CT Medicaid Primary Care Redesign: What the Evidence Says Part 4: Better, Safer Options

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Connecticut Medicaid is considering reforms to primary care delivery and payment. The CT Health Policy Project is collecting evidence from other states and programs to help inform that planning. Part 1 focused on Connecting with community services to improve health. Part 2 explored primary care payment reform, especially value-based reforms that move financial risk to providers.

While primary care in Connecticut’s Medicaid program is doing well, better than other states and in some cases better than private insurance plans, there is room for improvement, especially to improve health equity. There is wide agreement across stakeholders to Do No Harm; that any reforms should do nothing to undermine the progress Connecticut has made.

Some options are offered to further improve primary care in Connecticut’s Medicaid program, many with supporting evidence, that carry less risk of unintended harm. The lengthy list of options below address accountability, patient support and education, primary care practice support, technology and new care delivery innovations, access to care, care management, population health, data, and information, efficiently targeting resources, and improvements for people with disabilities.

Adoption of these options will promote health equity, but monitoring, team-based care, engaging trusted messengers, access options, targeting resources, data, and diversity in provider recruitment and retention are critical.

All options require investment, in money and time, which carries opportunity costs. While primary care payment rates should be sufficient to sustain practice, we describe the evidence that increasing payment rates alone does not improve access or quality of care. It is important to consider any option’s costs in comparison to other opportunities. Investment in proven public health initiatives have demonstrated higher Returns on Investment (ROI) (net to the state) than the federal government’s Medicaid matching rate for medical costs. We drill deeper into the evidence on competing opportunities for investment.

This list of options was informed by the evidence, the experience of other states, and input from Connecticut advocates. However, most reviews acknowledge that there is not enough evidence to evaluate many options that are being tried. Before wide-scale adoption, any policy change should be piloted and evaluated in Connecticut’s context by an independent entity for both benefits and consequences.

This list offers a place to begin discussions of real-world options to improve primary care in Connecticut’s Medicaid program while preserving hard-won progress.