In Connecticut, Saving Lives Comes With an Unexpected Perk: Saving Money

Across much of the U.S., a person who’s poor, overweight and a candidate for obesity-related diseases might not visit a doctor until they’ve already contracted diabetes — that is, if they can even find a physician who will accept Medicaid, the federal health insurance program aimed at the neediest Americans.
But in Connecticut, they’re doing things differently. There, state employees actually reach out to those at the greatest risk before they’ve exhibited any noticeable symptoms, then work diligently to connect them with the right care. Doctors are paid a bonus for getting a patient to see the appropriate specialists, and out-of-the-box arrangements are made when other solutions prove necessary; a low-income senior facing eviction, for example, might be given a “prescription” of a rental voucher so that she can remain in her own neighborhood.
In treating poverty as an ailment in and of itself, Connecticut has adopted a proactive approach to improving the health of its poorest residents — and it’s saving money in the process. After switching to a rarely used Medicaid payment model, known as fee-for-service (FFS), the state faced a daunting challenge: Keep those unable to pay out of the emergency room, or see its budget eaten up by soaring medical costs.
Here’s how it works: Using the extensive data collected from all Medicaid patients, the state’s predictive modeling identifies those most in danger of expensive, chronic ailments like diabetes. Then, says Dr. Robert Zavoski, a former pediatrician who now serves as the state’s medical director, “We make sure they’re getting preventive care so that, 10 years from now, we’re not paying for dialysis for renal dysfunction and amputations for limbs that would have been better left where they were.”
After Connecticut dropped three private companies who administered its Medicaid program and decided to run the massive entitlement on its own, other states practically took bets on when the system would implode.
“They patted us on the head and said, ‘Good luck with that,’” Kate McEvoy, who oversees all of Connecticut’s public health services, recalls of the 2010 decision.
In booting private insurance companies off the job (in Hartford, a city that’s known as the insurance capital of the world, no less), Connecticut was bucking a trend. Thirty-nine other states, representing nearly three-quarters of the nation’s enrollees, have hired managed-care organizations, or MCOs, to oversee Medicaid, with even more governors pondering following suit. Of the rest, only Alaska and Wyoming have a system like Connecticut’s.
Without relying on MCOs to set standards and manage the process, Connecticut’s been on the hook for whatever care its Medicaid population requires, which can include check-ups, specialist visits and hospital drop-ins. The looming receipts have created an incentive for Connecticut to keep its poor healthy.
The tactic has already paid off in the short term and promises to deliver even bigger dividends in the future.
According to a recent analysis of federal payment data published in the journal Health Affairs, Connecticut led the nation in reducing Medicaid costs. The state’s per-patient spending on Medicaid dropped by an average of 5.7 percent each year between 2010 and 2014. One explanation is simple. “We got rid of [the MCOs’] profit and overhead,” says Ellen Andrews, the head of Connecticut Health Policy Project, a nonpartisan analyst. But officials also believe, financially and morally, they’ll do better by paying upfront.
“The old adage went, ‘If you can predict something, you can prevent it.’ And yet as a practitioner, when we look at the population of inner-city children, a lot of stuff was happening that you could predict but nobody was preventing anything,” Zavoski says. “Standing in the capital city in the richest state in the richest country in the world, that’s not acceptable.”
Under Connecticut’s FFS system, primary care doctors are given bonuses for coordinating their Medicaid patients’ care. “They don’t just say, ‘You have a heart problem.’ They’ll make an appointment with a cardiologist and follow-up,” Andrews says.
Paying out doctor bonuses won’t break the bank, but other preventive measures do involve five-figure decisions. Previously, under managed care, insurers denied coverage of top-dollar treatments — exclusions the state has now reversed. For example, Connecticut will pay $94,500 for a prescription that cures Hepatitis C, with the confidence that it will lower costs in the long run. Zavoski reasons that a one-time course of drugs, paired with education about reinfection, might be cheaper than a lifetime supply of the older pills, which put the patient at risk of severe liver and kidney damage.
Of course, the resources might not always be there. As Connecticut’s legislature faces a massive budget deficit that could slash health programs and congressional Republicans attempt to dismantle Obamacare’s expansion, Medicaid is under constant assault. But if the Nutmeg State has one lesson for the rest of the country, it’s that deferring treatment will cost us later — in dollars and in lives.
Homepage photo courtesy of Joe Raedle/Getty Images.
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The Van That’s Saving the Lives of Homeless Kids, a Better Way to Govern Locally and More

 
Mobile Clinic Serves California’s Growing Homeless Youth Population, KQED News
In the Golden State, the number of school-age homeless children has jumped by a third in just three short years. Unstable living environments wreak havoc on these youngsters, resulting in increased risk of chronic illness, mental health disorders and trauma. Doctors aboard the Teen Health Van provide free medical (both physical and mental), nutritional and substance abuse care to hundreds of uninsured and homeless youth.
In Snow Removal, a Model for Change, Governing
City officials in St. Paul, Minn., set out to improve how snow was removed from roadways, but in the process, found a smarter method of governing. The unique approach (which should be replicated nationwide) involved teams consisting of outside consultants, working pro bono, and members of the Department of Public Works, who could provide internal perspectives. (Normally, consultants work on their own to create recommendations.) The result of this public-private pairing? More effective snow removal, and innovative, restructuring changes that DPW employees embraced.
When Families Travel for Medical Care, Strangers Open Their Homes — and Arms, Stat News
Health insurance can help defray the costs of medical expenses, but little financial assistance is available for housing expenses incurred by patients and their families when they must receive life-saving treatments at hospitals far from their homes. Since 1983, the nonprofit Hospitality Homes has been connecting out-of-towners (most are low-income) with host families providing a free place to stay in Boston, where the average hotel room costs more than $100 each night.

The New Devices That Make It Easier to Follow the Doctor’s Orders

Ever forgotten to take a prescription medication before leaving for work in the morning? Maybe even accidentally skipped a whole day of antibiotics once you started feeling better? Of course you have. No harm done, right? Don’t be so sure.
Aside from the obvious dangers of someone forgetting to take medicine they need, the Atlantic estimates that the U.S. hemorrhages $100 to $300 billion dollars from medication non-adherence, or “taking too many pills, not taking enough pills, taking the wrong pills at the wrong times.” Between wasted pills, unnecessary doctor’s visits and hospitalizations, even premature deaths, this mistake is all too common.
For decades, the answer has been those plastic pill organizers with a little box for each day of the week. No more. Companies like Vitality and PillPack are invoking a 21st century consciousness to bypass the dangers — both medical and financial — posed by medication non-adherence. And with 20 percent of American adults taking five or more prescriptions, the market is poised for an easy solution.
From Vitality comes GlowCap, a device that fits over most prescription bottles and “that lights up when it’s time to take a pill, then chirps, and finally sends a text reminder,” reports the Atlantic. Soon, Vitality also plans to release the GlowPack, which will monitor adherence for sirups, inhalers, ointments and blisters packs as well.
And PillPack wants to get rid of the current script bottle entirely. Instead of providing each medication separately, PillPack is a full-service pharmacy that arranges and mails all of your medications in single-use packets labeled for the specific time they should be taken, eliminating virtually any risk of taking too much or too little of your meds. PillPack’s CEO, T.J. Parker, isn’t shy about his product’s appeal: “We have the opportunity to make everyday tasks delightful. Even something as unsexy as taking pills,” he says.
MORE: These Pharmacists Are Making Affordable Medication for All a Reality

The Doctor Is In…Your Living Room

Ever Google “stomachache” and get scared into thinking you had appendicitis? Couldn’t decide whether that rash was skin cancer or contact dermatitis? Well pretty soon, you’ll be able to scroll past the witchdoctor websites and get the expert diagnosis you need from an online doctor’s visit.
Through their “Helpouts” product, Google is currently running a pilot program that uses search terms to connect would-be patients with doctors via video conference. According to the New York Times, they’ve partnered with Scripps and One Medical, groups that are “making their doctors available and have verified their credentials.”
An accurate diagnosis isn’t the only potential benefit, either. For those who look to the private sector to rebalance American healthcare costs, Engadget.com is speculating that internet-appointments could help bring down the cost of seeing a doctor.
Jonothan Linkous, chief executive of the American Telemedicine Association points out that “between 800,000 and one million consultations will be done over the Internet directly to consumers in the United States” this year. So it’s no surprise that the tech behemoth is looking to carve out a piece of the healthcare pie.
Google isn’t the only tech giant looking to elbow into the U.S.’s $3 trillion healthcare industry. Apple’s new HealthKit records a user’s vitals and physical activity for synching with third-party health and fitness apps. And, similar to Google, Wal-mart is testing Kaiser Permanente Care Corners, a telemedicine clinic where eligible members can walk in without an appointment to confer with a doctor.
So keep your slippers and bathrobe on next time you’re home sick — and keep your laptop close by, too.

These Pharmacists Are Making Affordable Medication for All a Reality

What good is health insurance when a person can’t afford the medication they need because of an expensive co-pay? When out-of-pocket costs for prescription drugs reach thousands of dollars, a trip to the pharmacy might mean rent can’t be made that month. That’s why in 2009, former pharmacists Jeff Spafford and Edward Hensley set up The Assistance Fund, a charity that covers prescription costs for insured Americans who can’t afford their co-pay.
Spafford, who used to run a pharmacy in Orlando, Fla., recently spoke with My News 13 about how a medication can be a luxury. “Taking care of these patients, I saw more and more of them coming to me, patients who had insurance but could not afford their co-pay or their financial responsibility and as such were having to make pretty hard choices about whether or not they paid their rent, or really got access to their specialty medication,” he said.
MORE: Making House Calls to People Without Homes
The charity is able to help people in need thanks to donations from corporations, grants and drug manufacturers, the station reports. The Assistance Fund has reportedly raised more than $100 million to help more than 19,000 people across the country, such as Deborah Leigh Howie, who has Multiple Sclerosis. “The Assistance Fund helps me get Copaxone with no co-payment each month,” Howie told Good News Network. “Otherwise, I would be without treatment for MS.”
Spafford told My News 13, “It’s stories that we get from patients every day and how we’ve been able to help them and how we’ve been able to make a difference in their lives that really helps, keeps us going.” To learn more about the charity and if you might qualify for assistance, check out the group’s website here.