Care Management

Rest of US catching up with CT – Medicaid managed care doesn’t work

Two Health Affairs blog posts highlight the disappointments states are having with their capitated Medicaid managed care programs. Managed care across the US is growing fast, making big profits for private insurance companies, promising improved health outcomes and lowering costs. But CT found exactly the opposite effect when we shifted away from capitated managed care…

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Committee develops care plan best practices recommendations for Medicaid

The Complex Care Committee of CT’s Medicaid Council has made recommendations to DSS for careplans in the Medicaid program. The importance of effective care plans has arisen often throughout the committee’s work diving deep into barriers to care for Medicaid members with complex health needs. Effective care plans ensure that people are driving decisions about…

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CTNJ: Advocates must inform consumers of risks when the state won’t

This week, independent advocates launched PCMHPlusFacts.org, a campaign to give HUSKY members balanced information about an experimental, new payment model expanding across the program. PCMH Plus has risks for consumers along with possible benefits, but HUSKY members aren’t aware of them or that they have the right to opt-out of the new payment model. Read more

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Webinar on new HIE for Connecticut

For years, Connecticut providers and payers have been begging for a functional Health Information Exchange (HIE). An HIE allows providers delivering care to each patient to share information, notes, careplans and lab results. A functional HIE should help coordinate care, lower costs, avoid duplication and overtreatment, and make everyone’s lives easier. Despite numerous attempts, many…

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Quality challenges remain in CT Medicaid PCMHs

Also at Friday’s meeting, DSS reported on a selection of quality results from 2015, highlighting concerns. The results compared quality measures for patients receiving care from private practice and community health center Patient-Centered Medical Homes. In other programs, PCMHs have improved quality performance over non-PCMH practices. There remains a lot of room for improvement. Only…

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Community Care Teams addressing high-cost Medicaid member needs

Friday’s MAPOC Complex Care Committee meeting focused on Community Care Teams (CCTs) that collaborate across social service to help people with complex health problems. So far, seven CT communities are developing or already operating CCTs that focus on frequent ED visitors. The CCT teams include hospitals, behavioral health and primary care providers with community resources…

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Advocates’ Medicaid Study Group offers recommendations for Medicaid shared savings reform

Over a dozen Connecticut independent consumer advocates representing diverse populations and issue areas spent the last several months diving deep into Medicaid shared savings and today released recommendations for our state’s program. The Medicaid Study Group formed early in 2015 in response to a request from the Co-Chairs of the Medicaid Council’s Care Management Committee to…

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Advocates’ guide to underservice recommendations

Connecticut’s State Innovation Model (SIM) is seeking to radically transform our state’s $30 billion health system by aligning incentives to build value. SIM has chosen a shared savings payment model for those reforms. Advocates are concerned about incentives to deny necessary care under the new payment model, as happened in the past. SIM’s Equity and…

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Advocates’ guide to underservice recommendations

SIM is seeking to radically transform our state’s $30 billion health system and has chosen a shared savings payment model for those reforms. Advocates are concerned about incentives to deny necessary care under the new payment model, as happened in the past. SIM’s Equity and Access Council was charged with developing protections to limit and…

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