CT primary care redesign: What the evidence says

Early in 2023, Connecticut’s Department of Social Services (DSS) embarked on an ambitious planning process to make significant changes to primary care delivery and payment in our state’s Medicaid program. DSS’s planning committee meeting materials and recordings are available here.

In Connecticut, there have been differing perspectives about the status of primary care, Medicaid and beyond, and what the problems are. Consumer advocates, state agencies, and primary care providers disagree on the specific concerns, the strengths of the current system, the scope of needed change, and whether primary care reforms should be a priority over other pressing problems.

DSS’s goals for reform are to:

• Improve the biopsychosocial health and well-being of our members – especially for our most historically disadvantaged members and in a way that reduces inequities and racial disparities.
• Be fiscally responsible and sustainable relative to the no- reform baseline. Any increases in primary care spending should be offset by savings from improved member outcomes and not by restricting access to services.

(DSS presentation to the Primary Care Advisory Committee, 4/6/2023, Slide 6)

Other goals that have been voiced by Committee members and other stakeholders throughout the process include:

• Address patients’ social needs, connect to and coordinate with community services
• Ease the financial and administrative burdens on primary care practices
• Reduce unintended consequences and retain what is working, identify underserved populations and increase access there – e.g., people with developmental disabilities
• Empower Medicaid members to improve and maintain their health, offer better options
• Reduce overservice – provision of unnecessary care that can cause harm
• Reduce underservice – lack of access to appropriate, necessary care that is proven effective
• Increase specialist engagement with primary care and increase access to specialists for patients
• Increase the number of patients accessing primary care and attributed to a primary care provider
• Increase the percent of Medicaid primary care providers practicing in person-centered medical homes, a proven initiative to improve care while lowering costs, in Connecticut Medicaid and beyond

To inform the process, the CT Health Policy Project will be collecting evidence on primary care reforms in other states and programs as well as offering promising options.

Part 1 — Connecting with community services to improve health — September 12

Part 2 — Primary care payment reform performance in other states and programs — October 12

Part 3 – Current Connecticut Medicaid primary care performance

Part 4 – Promising options — November 21