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 highest and lowest quality performing ACOs received the same payment per member-months. The program rewarded lower performing provider groups. PCMH Plus ACOs had higher per member costs and higher emergency room visit rates than other Medicaid providers; PCMH Plus did not make progress in closing that gap.
As the state considers whether/how to continue PCMH Plus, Connecticut Medicaid’s shared savings program, the Medicaid Study Group offers recommendations to protect both consumers and taxpayers. The Medicaid Study Group is a collaboration of independent consumer advocates dedicated to improving the program that cares for 840,000 state residents.