Health Reform would track and limit healthcare cost increases. The proposal also called for the creation of “consumer care organizations” -- networks of healthcare providers that would receive large payments based on the total number of consumers using the services in its network. Providers in consumer care organizations would be paid based on the quality of their care.
Many Connecticut residents still don’t know that by the end of this year, Anthem Insurance Co. and Cigna may merge, forcing us all into a dire situation, according to Frances Padilla of the Universal Health Care Foundation of Connecticut. Mergers are justified on the basis of increased efficiency and opportunity for innovation, but past experience doesn’t uphold those claims. They should be carefully questioned, because they can be expected to increase health insurance premiums, and cause deductibles, co-pays, and co-insurance out-of-pocket costs to spike.
A new law in Connecticut, which goes into effect January 1, 2016, requires hospitals and health systems that acquire a physician practice to notify all patients within 30 days after the acquisition that their outpatient services will now include facility fees, reports Modern Healthcare. Additionally, hospital bills must clearly state that the fee is to be used for the hospital's operational expenses, that the patient would likely be charged less at an outpatient care center not owned by a hospital and that the patient has a right to request a reduction in the facility fee. The provisions are part of a larger bill passed in June aimed at improving price transparency for patients.
Drawing on examples from several states, this report explores the pros and cons of a public utility model for healthcare for Connecticut.
Connecticut Health I-Team: Federal investigators have found that Medicare officials rarely enforce rules for private insurance plans intended to make sure beneficiaries will be able to see a doctor when they need care. It's a problem many Connecticut seniors know too well. In 2013, UnitedHealthcare, the nation's largest health insurance company, dropped hundreds of healthcare providers from its Connecticut Medicare Advantage plan, including 1,200 doctors at the Yale Medical Group and Yale-New Haven Hospital. Medicare Advantage beneficiaries scrambled to find new insurance or new doctors while the Fairfield and Hartford counties medical associations went to court to try to stop the terminations.
The Connecticut Mirror: The financial condition of Connecticut’s hospitals, and how they’ve fared under the federal health law, has been a source of dispute among state lawmakers. Hospitals have faced repeated funding cuts and increased taxes in recent state budgets. This article looks at recently released financial data from the 2014 fiscal year, the first after the major coverage expansion provisions of the health law took effect.
Hartford Courant: Most insurance companies selling health plans in the state's individual market will get to raise customers' premiums in 2016, but not by as much as they proposed, and ConnectiCare Benefits—the largest carrier in the state's insurance exchange—will have to lower rates, according to decisions released by the Connecticut Insurance Department.
This report by the Trust for America’s Health, financed by the Prevention and Public Health Fund, details public health and prevention activities around the state.
The Connecticut Health Policy Project released a report that examines how much Connecticut spends on healthcare. The report discusses Connecticut health spending and projected growth rates. The report also covers who pays the healthcare costs, where each healthcare dollar is spent, and what factors are driving healthcare costs, both nationally and in Connecticut.
This report, funded by the Connecticut Health Foundation, identifies opportunities to influence the design, development and governance of Connecticut’s APCD to maximize its usefulness specific to patient safety and health equity/disparities researchers, and consumers. Key findings include: (1) APCDs are providing consumers access to patient safety and quality reports to make informed healthcare decisions, (2) health equity/disparities researchers are working together in data, cost, and quality collaboratives, (3) NIH is funding health data research using the APCD, (4) state cost and quality councils are utilizing APCD data to regulate hospital performance and reimbursement, (5) APCDs are predominantly operating within state agencies, independent of health insurance exchanges, and (6) opportunities for engaging stakeholders to influence the design and implementation of Connecticut’s APCD.
This report evaluates the early implementation of Connecticut's Health Enhancement Program, a new value-based insurance design plan for state workers created in partnership between the governor's office, a coalition of unions representing state employees.