Yesterday’s organizational meeting of the SustiNet Patient-Centered Medical Home Advisory Committee was very encouraging. There is a lot of energy across stakeholder groups, especially among providers and payers. We are soliciting input on who/what groups to consult for input and what issues to consider. Suggestions include business coalitions, NCQA, medical homes from other states, consumer and provider groups. Issues raised include integrating primary care with behavioral health, the role of chiropractic care, primary care shortages, health IT, the costs of implementation, and savings to the health care system. It was also noted that while policymakers are learning about the medical home model, most providers still need to understand it.
Unfortunately, the meeting of the Medicaid Managed Care Council’s PCCM Subcommittee that followed did not go as well. DSS has refused to remove the irrelevant and intimidating Freedom of Information clause in PCCM provider contracts. As one provider in the room put it – the first time a provider gets a request or a subpoena, that will be the end of the program. It is important to note that providers participating in HMOs are not required to sign similar contract language. DSS also continues to refuse to devote any resources to marketing PCCM, despite the overwhelming marketing allowed by the HMOs, paid for out of tax dollars. DSS estimated that the HMOs were spending 1% of the cap rates on marketing, which is roughly $7 million/year. Marketing activities by HMOs, approved by DSS, and paid for out of tax dollars, include free ice cream and haircuts to sign up with an HMO, a banner behind an airplane at a community festival, gifts, radio and billboard advertising, and raffles for school uniforms and supplies. DSS noted that when they talk to providers about signing up for PCCM, they also encourage them to sign up for the HUSKY HMOs and Charter Oak. It is unclear whether providers understand that they can sign up for just PCCM or if they believe they have to also sign contracts with the HMOs. DSS also announced that they will hire Mercer to conduct an evaluation of PCCM to be done by July. However, they acknowledged that the very small enrollment in the program so far makes it nearly impossible to make valid statements about how well the program is doing in providing care, reducing costs, or improving quality. Mercer was the DSS contractor that approved the 24% HMO rate increases for the HUSKY HMOs, which were called into question by the Comptroller’s independent audit, and derives a great deal of their business from managed care plans, in CT and nationally.
In the meantime, advocates are working without any tax dollars to market PCCM to both providers and consumers in New Haven and Hartford in anticipation of the program’s roll out there January 1st. We have an army of volunteers and energetic students mailing and calling providers, practice managers, community organizations and consumers. We are holding two forums open to anyone interested, and eligible to join, the program. By far the largest obstacle we are encountering is skepticism about DSS’s commitment to the program and a strong distrust of the state. If you are considering PCCM, for more information click here.