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I moderated a panel of 5 state agency leaders yesterday. We talked about health, disparities, costs, and the role of employers. It was part of the @GNHCC's #BigConnect event.
Since I couldn’t live tweet the discussion, here are some highlights.
Since I couldn’t live tweet the discussion, here are some highlights.
We talked about a lot of topics but one of the most resonant was health disparities. CT is generally a very healthy state, according to overall data, but a deeper look shows huge disparities, especially by race and ethnicity.
@ctdph Commissioner Renee Coleman-Mitchell noted that babies born to black women are 4x as likely to die before turning one than babies born to white women. That's just one of many stark disparities.
Disparities are often attributed to "social determinants of health" – nonmedical factors that affect health, such as housing, transportation, neighborhood safety, food security, etc.
But Coleman-Mitchell said that doesn’t fully explain them.
But Coleman-Mitchell said that doesn’t fully explain them.
Coleman-Mitchell: Even controlling for socioeconomic status, people of color face significantly worse health outcomes. Ex: black women w/ a college degree or more are 1.6x more likely to die from a pregnancy-related cause than white women w/o a HS degree. https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm?s_cid=mm6835a3_e&deliveryName=USCDC_921-DM8344
So if socioeconomic status and other social factors don’t explain the disparate outcomes, we need to look at another culprit: Racism. Coleman-Mitchell noted there’s research on the physiological effects of experiencing racism and discrimination. https://www.npr.org/2017/10/28/560444290/racism-is-literally-bad-for-your-health
CT Insurance Commissioner Andrew Mais echoed Coleman-Mitchell's remarks and noted that there’s also disparate treatment in medicine, with people of color generally receiving less aggressive treatment than white patients.
Mais added that this disparate treatment can be compounded by algorithms that provide care recommendations based on current usage and treatment patterns, which institutionalize disparate treatment. https://www.washingtonpost.com/health/2019/10/24/racial-bias-medical-algorithm-favors-white-patients-over-sicker-black-patients/
Mais also related to the issue in a personal way: I’m only here, he said, bc medical guidelines changed for African Americans and allowed me to get a cancer screening covered by insurance. It found a tumor at a stage that was far more survivable than had it been found later.
To address disparities, we need to measure outcomes by race, ethnicity, language preference, as well as sexual orientation and gender identity, said @VickiVeltri of @OHS_CT. (Acronym alert: REL and SOGI!)
(Shameless plug: Stay tuned for a report on disparities in CT and what we can do from @cthealth in January!)
@CTDMHAS commissioner Miriam Delphin-Rittmon noted that some people don’t feel comfortable in traditional health care settings. Her department supports street psychiatry on the New Haven Green to reach people who are probably not getting care otherwise. http://c-hit.org/2018/04/25/street-medicine-helping-the-homeless-where-they-live/
Coleman-Mitchell made the case for why employers should care about public health: It affects the health of the workforce and productivity. Childhood asthma might not sound like a business issue, but it leads to kids being absent from school, which means parents miss work.
We also talked about health care costs and the role of employers. One of the elephants in the room on health care: Health care is a big employer and economic driver. It’s also a huge cost problem.
Veltri said costs are a problem for everyone; even health care providers struggle to pay for health care coverage for their employees. Many hospitals use a narrow-network plan for their own workers. Costs are unlikely to go down, but we can slow the rate of growth.
A health care cost growth benchmark could be helpful, as Mass. has, Veltri said. It could help pinpoint outliers in cost and help target action. It’s not as aggressive as rate-setting.
More on the idea of a benchmark for health care costs: https://www.journalinquirer.com/politics_and_government/ways-to-make-health-care-more-affordable-explored-at-forum/article_5599309c-07c4-11ea-b8d7-63cddf543188.html
More on the idea of a benchmark for health care costs: https://www.journalinquirer.com/politics_and_government/ways-to-make-health-care-more-affordable-explored-at-forum/article_5599309c-07c4-11ea-b8d7-63cddf543188.html
Mais said the state needs more tools to address health care costs, and he said he supports a benchmark.
CT has a process to review insurance premiums, but those are a reflection of other costs – hospitals, docs, RX, etc.
CT has a process to review insurance premiums, but those are a reflection of other costs – hospitals, docs, RX, etc.
So what can employers do about costs? Veltri noted that employers can have leverage on health policy issues, especially larger employers, since they pay for coverage. They could play a much bigger role on cost discussions.
Another recommendation from Veltri: The workers’ comp system exists separate from the rest of health care. We need it to be coordinated. Workers often get treated by one provider through workers’ comp and their PCP never finds out about it.
Veltri also noted that employers can use their leverage with their health plan providers to ask them to collect race, ethnicity, language, sexual orientation, gender identity data and track health outcomes by these factors.
Delphin-Rittmon talked about @CTDMHAS work to promote recovery-friendly communities. 10 communities are now doing this. Examples include having leadership committed to supporting people in recovery and info on town website. Here’s Danbury’s https://www.danbury-ct.gov/recovery/
DMHAS now has funds from the Dept of Labor to work on recovery-friendly workplaces to help support people in recovery with behavioral health issues. Delphin-Rittmon said examples include offering flexible schedules so people can attend 12-step meetings.
Recovery-friendly workplaces & communities also involves learning about language that doesn’t perpetuate negative stereotypes about people with behavioral health issues, who often feel stigma about themselves, Delphin-Rittmon said. To learn more: https://www.ct.gov/dmhas/cwp/view.asp?a=2901&q=335084
Mental health parity is another big issue. A report this week emphasized the challenges people face getting affordable behavioral health treatment. Mais acknowledged that it’s a problem, even as his dept enforces CT’s mental health parity law. https://khn.org/news/affordable-mental-health-care-its-getting-even-tougher-to-access/
A big problem, Mais said, is the lack of behavioral health providers who accept insurance. A lot more work needs to be done in that area.
He urged anyone facing problems to get in touch with his dept: https://portal.ct.gov/CID/Consumer-Affairs/File-a-Complaint-or-Ask-a-Question
He urged anyone facing problems to get in touch with his dept: https://portal.ct.gov/CID/Consumer-Affairs/File-a-Complaint-or-Ask-a-Question
We also talked about Medicaid, which covers more than 850k people (1/5 state residents). Kate McEvoy, the state’s Medicaid director, acknowledged that Medicaid is a big part of the state budget, but said it’s important to understand why.
Most Medicaid clients are parents and their children. Their costs are relatively low. Seniors and people with disabilities make up ~10% of Medicaid clients – and 40% of the costs, with a lot of spending on nursing homes, other long-term care.
CT actually spends a low proportion of its budget on Medicaid than any other New England state, McEvoy said. Here’s more from a presentation on Medicaid financial trends: https://www.cga.ct.gov/ph/med/related/20190106_Council%20Meetings%20&%20Presentations/20190208/HUSKY%20Financial%20Trends%20MAPOC%200208.pdf
So what about Medicaid work requirements? McEvoy said CT has not embraced them, in part because most working-age adults in Medicaid already work and studies show Medicaid coverage actually helps people be able to work. Her dept views Medicaid as a platform to employment.
Made it this far? Thanks for reading! Thanks also to all the panelists, who taught me stuff I didn't know, and to @GNHCC for hosting us.
