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| Public Policy | Connecticut | Federal |
In many cases, federal reform will be implemented at the state level, allowing Connecticut to choose an approach that meets the needs of our residents. At the same time, there are many state-based initiatives underway to achieve the goals of access, lower cost, better care and better health. Success will require unprecedented cooperation among different state departments and between state government and the private insurance and delivery system.
The establishment of the SustiNet Health Care Cabinet and the Office of Health Reform and Innovation, through the passage of PA 11-58, An Act Concerning Healthcare Reform, was intended to assure that Connecticut will take a coordinated, integrated approach to improving health and health care. Cabinet members were appointed in September, 2011. The cabinet is chaired by Lt. Governor Nancy Wyman and its work is supported by the Office of Health Care Reform and Innovation (OHRI). The cabinet is composed of public, private and non-profit stakeholders.
State government, as a major purchaser of health care and insurance coverage, can drive health system improvement, but it cannot succeed without the cooperation and buy-in of the other participants in the system, including health care providers, insurers, employers who purchase or provide insurance, and consumers. Success – especially in times of economic constraint and volatility -- depends on the public and private sectors working together to establish and coordinate the use of incentives that produce the outcomes they seek, to partner to collect and analyze data to measure progress and to seize funding opportunities as they arise.
Several specific charges to the SustiNet cabinet are laid out in PA 11-58 to promote health delivery system change and new insurance options including:
- Coordinate with the Office of Health Reform and Innovation concerning the effectiveness of delivery system reforms and other efforts to control health care costs, including, but not limited to, reforms and efforts implemented by state agencies;
- Advise the Governor on matters relating to: (A) The design, implementation, actionable objectives and evaluation of state and federal health care policies, priorities and objectives relating to the state's efforts to improve access to health care, and (B) the quality of such care and the affordability and sustainability of the state's health care system.
- Develop a business plan to be provided to the Governor and the Office of Health Reform and Innovation that… evaluates private or public mechanisms that will provide adequate health insurance products commencing on January 1, 2014, including, but not limited to, for-profit and nonprofit organizations, insurance cooperatives and self-insurance. The law specifies that the plan must be completed by October 1, 2012.
To follow the work of the cabinet, click here.
The health reform law also specifies that working groups can be established to make recommendations concerning the development and implementation of service delivery and health care provider payment reforms, medical homes, electronic health records and evidence-based health care quality improvement. The following work groups have been established:
- Business Plan Development
- Connecticut Initiative
- Delivery System Reform
- Health Technology
- Statewide Multi-Payer Data Initiative
Learn more about workgroups here.
In addition, PA 11-58 calls for the creation of a Consumer Advisory Council to monitor and provide input to the work of the SustiNet Cabinet and the Health Insurance Exchange Board, and the Office of Health Reform and Innovation.
The Office of Health Reform and Innovation (OHRI) is charged with coordinating and implementing Connecticut’s responsibilities under state and federal health care reform. OHRI is housed in Lt. Governor Nancy Wyman’s office and is managed by Jeanette DeJesus, Special Advisor to the Governor on Health Reform and Director, Office of Health Reform & Innovation. Learn more.
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The eleven member SustiNet Health Partnership Board was established in 2009 by PA 09-148 to carry out state-based health care reform. The Board was empowered to develop implementation recommendations for a public health insurance plan, originally envisioned in a policy brief published by the Universal Health Care Foundation. Learn more.
The SustiNet plan – named from the state’s motto-- was envisioned to be a publicly administered health plan that would provide coverage to Connecticut’s uninsured and underinsured residents. This new insurance vehicle would also be designed to slow the rate of health care cost growth and improve quality of care through the implementation of delivery system reforms and public health initiatives. It would be offered as an option in the health insurance exchange required by federal reform. In addition, the same delivery system reforms would be applied to the coverage of state employees and Medicaid recipients. Eventually the health care system in Connecticut would serve all residents more efficiently and effectively.
The Board also convened eight advisory committees and task forces:
- Health Disparities and Equity Advisory Committee
- Health Information Technology Advisory Committee
- Patient Centered Medical Home Advisory Committee
- Preventive Healthcare Advisory Committee
- Healthcare Quality and Provider Advisory Committee
- Healthcare Work Force Task Force
- Tobacco and Smoking Cessation Task Force
- Childhood and Adult Obesity Task Force
The final report of the board and committees, issued in January 2011, can be found here.
The work of the SustiNet board is moving forward in many ways, including through the SustiNet Health Care Cabinet and the Health Insurance Exchange Board.
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In 2014 individuals without insurance coverage and small employers will be able to purchase insurance through Connecticut’s health insurance exchange. Planning for the establishment of the exchange is well underway with start-up costs completely covered by ACA grants. To-date Connecticut has received over $7 million for exchange planning and implementation, with further funding anticipated in 2012. The exchange must be ready to enroll people by the fall of 2013, so that coverage will be available on January 1, 2014. By 2015, one year after the exchange is fully operational, the exchange must be financially self-sustaining and will no longer be able to rely on federal funding.
Legislation (PA 11-53) was passed in the 2011 General Assembly session to establish a quasi-public authority to operate the exchange in Connecticut. The governing board has been appointed and began meeting in September, 2011. Many significant policy decisions will be made by the governing board in the next two years to assure that Connecticut establishes an exchange that is responsive to the needs of individual and small business consumers, maintains an adequate choice of quality, affordable plans, guards against adverse selection, and is ultimately financially self-sustaining.
This is one of the most challenging parts of implementing the exchange in that it will require huge changes to the current enrollment and eligibility processes within the Department of Social Services (DSS), as well as significant upgrades to the Medicaid information system. The federal government will cover 90% of the costs of the computer system upgrade.
The New England states received an “Early Innovator” grant from HHS to work on this very complex task. The Early Innovator Grant Project will create a learning collaborative where participating states can share and develop cutting edge and cost-effective technology components and best practices. Massachusetts, which already operates a health insurance exchange, the Massachusetts Health Connector, is the lead state for this grant.
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