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State Releases Draft Vision For Health Care Payment, Delivery

by Christine Stuart | Oct 30, 2013 5:30am
(4) Comments | Commenting has expired
Posted to: Business, Health Care

Christine Stuart photo

Mark Schaefer, a clinical psychologist and director of medical policy for the Connecticut Department of Social Services, speaks about the framework for the process.

A group of state officials and other stakeholders in the health care debate released the first draft of a document Tuesday that lays out their vision for how medical services will be delivered to most Connecticut residents.

With a $2.8 million grant from the Centers for Medicare and Medicaid Services, most of which went to the global management consulting firm McKinsey & Company, the group is looking to reduce the overall cost of health care and improve access to services through better coordination of care. The 17-member committee was charged with designing a new health care delivery and payment model that will impact 80 percent of the state’s population, including those on both public and private insurance.

In 2012, health care spending in Connecticut was $29 billion. Connecticut ranks third highest among all states for health care spending per capita at $10,470. The goal, according to the draft report, is to save more than $1 billion over the next 10 years by reducing the growth of per-capita health care spending by 1 to 2 percent.

Anne Foley, an undersecretary at the Office of Policy and Management, told the group Tuesday that she didn’t think the draft document went far enough in addressing the goal of reducing the cost of the health care system.

“It’s crowding out the things we want to do. Both in the health care system and the state budget,” Foley said.

David Nuzum, a consultant for McKinsey who has been working with the group, said that within five years they’re looking at taking out about five percent of the waste in the system. Those savings will be redistributed to those participating in the new payment model the group is developing.

The payment model moves away from a system where a physician gets paid for every procedure they perform to a system where a physician is rewarded for providing high-quality care that reduces waste and inefficiencies, according to the report.

Deputy Insurance Commissioner Anne Melissa Dowling said it goes without saying that everybody is looking for the same outcome when it comes to quality of care and access to care, but “as I’ve said every time I’ve spoken up it comes down to the financials.”

“Whether it’s a crude thing to say or not, people are incentivized financially and their behaviors follow,” Dowling said.

She pointed out that the report doesn’t prioritize all the various goals of the group and the grant they’re looking to get from the federal government is only about $45 million when the report includes billions of dollars in goals.

But advocates like Ellen Andrews, executive director of the Connecticut Health Policy Project, aren’t necessarily concerned about whether the state gets another grant to move in this direction. She said she’s more concerned that the main way they seem to be cutting waste out of the system is by rewarding doctors for denying patients care.

“They intend to monitor for under-treatment and inappropriate denials of care, but are not committing to denying providers from sharing in the savings they generated by denying care,” Andrews said after the meeting. “It just makes sense that providers shouldn’t benefit from savings derived by denying people needed care.”

In order for this new payment model to work, most the practices in the state will need to buy into it and assume some of the risk. The payer and the physician will need to make a decision about what level of risk they’re willing to assume. The state, according to the report, will offer some level of support to physicians to help them achieve the scale and capabilities necessary to effectively manage a population of patients.

Advocates like Andrews have expressed concern that there are no independent consumer advocates or hospitals on the committee drafting this plan. State Healthcare Advocate Victoria Veltri said the document released Tuesday is only a draft and there will be opportunities in the future for public comment.

The final draft will be submitted to the federal government at the end of December.

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(4) Comments

posted by: art vandelay | October 30, 2013  9:14am

art vandelay

Have you ever tried filling out a 1040 on your own?  I can’t imagine doctors filling out forms that will be 10 times more complicated. The health care law will now create an entire group of professionals who’s sole purpose is to fill out health care medical forms.  When will people learn that the government can’t do anything right except print money.  Now they have your health care. God Bless this country.  We’re going to need it.

posted by: DirtyJobsGUy | October 30, 2013  11:38am

Have any of these people ever worked in any real job?  I see McKinsey (where are the Bobs?),  Government types, and activists.  All of them are promising to harass doctors unless we achieve some holistic wellness nirvana.  How about just leave us alone to figure this out ourselves!

posted by: oliviahuxtable | October 30, 2013  4:45pm

Will someone please explain how this 17 member committee and their recommendations will have authority over providers who see patients with private insurance? I can see them mandating to providers seeing medicaid clients…. But to private, commercial-insurance patients?

posted by: dano860 | October 30, 2013  11:18pm

The payment model moves away from a system where a physician gets paid for every procedure they perform to a system where a physician is rewarded for providing high-quality care that reduces waste and inefficiencies, according to the report.
So how do they see this being measured?
As they state most of the practices (doctors) in the State will have to buy into this in order for it to work. Do they really think that is going to happen?
Cash is King not some nebulous paperwork program that just fattened a few pockets with a $2.8 Million bogus study.