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At last week’s SustiNet Patient-Centered Medical Home committee meeting we heard about medical home initiatives in the two programs that will form the basis of SustiNet, the state employee plan and Medicaid/HUSKY. Tom Woodruff of the Comptroller’s Office presented on the state employee plan’s medical home initiative. The state will be moving to a self-insured ASO model as of July 1st and will include a very large pilot medical home program to start early next year; the state has chosen Anthem and United as administrators for the plan. They will partner with ProHealth Physicians to provide NCQA Level II or higher medical homes to their all 350,000 patients, including at least 40,000 state employee plan members, early next year. ProHealth Physicians is a large primary care practice with over 250 providers at 74 sites across the state. The Committee then heard about PCCM, the HUSKY medical home initiative, and the barriers placed by DSS on consumers and providers struggling to access care in the program. The committee then began considering questions and potential recommendations. The consensus of the group was to be as inclusive as possible in defining medical homes, but that payment must be tied to concrete standards. NCQA certification was identified as the goal and payment standard, with recognition for practices reaching milestones on the road to certification. The committee recognized the need for significant support to help practices reach that goal. Recognizing the lack of Medicaid providers, lower payment levels, and approximately 150,000 new CT Medicaid members in 2014 under federal health reform, that the committee does not want to jeopardize or undermine those providers in transitioning to a new system of care in which every state resident has access to a medical home. The committee will continue the discussion, focusing on national health reform, at our next meeting this Wednesday April 28th 10am to noon. The committee will be meeting at the Dept. of Transportation, Conference Room B, 2800 Berlin Turnpike in Newington.
Ellen Andrews