Patient Centered Medical Home Resources

PCMH + risk scores suggest possible gaming or worse; Advocates call on DSS to delay expansion to protect members and taxpayers

A new analysis of PCMH + members’ risk scores finds unexplained increases compared to the control/comparison group that could signal ACO gaming of the system for financial gain and/or, far worse, a decline in the health of members in the program. PCMH Plus, a controversial new payment model, allows ACO (large health systems) to share…

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PCMHs in CT – not the “shiny new toy” anymore but moving forward improving care, controlling costs

Ten years ago, patient-centered medical homes (PCMHs) were exotic in Connecticut. PCMHs are one of the best documented innovations to improve health. PCMHs are primary care practices that help keep people well by assessing needs, coordinating care, and giving people the skills and resources to maintain their own health. As a nurse managers told me,…

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Advocates get no answers to questions about HUSKY experiment

Last month, a group of independent consumer advocates, the Medicaid Study Group, sent questions to DSS about the impact of PCMH Plus, their new $10.8 million experimental program of shared savings in HUSKY. Advocates have been concerned about PCMH Plus’s potential to deny needed care, raise costs in the program, and erase hard-won progress. Questions…

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Committee develops care plan best practices recommendations for Medicaid

The Complex Care Committee of CT’s Medicaid Council has made recommendations to DSS for careplans in the Medicaid program. The importance of effective care plans has arisen often throughout the committee’s work diving deep into barriers to care for Medicaid members with complex health needs. Effective care plans ensure that people are driving decisions about…

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CTNJ: Advocates must inform consumers of risks when the state won’t

This week, independent advocates launched PCMHPlusFacts.org, a campaign to give HUSKY members balanced information about an experimental, new payment model expanding across the program. PCMH Plus has risks for consumers along with possible benefits, but HUSKY members aren’t aware of them or that they have the right to opt-out of the new payment model. Read more

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Quality challenges remain in CT Medicaid PCMHs

Also at Friday’s meeting, DSS reported on a selection of quality results from 2015, highlighting concerns. The results compared quality measures for patients receiving care from private practice and community health center Patient-Centered Medical Homes. In other programs, PCMHs have improved quality performance over non-PCMH practices. There remains a lot of room for improvement. Only…

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Connecticut’s Medicaid redesign update– Pros and Cons

  Connecticut’s Medicaid program has earned national recognition for combining improved access to high quality care with an impressive record of cost control. Shifting the program from a financial risk payment model to care coordination through person-centered medical homes (PCMHs) four years ago is widely credited with that success. Last year the administration began developing…

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