Good and bad Medicaid PCMH, PCMH Plus updates

At today’s MAPOC Care Management Committee, we learned that Medicaid’s successful Patient-Centered Medical Home (PCMH) program is growing and keeping up with higher enrollment due to COVID. In disappointing news, we also learned that the controversial PCMH Plus program has fewer care managers than expected and only 36% of ACO member advisory committees have any…

Read More

OHS committee considering dumbing down successful PCMH standards

Among other troubling plans, the Office of Health Strategy’s Primary Care Subgroup is considering four options to certify high-performing primary care practices for higher levels of reimbursement. The committee is deciding how to double spending on primary care while simultaneously capping healthcare cost growth. At their meeting this week, the committee of mainly primary care…

Read More

Share your ideas to support Connecticut health care coordination, access, and quality

The state is rushing to implement an expensive Health Information Exchange to access $48 million before a federal deadline. The state Office of Health Strategy (OHS) is moving forward very quickly despite concerns raised by consumers and providers about selling access to identifiable patient records to insurers and ACOs, privacy rights, the capacity of the…

Read More

Community health center quality behind the rest of Medicaid

Download the report The good news is that Medicaid health outcome quality measures generally improved in all practice setting from 2016 through 2018. Unfortunately, community health centers (FQHCs) are not doing as well as their counterparts, either other Patient-Centered Medical Home practices (PCMHs), or non-PCMH practices in serving Medicaid members. This data comes from CHNCT’s…

Read More

PCMH (no Plus) program continues to grow and improve care

At MAPOC’s Care Management Committee meeting Wednesday, the state provided the latest numbers from the successful Person-Centered Medical Home program. PCMHs are primary care practices that coordinate care for patients, offer expanded hours, and address population health needs. The program continues to grow, adding 52 primary care providers and seven new sites of care in…

Read More

Community health centers still struggle with ED visits

As in the past, Medicaid patients of Connecticut’s community health centers are far more likely to visit an ED than other Medicaid patients, according to a presentation by CHNCT at Friday’s Medicaid Council meeting. While rates have decreased a bit, the very large gap in ED use rate between clinic patients and other Patient-Centered Medical…

Read More

Survey finds CT ACOs planning services for high need members

Similar to national results, a new survey of Connecticut Accountable Care Organizations for MAPOC’s Complex Care Committee by the CT Health Policy Project finds that most are using multiple methods to identify high need members. But they are still working on implementing effective programs to address the needs. Many of their plans follow best practices…

Read More

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…

Read More

Coincidence? CT spends little on primary care, and we have high ED, preventable hospitalization rates

A new analysis finds that Connecticut, at only 3.5% of our health care dollars spent on primary care, is last among 29 states studied. Not surprisingly, we also rank among the highest in ED visits, all hospitalizations, and in avoidable hospitalizations. The US average is 5.6% of health care spending devoted to primary care, well…

Read More

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,…

Read More