A few years ago, patient navigators at Project Access-New Haven set out to see if they could change the course of health care treatment for some Medicaid patients who frequently used emergency rooms.
They contacted emergency departments at Yale New Haven Hospital and its Saint Raphael campus and enrolled 100 patients in their study in 2013. Those selected had visited emergency rooms four to 18 times in the past year for chest pain, abdominal pain or chronic migraines, among other ailments. The navigators at Project Access coordinated health care for the patients. They scheduled appointments with primary care physicians, provided reminders, accompanied patients to physician visits and followed up to ensure compliance with the prescribed treatment. The preliminary results were eye-opening: “We saw an average cost reduction of $153 per member per month,” said Dr. Roberta Capp, assistant professor, Department of Emergency Medicine at the University of Colorado Denver, and lead investigator of the study.
Connecticut has seen significant reductions in deaths from breast and colon cancer in the last three decades, but the state exceeds the national mortality rate for uterine cancer and three other cancers, as well as for mental health and substance use disorders. An analysis of data compiled by the Institute for Health Metrics and Evaluation at the University of Washington, published in JAMA, also shows wide disparities between Connecticut counties in death rates from certain cancers and other illnesses. Windham County had the highest mortality rates for seven of 10 cancers identified in the study as having the highest disease burden or responsiveness to screening and treatment, including pancreatic, uterine and lung cancer. Tolland County, meanwhile, had the lowest death rates for five cancers, including breast cancer, while Fairfield County was lowest for four. Similarly, deaths from chronic respiratory diseases in Windham County were nearly double the rate in Fairfield County – 63.13 per 100,000, compared to 34.15.
In 2015, the Rev. Nancy Butler, the charismatic founder of Glastonbury’s Riverfront Family Church who died earlier this month, was diagnosed with ALS, or Lou Gehrig’s disease. Neither the advanced degrees she and her husband, Gregory B. Butler, earned nor his experience as a corporate lawyer prepared them for the complexities of the health care system. “My wife gets sick and I don’t have a clue how to navigate,” Greg Butler said. “This stuff is enormously complicated. What does your insurance cover?
Blacks and Hispanics are less likely than whites to get flu vaccines, have a preventive health care visit, or receive follow-up care after being hospitalized for a mental health disorder, according to a first-of-its kind federal report that looks at health disparities among people on Medicare Advantage plans. “While these data do not tell us why differences exist, they show where we have problems and can help spur efforts to understand what can be done to reduce or eliminate these differences, ” said Dr. Cara James, director of the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health, which released the report. The report looks at 27 clinical care measures and eight patient experiences to gauge differences in treatment among whites, blacks, Hispanics, and Asians or Pacific Islanders. It has some bright spots: Blacks and Hispanics reported slightly better communication with doctors than whites did. Hispanics had higher rates than non-Hispanic whites of colorectal screenings, blood sugar testing for diabetes, and treatment for osteoporosis (among women) after a fracture.
Thousands of Connecticut residents are prediabetic but don’t know it and if they did, doctors say, early detection and lifestyle changes could prevent diabetes from developing in most people at risk. The state Department of Public Health reports that 83,000 adults in Connecticut have prediabetes, which occurs when a person’s blood sugar level is higher than normal but not high enough to be classified as Type 2 diabetes. Nearly 9 percent of adults in the state—about 257,000 people—have been diagnosed with Type 2 diabetes. Prediabetes has few early warning signs, but a blood test by a primary care doctor can detect at-risk patients. Once detected, changes in diet and exercise, sometimes with medication, can stave off the disease, doctors say.
Health insurance coverage might be more accessible and affordable in Connecticut if the state applied for certain Affordable Care Act and Medicaid waivers, according to advocates who say the options should be explored. Two waivers in particular—Affordable Care Act (ACA) Section 1332 and Medicaid Section 1115—would let the state disregard certain federal requirements, possibly lowering health care costs for some individuals, according to a policy brief commissioned by the Universal Health Care Foundation of Connecticut and the Connecticut Health Foundation. “What we need to do in Connecticut is really think about … how could we creatively, imaginatively, innovatively use waivers to expand coverage to quality care and really help improve health,” said Frances Padilla, president of Meriden-based Universal Health Care Foundation of Connecticut. “We haven’t had that conversation yet in Connecticut.”
The ACA waiver isn’t available until 2017 but the Medicaid waiver is already being used by dozens of other states to lower costs, she said. “It allows a state to get past some of the requirements of Medicaid and do some things that are innovative,” she said of the Medicaid waiver.
Kathy Navaroli, 50, of Windsor, hadn’t seen a primary care doctor in years when she decided to go for a physical this summer. She didn’t ask about preventive care screenings, such as a mammogram or Pap test, in part because she worried they might involve an insurance co-pay or deductible. Her household income is below $30,000 a year. “I got a physical, they did some blood work, and that was it,” she said. Kerrishian McCants, 31, of Hartford, a mother of four, has a family history of diabetes and high blood pressure, but has not discussed those possible risks with her doctor.
Thousands of low-income adults and children have gained access to dental services in recent years as the number of dentists accepting Medicaid and HUSKY patients has soared, according to state data. At the end of last year, there were 2,002 dentists who accepted Medicaid or HUSKY plans. That’s nearly three times the 703 dentists who accepted Medicaid or HUSKY on Dec. 31, 2008, according to the state Department of Social Services (DSS). “That’s a pretty expansive network,” Donna Balaski, director of dental services at DSS, said of the 2014 figure.
Forty-five percent of Connecticut adults in a survey released Wednesday reported that they have been diagnosed with a chronic disease such as diabetes, hypertension, asthma, heart disease or cancer. That rate was “very high,” said Frances Padilla, president of the Universal Health Care Foundation of Connecticut. She said she was also struck that 28 percent of adults aged 18 to 44 reported in the new Connecticut Health Care Survey that they have one of those serious illnesses. “With so many people reporting chronic illnesses and their complications, we have to have better access to care,’’ she said. Six health foundations released the results of a telephone survey of 5,447 adults conducted between June 2012 and February 2013.
Hypertension rates among women in all eight Connecticut counties increased from 2001 to 2009, with disparities widening for African American women compared to whites and Hispanics, according to a C-HIT analysis of data from the Institute for Health Metrics and Evaluation at the University of Washington. In fact, nearly one out of every two African American women living in Connecticut suffers from hypertension, a life-threatening condition that can lead to heart attack, stroke and kidney disease, research shows. The rising trend in hypertension coincides with increasing adult obesity rates in Connecticut and the nation, as stepped up efforts focusing on wellness — from Michelle Obama’s national physical activity campaign “Let’s Move!” to serving healthier meals at local public schools — look to stem the tide in future generations. The state findings on hypertension mirror national statistics showing black women with the highest rates. In Connecticut, health experts pointed to a mix of genetic, socioeconomic, and cultural factors as contributing to hypertension among black women.