Community health centers still struggle with ED visits

As in the past, Medicaid patients of Connecticut’s community health centers are far more likely to visit an ED than other Medicaid patients, according to a presentation by CHNCT at Friday’s Medicaid Council meeting. While rates have decreased a bit, the very large gap in ED use rate between clinic patients and other Patient-Centered Medical Homes, non-PCMH practices and even unattributed members without an attachment to primary care hasn’t changed. Responses to the chart, when it was highlighted in discussion, included concerns that people are busy, rising behavioral health issues, and a survey that patients want to visit a site that can also provide lab and other tests. However, none of those reasons explain the large difference between clinic and other patients. Community health centers receive far higher payment rates for patient visits than community providers. Interventions offered that could make a difference include same day visits and walk-in services and Patient Ping, a service that alerts providers when their patients visit an ER.

CHNCT also described their successful care management programs that are managing care, keeping people with complex needs out of the hospital and ED, attracting more providers to the program, engaging members, and supporting Person-Centered Medical Homes.

A presentation on quality performance and savings payments to ACOs in PCMH+ was also offered. Questions were raised about differences in 2017 costs per member and 2017 risk scores by ACO between this report and last year’s report. A question was also raised about the statewide benchmark that determines if the program saved money or cost the state more. The presentation reports that 2018 PCMH+ per member per month costs rose by 2.66%. The presentation also reports that statewide all Medicaid per member per month costs rose by 2.99% last year when OPM is reporting a 2.5% increase – a significant difference in a very large program. Questions were also raised about why a matched comparison group is missing from financial calculations this year, unlike the past report. However, PCMH (no Plus) quality results are reported in comparison to PCMH+. Concerns were raised about underservice, especially reductions in dental care for PCMH + members relative to other Medicaid members over both years. Concerns were also raised that both years, risk scores meant to indicate health status have gotten worse for PCMH+ members relative to the rest of the program, again potentially indicating underservice. More analysis and questions about the report will be coming.