In a recent meeting of the SustiNet board organizing a universal health system in Connecticut, state Comptroller Nancy Wyman confessed she did not know the name of the Business Council of Fairfield County.
Apparently, not too many locals are up to speed on SustiNet, either, according to Wyman”™s fellow SustiNet Chairman Kevin Lembo, who is the state health care advocate. As Wyman”™s and Lembo”™s board released a draft list of committee members who will create SustiNet, Lembo indicated that some experts declined to lead the effort after being nominated by their peers to do so.
“I started to call through the list and speak to people directly to gauge their interest and the time they had to put in on this,” Lembo said. “Some folks were very much ready to go and were completely aware they were on the list. Others were surprised ”“ wondered how I got their name and number, didn”™t know who I was, didn”™t know what SustiNet was, and really didn”™t have the time, frankly, even though they are leaders in their field.”
Just 20 of the 150 initial committee members are from Fairfield County, despite a quarter of the state”™s population being located within the county”™s borders. That is partly a function of the preponderance of health advocacy groups clustered in and around Hartford and New Haven that snapped up committee seats, and partly a concerted effort by SustiNet”™s board to ensure the committees have ample representation from all eight counties in Connecticut.
Fairfield County residents hold just two of the nine initial chairs or board liaisons of committees: former Pitney Bowes Inc. CEO Michael Critelli was nominated to lead a committee on preventative health, while Dr. Richard Torres of Optimus Health Care Inc. in Bridgeport steers a committee on health care providers.
Â
“In terms of the ”¦ geographic diversity of the committees, my poor little part of the state, western Connecticut, is very underrepresented,” said Jamie Mooney, chief information officer of Norwalk Hospital and a SustiNet board member.
In response, Wyman and Lembo urged Mooney and others to recruit new committee members from physician and business groups in Fairfield County.
Â
In all, at least five committees and three related task forces will create a near-universal health system, after the Connecticut General Assembly passed a bill to do so and overrode Gov. M. Jodi Rell”™s veto, which she exercised over cost concerns.
About 150 people statewide have already been assigned to the Sustinet committees (see associated table). They face the daunting charge from the Assembly of providing insurance for nearly everyone in the state, while reducing overall health costs so that insurance premiums are held in check.
Massachusetts enacted universal health last year by underwriting relatively low-cost policies for residents there, while penalizing residents at tax time if they do not have insurance.
“The costs are just out of control because they thought just giving health insurance to everybody would kind of fix the problem,” said Sal Luciano, a SustiNet board member who is executive director of the Connecticut operations of American Federation of State, County and Municipal Employees. “Health insurance and health care are two very different things, as we know and so now they are looking at models like pay for performance. This would allow us the flexibility of doing that from pretty much from the beginning should we decide if that is the place to go.”
Â
The committee tasks
The health information technology committee has until July 2010 to establish a unified platform for electronic records in Connecticut, including making financing available to help physicians purchase or subscribe to a resulting system. The committee”™s work has already been helped along via the recent publishing of a state health-information technology plan.
Â
“This to me is a ($500,000) consulting assignment in the private sector,” said Mooney, who lives in Larchmont, N.Y. “I felt there should be a little more in here about defining who is going to put together all the specifications for the systems we need, and I am not talking about the technical stuff, I am talking about what we want the system to be able to do for the doctors.”
A second committee will focus on so-called medical homes, in which individuals are assigned health professionals to oversee their case histories and act as liaisons between specialists. The committee plans to study such systems in other states, with challenges including how to certify health professionals for the job.
By March, the committee intends to have a plan for a pilot medical home program, and to underwrite some of the costs of consultants to help physicians switch to the new model.
“I know in North Carolina and in certain other places ”“ at Duke (University) ”“ they have functional communities of medical homes, and it might be worthwhile actually reviewing what they have done,” said Dr. Bruce Gould, an associate dean of the UConn School of Medicine. “It is going to be quite an undertaking to get the present state of practices in Connecticut and bring them to that new model functionally.”
A health-quality committee will formulate a plan for hospitals and doctors to improve care, in part through reducing errors that lead to medical complications, with hospitals potentially facing unspecified incentives or sanctions depending on their performance. Physicians and clinics will likely be required to periodically review the quality of their care.
Â
The committee also plans to investigate the steps pharmaceutical companies take to win business from doctors, including any payments, gifts or free drug samples.
Â
A fourth committee will attempt to find ways to get individuals taking preventative steps to improve their health, whether through diet, exercise or regular checkups. The panel”™s work will include analyzing how to deliver services at job sites to increase the number of people who take advantage of preventative options.
“Prevention is a very difficult thing to ”˜cost,”™” said Norma Gyle, deputy commissioner of the Connecticut Department of Public Health. “It is hard to say what you are saving; but you know you are saving with prevention.”
Finally, a health “equity” committee will focus on how to improve care for racial and ethnic minorities that may not enjoy similar access to quality health care. That committee”™s membership had yet to be determined at deadline.
SustiNet is also setting up task forces to address health work force challenges, and minimizing obesity and the use of tobacco and alcohol by state residents, with Mooney citing alcohol abuse as an urgent need for the state based on admissions at Norwalk Hospital and others.
