HCCD Report Connecticut 06443

Health Care Community Discussion Madison, CT December 16, 2008

Facilitated by Dennis

Policy Background and Key Questions

The President-elect believes that every American should have high quality and affordable health care, and to reach this goal, we must modernize our health care system in order to:

–    Improve health care quality and cut costs;
–    Expand coverage and access; and
–    Increase the emphasis on primary care and prevention.

Agenda

Welcome and Introductions of Attendees
Goals of the Health Care Community Discussion
Procedures for the Meeting
Discussion Questions
Participant Survey
Drafting of Group Submission for Transition Health Policy Team
Group Photo or Video (If possible)

Questions

Briefly, from your own experience, what do you perceive is the biggest problem in the health system?
How do you choose a doctor or hospital? What are your sources of information? How should public policy promote quality health care providers?
Have you or your family members ever experienced difficulty paying medical bills? What do you think policy makers can do to address this problem?
In addition to employer-based coverage, would you like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare?
Do you know how much you or your employer pays for health insurance? What should an employer’s role be in a reformed health care system?
Do you know how much you or your employer pays for health insurance? What should an employer’s role be in a reformed health care system?
On the following slides are examples of the types of preventive services Americans should receive. Have you gotten the prevention you should have? If not, how can public policy help?
How can public policy promote healthier lifestyles?

Who participated in our discussion

Small business owner (<5 employees)
Retired professional (architect) – now covered under Medicare)
Retired professional – now covered under Medicare
Self-employed yacht designer
Retired surgeon – on board of Madison
US State Senator
US State Representative
Self-employed small business individual (graphic design and yoga)
Self-employed small business individual (garden design)
US Fortune 100 company manager (pharmaceuticals – strategic planning focus)
US Fortune 100 company bio-informatics manager (pharmaceuticals – bioinformatics focus)
Charity non-paid volunteer
Middle school student
Hospice nurse (now retired), but trained in UK under Dame Cecily Saunders
Pediatric/Adolescent Psychiatrist and Parent of pre-teen and teenage children

Resources provided to participants

Participant Guide for Health Care Community Discussions - http://change.gov/page/-/Health%20Care%20Community%20Discussion%20Participant%20Guide.pdf
McKinsey and Company – Accounting for cost of US healthcare - www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp
Promoting Prevention and Preempting Costs - www.americanprogress.org/issues/2006/10/pdf/health_lambrew.pdf
Goldsmith blog - http://healthaffairs.org/blog/2008/12/15/daschle-what-can-we-expect-of-the-health-czar-in-waiting/

Discussion – 1. Briefly, from your own experience, what do you perceive is the biggest problem in the health system

Lack of easy flow of health information from one practitioner to another, e.g. immunization records. HIPAA regulations have made this more difficult not easier
Amount of waste (time of practitioners, patients, caregivers) due to lack of care coordination
Coordination of care – e.g. I had breast cancer and one member of care team was not easily connected to other members (this was the patient and/or their families responsibility)
Cost of health insurance
HIPAA Regulations – makes it more difficult to share/transfer information
When you have more than one condition (e.g. Asthma and Arthritis) – lack of coordination – Asthma Doctor A doesn’t work jointly with Arthritis Doctor B
Inequity of the system – there seems to be endless discussion but no real change. We need more homogeneity – to get more fairness
Cost of healthcare – underpayment of Medicaid to providers. This is getting exacerbated because of rising Medicaid population in state of CT.
One doctor now runs a charity clinic to serve Medicaid patients
In 2007 – 450,000 people in CT without health insurance.
Connecticut Charter Oak Plan Adding Providers, but some Are concerned reimbursement rates are too low to attract physicians and hospitals (see http://www.courant.com/features/hc-susan1130.artnov30,0,7795358.column)
Health care costs are so much greater than they were in the past. Costs are not bundled – you are paying for each professional separate (surgeon, anesthesiologist, etc.)
Medicaid may pay for the surgery – but not for office visits. Reimbursement rates for Medicaid are so low, that it is better to categorize them as a charity care or write-offs
Complexity of current system generates an enormous amount of paperwork which is just administration, and does not approve the delivery of care.
Healthcare is way too expensive - $1800/month for a family plan for non-group plan
The current system really penalizes people who actively seek preventative care. Finding something wrong with you can lead to a pre-existing condition
Cost / equitability is not in current system
Individuals have no bargaining power – either pay $24,000 per annum for a family plan or buy a policy with high deductible for $10,000 per annum. Corporate plan, in contrast, is about $1200/month for family plan (75% employer/25% employee cost share)
Healthcare problems are inter-related. For example, lack of preventive care drives cost spirals. Lack of coordination of care drives costs. Ability to deny payment (due to exclusions, pre-existing conditions) leads to reluctance to seek care driving costs.
Cost of drugs

– Only 2 countries allow DTC – USA and New Zealand.
– Need more use of generic drugs – right now you have to ask. E.g. Recently my husband who is recovering from prostrate cancer had a prescription where a generic substitution was available. Our local pharmacy did not make this automatically available to us, so we had to ask

A lot of hours are spent trying to access basic healthcare services. This is not the case in Europe where basic care is more readily available and accessible

Discussion – 2. How do you choose a doctor or hospital? What are your sources of information? How should public policy promote quality health care providers?

Do not use healthcare scorecards – use personal referrals as primarily source.
If I have a health problem – first I see who is on my panel of my insurance plan. I try and find out if someone knows anyone on list – and then seek appointment with that individual.
Sometimes when multiple professionals are involved in care – some are covered by your plan, others are out-of-network
When I was diagnosed with breast cancer after a routine physical with my Primary Care Provider (PCP) – I was told to pick a surgeon (no referral). I had to look at the list of providers in my insurance plan panel. There were 6 and I had to make independent decision with little information. Due to my husband’s change of employment I then had to have both the chemotherapy and radiotherapy at yet another hospital and again had to look who was on a panel. Within the same hospital – some oncologists were on the panel and others were not. So when my oncologist was unavailable – occasionally an oncologist covering for her would not be on the panel requiring additional payment.
I use the Best of section in magazines such as Connecticut Magazine and New York magazine
I assume if a physician is on staff at Yale-New Haven Health System (www. yalenewhavenhealth.org/) they must be okay
Put in a plug for preventive mental health care for children! All data shows early treated depression and anxiety lessens illness recurrence and severity in adulthood- a huge cost saver over time! And put in a plug for in-home psychiatric services ( part of what I do), developed at Yale, which data shows prevents use of higher levels of more expensive care! And studies show kids with ADHD on appropriate medication treatment less likely to abuse drugs/alcohol and smoke!
Make insurance really portable and not conditioned on employment
Make Ombudsman role more effective. In CT, this is Office of Healthcare Advocate (see http://www.ct.gov/oha/site/default.asp)

Discussion – 3. Have you or your family members ever experienced difficulty paying medical bills? What do you think policy makers can do to address this problem?

Currently uninsured
Insurance industry (particularly HMOs) look for way to exclude payment of services

Discussion – 4. In addition to employer-based coverage, would you like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare?

Think Medicare plan is excellent and should be made available to all Americans as alternative. Not the administrative cost of running is much lower than private insurance sector.
Support expressed for access to the Federal Employees Health Benefit program http://www.opm.gov/insure/health/index.asp)
There are good government insurance programs in place

–     Medicare
–     VA Health System
–     Tricare for Life
–     DoD Healthcare

Discussion – 5. Do you know how much you or your employer pays for health insurance? What should an employer’s role be in a reformed health care system?

$1200/month for corporate family plan
Private subscription is $2000/month for family plan for one participant
Private subscription is $1800 for family plan for one participant
One participant bought annual personal plan of $10,000. Does not think this is unreasonable.
Important that reforms insure that everyone gets access

Discussion – 6. On the following slides are examples of the types of preventive services Americans should receive. Have you gotten the prevention you should have? If not, how can public policy help?

As mentioned earlier – you can be penalized for seeking preventative care as this may label you with a pre-existing condition
Preventive screening limited by lack of coordination of care and flow of information (e.g. can’t recall when last had tetanus shot, immunizations etc.)
Make pre-existing conditions restrictions only apply to individuals 18 years or older
Limited awareness of Pay for Performance (P4P) programs

Discussion – 7. How can public policy promote healthier lifestyles?

Tobacco settlement money in CT has gone into general fund. This should be refocused on child obesity (estimated at 15-20% of population)
Schools should had back in physical education class which some schools have been reducing/limiting
By mandating that every US citizen / Green Card Holder/ Other Visa holders be in some type of insurance pool this will provide more incentives to focus on management of risk.

– E.g. Fire brigades become more prevalent after fire insurance policies came into force, Shipping regulations/codes of practice came into place after establishment of insurance market at Lloyds.

People who practice preventive health behaviors/adopt healthy lifestyles should get break on insurance similar to the safe driver discount provided by auto insurance companies

Other

Beware law of un-intended consequences.

– E.g. To reduce obesity, need to reduce amount of processed foods. This would mean some new regulations for this industry (such as labeling on amount of sugar, calories etc.) which will be new burden on this sector of econom

Somehow we have to find a way to cut the cost of everything related to healthcare
Ban television advertising for drugs, other healthcare services
One of our participants who was originally from UK stated that if they wanted something they could get it a lot fast in the US than in UK