As New York Moves to Reshape its Electricity System, a Focus on Renewables, and Jobs

Two years ago, New York Gov. Andrew Cuomo launched Reforming the Energy Vision (REV), a bold plan to restructure the electricity system to accelerate the development of cleaner forms of power, enhance the grid’s resiliency to severe weather and improve affordability for residents throughout the state.

At a recent energy conference in New York City, state officials provided details on the programs devised to support REV, and help the state meet a series of ambitious 2030 goals:

  • Reducing greenhouse gas emissions 40% from 1990 levels (and 80% by 2050);
  • Deriving 50% of all energy in the state from renewable sources; and
  • Lowering energy consumption in buildings 23% from 2012 levels.

Projects intended to help the state meet its 2030 targets include a 10-year, $5 billion Clean Energy Fund and a $1 billion New York Green Bank, a state-sponsored entity that was launched to partner with private sector lenders to support renewable-energy projects. The bank has received proposals for some $4 billion in clean-energy financing for projects throughout the state, said John Rhodes, President and CEO of the New York State Energy Research and Development Authority, during the conference. The event was organized by the Advanced Energy Research & Technology Center at Stony Brook University.

New York is also pouring funds into the development of microgrids – local energy networks that can separate, or “island” from the grid in the case of an outage, and keep electricity flowing to critical buildings. Microgrids are powered by onsite sources of generation, such as combined heat and power, and can easily incorporate solar and other forms of renewables. The NY Prize competition awarded $40 million to 83 communities to conduct feasibility studies for developing and installing community microgrids; a second phase of the program is now accepting applications.

One of the foundational elements of REV is to make clean energy and energy efficiency integral rather than ancillary to basic system planning and operations, and to provide consumers with the opportunity to play a more active role in their power use. Through a regulatory overhaul, REV envisions a dramatic transformation of the current electricity system, which for much of the last century has been powered by large-scale fossil-fuel plants located far from demand, or load, centers.

Continue reading on Green Matters.

Rich/Poor Life Expectancy Gap Depends on Where You Live

The richest 1% of Americans live 14.6 years longer, on average, than those with the lowest 1% of incomes and that gap is growing. While this disparity is well-known, the reasons are not well-understood. The Health Inequity Project is working to change that. Publishing their results in JAMA, researchers from across academia joined forces to map income disparities in life expectancy finding wide variation across the US. Rich Americans’ life expectancy is growing regardless of where they live, but gains and losses for poor Americans vary considerably by geography. Some large cities are making good progress extending the lives of the poor. New York City leads the nation with the highest life expectancy for low-income 40 year-olds. However in other regions, poor residents have lifespans closer to very poor countries and are losing ground. The ERC region does relatively well, with most regions at average or better life expectancies for the poorest citizens. Improvements correlate with reducing health risks such as smoking and obesity, and with local circumstances such as public health programs and education. The authors argue that health equity efforts need to happen at the local level as well as nationally.

Bottom income quartile life expectancy at age 40, men and women among largest 100 US Counties by population – CSG/ERC region
Rank among top 100 counties County State Life expectancy at age 40
1 Queens NY 82.6
2 Kings NY 82.6
3 Montgomery MD 82.2
4 Nassau NY 82.0
5 Bergen NJ 81.9
6 New York NY 81.8
7 Westchester NY 81.8
11 Suffolk MA 81.5
22 Fairfield CT 80.9
23 Suffolk NY 80.8
25 Middlesex MA 80.7
26 Essex MA 80.7
27 Middlesex NJ 80.6
31 Hudson NJ 80.4
32 Essex NJ 80.4
33 Norfolk MA 80.4
35 Bronx NY 80.3
36 Monroe NY 80.3
41 Monmouth NJ 80.1
43 Providence RI 80.1
50 Hartford CT 79.8
52 New Haven CT 79.6
54 Montgomery PA 79.6
56 Prince Georges MD 79.6
58 Bucks PA 79.6
63 Worcester MA 79.3
70 Erie NY 78.9
78 Baltimore MD 78.6
80 Allegheny PA 78.6
83 Philadelphia PA 78.3
88 Baltimore City MD 78.1

Update – Palliative Care Webinar time change

Due to an unavoidable conflict, the time for the webinar: The Potential of Palliative Care for People with Serious Illness by the MAPOC Complex Care Committee will be an hour later than originally scheduled. The webinar will still be on May 9th but will be at 10:30 am. All registered participants should have received an email about the change. Registrants will receive a link to the slides and video after the webinar, whether or not they can attend. We apologize for any inconvenience. Click here to register.

 

Palliative care offers great potential to improve and extend the lives of people with serious illness, allowing them to get care at home if they wish, while controlling costs. In addition to her considerable expertise and knowledge, Dr. Diane Meier is an enthusiastic advocate for palliative care. She directs the Center to Advance Palliative Care in addition to her position on the faculty at the Icahn School of Medicine at Mount Sinai in New York City. Among many awards, she won a 2008 MacArthur Fellowship. Join the us May 9th at 10:30 am to hear from Dr. Meier about the potential of palliative care and how it could benefit seriously ill Medicaid members.

Private employer costs higher in ERC region, but health costs are less of the total

According to the US Bureau of Labor Statistics, employers in New England and the Mid-Atlantic states paid the highest total compensation per worker in December 2015 averaging $38.14 and $37.62/hour respectively; well above the US average of $31.70. Health insurance costs were also highest in New England and the Mid-Atlantic states, but not as a percent of total compensation. Health insurance was 7.7% and 7.8% of total compensation in New England and the Mid-Atlantic states, respectively. In comparison, health insurance comprised 8.5% of total compensation in West South Central states (AR, LA, OK and TX), 8.3% in West North Central states (IA, KS, MN, MO, NE, SD and ND) and 8.2% in East South Central states (AL, KY, MS and TN). Nationally, life and disability insurance costs sixteen times less than health insurance benefits.

Large increase in Medicaid dental access for children across states

From 2000 to 2013, the percent of children covered by Medicaid with a dental visit grew in every state, according to a report by the American Dental Association. Still just under half of American children covered by Medicaid visited a dentist in 2013. Among all states, in 2013 children in Connecticut’s program were the most likely to have had a dental visit at 64%. Children in Maryland saw the greatest increase in access to dental care rising 46 points between 2000 and 2013, despite only one in four Maryland dentists participating in the program. Vermont saw the greatest rise in private dental plan charges from 2003 to 2013, while dental plan costs dropped significantly in Rhode Island for both adults and children over that decade. Half of the top ten states in dentists per population are in the Eastern Region.

Children covered by Medicaid with dental visit in last year (2013) Dentists participating in Medicaid for children (2014) Dentists per 100,000 population (2013)
Connecticut 64% 46% 76.2
Delaware 49% 55% 45.4
Maine 43% 42% 52.2
Maryland 58% 25% 71.9
Massachusetts 58% 39% 78.0
New Hampshire 60% 45% 64.0
New Jersey 50% 24% 81.2
New York 43% 38% 73.5
Pennsylvania 45% 68% 60.2
Rhode Island 47% 45% 53.7
Vermont 60% 76% 58.2
US average 48% 42% 60.5

Disparity Between Ag Jobs and Millennial Interest

A recent report by Purdue University estimated that for graduates with a college degree or higher in the areas of food, agriculture, renewable natural resources, or the environment there would be an estimated 57,000 annual job openings from 2015-2020. With an average of 35,000 U.S graduates entering agriculture related careers, this still means over 22,000 positions will be left unfilled annually, highlighting the growing disparity between the Ag industry and millennials seeking jobs.

According to a survey conducted on behalf of Land O’ Lakes Inc., only 9 percent of millennials and 3 percent of college graduates would consider a career in Ag.

Read the report from Purdue.

Read the press release from USDA.

Read the press release from Land O’ Lakes Inc.

Webinar: The Potential of Palliative Care for People with Serious Illness

Palliative care offers great potential to improve and extend the lives of people with serious illness, allowing them to get care at home if they wish, while controlling costs. In addition to her considerable expertise and knowledge, Dr. Diane Meier is an enthusiastic advocate for palliative care. She directs the Center to Advance Palliative Care in addition to her position on the faculty at the Icahn School of Medicine at Mount Sinai in New York City. Among many awards, she won a 2008 MacArthur Genius Fellowship. Register for the webinar May 9th at 9:30 am and hear from Dr. Meier about the potential of palliative care and how it could benefit seriously ill Medicaid members.

Northeastern physicians lowest paid in US

According to Medscape’s 2016 Physician Compensation Survey, at $266,000 physicians from Northeastern states have the lowest incomes in the US, closely followed by their colleagues from Mid-Atlantic states at $286,000. Among ERC states, only New Hampshire (2nd highest) was in the top ten states for physician compensation, while Rhode Island (lowest), Maryland, Massachusetts, New York and Vermont were in the bottom ten. Medscape reports that uneven distribution between physicians and patients drives compensation levels. Just over half (52%) of US physicians believe that their compensation is fair. Specialists tend to make more than primary care doctors; highest paid are orthopedists while pediatricians make the least. Dermatologists are most satisfied with their career, while nephrologists tend to be least satisfied specialty. In very good news, 77% of self-employed and 84% of employed physicians report that they are taking new and keeping current Medicare and Medicaid patients, up from 64% and 79% respectively last year. Most physicians spend between 13 and 20 minutes with each patient, which has been relatively stable since 2011. Over half of US physicians spend at least ten hours each week on paperwork and administration. Only 30% regularly discuss treatment costs with patients. The survey included 19,200 physicians across 26 specialties.

April Health Affairs features CT state employee VBID plan results

An evaluation of CT’s state employee Health Enhancement Program (HEP) published in Health Affairs found improved access to primary care, reductions in ED use, and better medication adherence but has not produced savings. HEP is an early adopter of the Value-Based Insurance Design (VBID) model, linking consumer costs to the value of care. Implemented in 2011, HEP encourages preventive care and chronic care disease management with lower premiums and deductibles combined with $35 copays for non-emergency ED visits. Before HEP, per person spending in CT’s program was $7,914, far higher than a matched comparison group from other state employee programs at $4,375, almost three times as many CT state employees had high health costs (over $50,000), and ED use was 56% higher. Over 98% of members enrolled in HEP and utilization of preventive care rose significantly. ED visits dropped by a modest amount while visits in the comparison group rose. Results for members with chronic conditions were mixed and modest. Not unexpectedly, in the first two years costs per person rose – by $730 in the first year and $961 in the second. The authors suggest that this is due to increases in use of preventive care and plan administrators expect to benefit in the long term from this investment in the health of employees.

CEPAC meeting affirms the value of outpatient palliative care, but more research is needed

At yesterday’s meeting in Hartford, CEPAC took a deep dive into the clinical and cost effectiveness of palliative care delivered in outpatient settings.

From CEPAC’s report, “Palliative care is a management approach that provides symptom relief and comfort care to patients with serious or life-threatening illnesses, with the goal of improving quality of life for both patients and their families. Unlike hospice care, which is typically restricted to individuals with a prognosis of survival of six months or less, palliative care can begin at diagnosis and is often provided along with treatment aimed at prolonging life, such as chemotherapy or radiation for cancer.  One of the primary objectives of palliative care is to help patients prioritize their goals of care, and may include conversations around advance care planning (e.g., a “living will”) depending the anticipated disease trajectory.”

The group voted unanimously that there is evidence to demonstrate some forms of outpatient palliative care treatment are effective at improving the quality of life and reducing hospitalizations and ED use. The majority also voted that outpatient palliative care is a high value treatment. But members expressed concern that more research is needed to persuade payers to cover it. Other concerns included workforce capacity challenges, time for training busy primary care providers in palliative care, and teasing out which parts of the model are critical to success. Aetna described their successful Compassionate Care program which has an impressive record of improving the quality of life for people and their families facing serious illness, as well as saving money.

 

Evidence is growing that palliative care can prolong life as well as support patients who choose to remain home. For more on the issue, read CEPAC’s Palliative Care: Barriers, Opportunities and Considerations for Quality Improvement.