Care Management
Advocates offer recommendations for Medicaid shared savings future
The first year of Connecticut Medicaid’s PCMH Plus experiment in shared savings was disappointing. The program cost the state at least $1.3 million extra tax dollars and quality did not improve compared to Medicaid members outside the program. Every Accountable Care Organization (ACO), regardless of savings or quality improvement, was rewarded with a payment. The…
Read MoreBetter, safer ideas to support primary care in Connecticut
Download the report Primary care is the foundation of the health system. It is, or should be, patients’ first interaction with the healthcare system for non-urgent issues. There is strong evidence that care coordination linked to primary care practices, such as patient-centered medical homes (PCMHs), foster improved health while lowering costs.[i] Areas with more primary…
Read MoreSIM primary care capitation proposal gets another tepid reception
This week, SIM presented to the Healthcare Cabinet their proposal to capitate primary care, initially for Medicare members, but eventually for all state residents. The proposal is to move primary care to capitated “bundles” – one for basic primary care services and a voluntary, supplemental payment for expanded activities such as infrastructure and HIT and…
Read MorePCMH+ update: discussions ongoing to fix problems
At yesterday’s MAPOC Care Management Committee meeting, DSS and Mercer reported on their plans for PCMH+, the controversial shared savings Medicaid program. A workgroup has been meeting at DSS to drill down on what didn’t work. DSS has lobbied the Governor to include a new Wave 3 to update the current program in his budget…
Read MoreCTNJ: ACOs may be the new HMOs, And they need a watchdog
Care for a growing number of Connecticut residents is being directed by an Accountable Care Organization (ACO) and very few patients know it. Read more
Read MoreSeven years later, Connecticut Medicaid still saving taxpayers money
Download the report As with most health care in Connecticut, Medicaid spending was rising quickly before 2012 growing by almost half over the prior four years. But in 2012, Connecticut made a remarkable and unique move — Medicaid switched from a capitated payment model using private insurers to a care coordination-focused, self-insured payment model. Since…
Read MoreMixed results from great study on Medicaid behavioral health interventions
Yesterday’s MAPOC Complex Care Committee meeting focused on results of an adult high behavioral health need member initiative by Beacon, Medicaid’s behavioral health administrator. The program serves high utilizers of hospital services with behavioral health needs providing intensive care management by teams of clinicians and peer specialists. Medicaid members with high behavioral health needs were…
Read MoreComments to DSS opposing increase in PCMH Plus funding for program that didn’t improve quality and increased state costs
Read the full comments Thank you for this opportunity to oppose this amendment to add an additional $600,000 to the growing costs of PCMH Plus, the experimental new Medicaid shared savings program. The state cannot afford to spend more on this program that, in 2017 its first year, did not improve the quality of care…
Read MorePCMH Plus Year 1 Performance and Savings Results: Increased state costs but little evidence of impact on quality
Read the full report This month, Connecticut Medicaid announced the first year performance of PCMH Plus[1], their controversial new shared savings program[2] compared to the prior year. Under shared savings, if health systems (ACOs) are able to lower the cost of their members’ care, they receive a bonus equal to half those savings. PCMH Plus…
Read MoreAdvocates get no answers to questions about HUSKY experiment
Last month, a group of independent consumer advocates, the Medicaid Study Group, sent questions to DSS about the impact of PCMH Plus, their new $10.8 million experimental program of shared savings in HUSKY. Advocates have been concerned about PCMH Plus’s potential to deny needed care, raise costs in the program, and erase hard-won progress. Questions…
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