Medicaid Council and PCCM updates

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At Friday morning’s Medicaid Council meeting we heard from Mercer about their HUSKY quality review project. The authors pointed out that most of the measures were about paperwork, not outcome-based, and of limited usefulness. For example, the study measured the reading level of member handbooks but not whether any members actually received or used them. The authors were eager to get input on how to make future reporting more meaningful. Despite its drawbacks the report’s review of coordination and continuity of care was helpful – especially as PCCM and care coordination will become a focus of the program going forward.

“Aetna does not have a process in place to require PCPs to develop a treatment
plan as required by the contract between Aetna and DSS.”

AmeriChoice’s care coordination appears to focus only on identifying enrollees with other coverage to ensure that other payers are paying their share.

“However no documentation of processes were provided. The current process
appears to be more reactive than proactive in nature.”

CHN was not assessed in 2010 as they met the care coordination standards in 2009. Hopefully these performance reviews will be considered in choosing an ASO for the program going forward.

In very good news, DSS provided new, internally-generated HEDIS plan performance reporting on a variety of measures. While the program is changing radically next January, this is important benchmark information to judge and track progress under the new ASO/PCCM model. It is critical to know where we’ve been to figure out how to improve. The Council applauded the team of analysts at DSS that has developed this long-needed capacity.

At the PCCM committee meeting Friday afternoon we also learned that the dreaded PCCM evaluation has been re-tooled to become a constructive, qualitative study meant to identify barriers to implementation, not as a comparison with the current program. All agreed that with only 516 current PCCM members, no meaningful comparison is possible.

Unfortunately we also learned that does not DSS intend to build on prior collaborative, constructive, diverse planning processes that developed the current PCCM policies, but to start over from scratch in a lengthy process to add more bells and whistles to the program. Advocates and legislative leadership urged the department to continue to build on the foundational current program structure, which was highlighted in the administration’s ASO/PCCM announcement and enjoys strong provider, consumer and legislative support, while they are planning future improvements. Deep concerns were raised about a loss of momentum, and damage to future collaboration, if implementation of PCCM is further delayed. Concerns were also raised that delaying full PCCM implementation would jeopardize CT’s ability to access 90% federal health home matching funds for care coordination services. States only receive those funds for 2 years (eight quarters); if we start the clock ticking with the current 516 enrollees, we will squander an important opportunity to secure federal resources for care coordination. CMS has indicated willingness, eagerness even, to advocates to work with CT in applying the 90% match health home option to our PCCM program.
Ellen Andrews