Healthy Kids Connecticut. Insuring All The Children

Transcription

1 Healthy Kids Connecticut Insuring All The Children

2 Goals & Objectives Provide affordable and accessible health care to the 71,000 uninsured children Eliminate waste in the system Develop better ways to deliver health care to children Identify the barriers to enrollment and treatment Preventative care is more cost effective determine how we can increase preventative care?

3 Four Pillars Necessary To Improve Health Care. Efficiency in the System, Reduce waste in the system provide additional funds for more coverage Prevention and Personal Responsibility Affordability and Sustainability Accessibility and Quality care for Children.

4 Participants Legislators Health Foundations State Agencies Federally Qualified Health Clinics School Based Health Centers Physicians/heath care providers Advocates Insurance and Managed Care Companies Business Groups Hospitals

5 What Do We Already Have? Husky All identified uninsured Children are eligible for Husky School Based Health Centers, most of our large cities have at least one school based health center. Offers medical, dental and behavior health services to all, including those who are illegal or have private insurance. Federally Qualified Health Centers Provides services regardless of ability to pay One out of every 18.4 people in CT uses a FQHC

6 HUSKY: Healthcare for CT Kids The HUSKY Plan is Connecticut s free or lowcost health insurance program for children and youth up to age 19. Designed to provide health coverage to all uninsured children Other eligible groups include parents or relatives that are caregivers and pregnant women (income limits apply)

7 HUSKY Programs HUSKY A: a traditional Medicaid program Full Medicaid benefit package with no premium or co-payments Children up to age 19 with incomes up to 185% FPL Parent, relative caregiver eligible up to 150% FPL Pregnant women eligible up to 185% FPL

8 HUSKY B: medical coverage for children from higherincome families; Some co-payments Band 1 No premiums, income between 186% and 235% FPL Band 2 Monthly premium of $30 for 1 child; $50 for 2 or more children; income between 236% and 300% FPL

9 Husky B continued Band 3 group premium rate ranging from $ per month per child; incomes above 300% FPL HUSKY Plus: supplemental coverage for intensive physical and behavioral health care needs. Must be eligible for HUSKY B to qualify for Husky Plus

10 HUSKY: Benefits Package Members receive a comprehensive health care benefits package, including: Preventive care / well child exams Immunizations Prescriptions X-ray and lab tests Medical equipment and supplies Vision and dental care Physical Therapy Mental Health and Substance Abuse Services Hospital Services including emergency room care Home Health Services Family Planning Services Chiropractic Services

11 Work With What You Have Strengthen the program Stimulate them and us to do more Support and sustain with adequate funding Streamline Stipulate

12 Streamline Medicare s paperwork administrative costs accounts for approximately 5% of the healthcare dollar Doctors, hospitals, and all providers are familiar with the Medicare healthcare rules and regulations Insurance companies have no set standards, Rules and regulations vary and change frequently.

13 Streamline Insurance Paperwork The multitude of rules and regulations, The mystique of the claim processing eats up 31% of the healthcare dollar Creates unnecessary expenditures on all sides, Create Medicare rules for all insurance companies.

14 National Healthcare Number Insurance numbers can change when the patient switches insurance companies Using social security numbers invades privacy and leads to stolen identity The government should issue a National Healthcare number that stays with the citizen for life.

15 Prevention Practicing effective disease management Preventive care in Connective would save $0.9 billion per year

16 Stipulate (Electronic Medical Records) Emergency room management coupled with Web-based encrypted safe HIPAA complaint electronic medical records will save CT $5 billion per year Prevents medical errors, saves pain and suffering and saves money Prevents duplication of diagnostic tests One-third of a medical assistant s time is finding the paper medical record

17 Stipulate (continue) A significant amount of floor space is used for filing paper medical records in offices and health care facilities Free up staff time, and floor space, will save money A doctor on call at home would have access to the patient s electronic medical records, even when they are covering for another provider

18 What are some of the Problems Inadequate funding, Need to expand the system of School Based Health Systems Make sure everyone has access to a FQHC Lack of adequate preventative programs Provider fee schedules are low Difficulty finding provider who will take Husky patients

19 Research Findings Current health care spending in CT is approximately $15 billion CT fails to access millions of Federal health dollars for example SCHIP $82.1 million for CT spends more than any other state on elderly, nursing home care and less than most states on children Low-wage workers most likely to be uninsured

20 Children s Health Care Needs Children are generally healthy Need preventative care and early intervention for common health conditions, (injuries, asthma, dental caries, vision problems) Undergo developmental changes that have profound effects on future health, learning, and social function.

21 Children in Low Income Families Have Greater Health Care Needs Poor children are more likely to be: Low birth weight or preterm at birth Exposed to environmental, nutritional and other health risk factors In need of health care Uninsured

22 Health Insurance is Strongly Associated with Access to Care Compared with those who have coverage, uninsured children are Less likely to have usual source of care Less likely to have seen provider in past year More likely to have gone without needed care

23 Demographics of the Uninsured Young single adults Lower family income, earning under $35,000 Minorities were more likely to be uninsured than non-hispanic whites Hispanics comprised 40% of the uninsured Two-thirds of uninsured (19 to 64 years) were employed.

24 What We Did Raised the income limits for Husky A Expand Husky B for children in higher income families, Require automatic enrollment of uninsured newborns in HUSKY Requires the DSS commissioner to (1) develop and implement a plan for a preventive health services system for children covered by HUSKY A and B and (2) establish a child health quality improvement program to promote the implementation of evidencebased strategies by HUSKY providers to improve the delivery of and access to children's health services.

25 Spread the Risk The legislation extends, from age 22 to 26, the age to which group comprehensive and individual health insurance policies that cover children must do so. The act eliminates the requirements that children be dependent or full-time students and limits the continuing coverage to those who live in Connecticut. Except it extends coverage for children who attend accredited out-of-state colleges or who live in another state with a custodial parent.

26 End Racial and Ethnic Health Disparities The system's goal must be to improve health outcomes for all children enrolled in HUSKY reduce racial and ethnic health disparities. ensure that federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program services are provided to children enrolled in HUSKY A.

27 CHILDREN'S HEALTH QUALITY IMPROVEMENT PROGRAM DSS commissioner to establish a child health quality improvement program to promote HUSKY providers' implementation of evidence-based strategies to improve the delivery of and access to children's health services.. The evidence-based strategies must focus on physical, dental, and mental health services. They must include: ways for early identification of children with special health care needs; integration of care coordination and planning into children's health services; implementation of standardized data collection to measure performance improvement; and implementation of family-centered services in patient care, including the development of parent-provider partnerships (medical home).

28 Data Collection The legislation requires DPH to develop electronic data standards to facilitate the development of a statewide, integrated electronic health information system for use by state-funded health care providers and institutions. statewide health information technology plan that includes standards, protocols, and pilot programs for health information exchange. Health information exchange organizations are typically geographically defined entities that arrange for ways to electronically exchange health information, develop and maintain standards for this process, and develop and manage a set of contractual conventions and terms for exchanges.

29 The act defines: 1. electronic health information system as computer hardware and software that includes (a) a patient electronic health record that can be accessed in real time; (b) a personal health record through which individuals and their representatives can manage the person's health information; (c) computerized order entry technology that allows a health care provider to order tests, treatments, and prescriptions; (d) electronic reminders to health care providers concerning screenings, other preventive measures, and best practices; ( e) error notification procedures; and (f) tools to collect, analyze, and report adverse event data, quality of care measures, and patient satisfaction;

30 Continued 2. interoperability as the ability of separate systems to exchange information including (a) physically connecting to a network, (b) enabling a user who presents appropriate permission to conduct transactions over the network, and (c) enabling such a user to access, transmit, receive, and exchange information with other users; and 3. standard electronic format as one that (a) enables using health information technology for collecting clinically specific information, (b) promotes interoperability across health care settings, including government agencies at all levels, and (c) facilitates clinical decision support

31 DATA Collection 1. provide accurate, timely, and accessible health data to state and local, public and private leaders and policymakers; 2. inform citizens to improve community and individual health; 3. maintain strict confidentiality and privacy standards; 4. identify the best available data sources; and 5. coordinate the compilation of existing healthrelated data and statistics.

32 SCHOOL-BASED HEALTH CENTER GRANT requires DPH, to expand school-based health clinic services in FY 08 for (1) priority school districts and (2) health professional shortage areas and medically underserved areas. )

33 COMMUNITY-BASED HEALTH CENTER GRANTS The act requires DPH to fund infrastructure improvement grants to Community-based Health Centers, including health information technology Mobile dentistry

34 Encourage A Medical Home Include ways to create financial incentives and rewards for participating health care providers, such as case management fees, pay for performance, and for technical support and patient registry data entry. Open access

35 PA The legislation actually did a great deal more however I focused on the legislation which was a result of the Healthy Kids Committee