Medicaid Council update

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Today’s meeting started with an entertaining LOB intruder alert drill by the Capitol Police. DSS described shift to ASO for Charter Oak, HUSKY A and B, low income adults and all other Medicaid clients. The goal is to create dynamic, innovative local systems of care and support that are rewarded for providing better value over time. Most decisions have not been made. They do not believe they need any legislative changes to implement the program and expect to release an RFP next month and have the program operational Jan. 1, 2012. ASO functions will include a call center, utilization management, assignment of members to primary care providers or patient-centered medical homes, routine and intensive care management/coordination, coordination with other medical programs, risk modeling, member handbooks, and cost and quality data aggregation. DSS will remain responsible for provider contracting, credentialing and claims payments. By January they expect to have every member assigned to a primary care provider, but sufficient expect patient centered medical homes capacity to take longer. They will make 5% of the ASO’s payments contingent on reaching quality and savings standards. Eventually DSS wants to have similar incentives for providers and move to a shared savings model. Advocates suggested that the state contract with only one ASO to reduce fragmentation and competitive distractions in the program, to attract the widest possible range of bidders that there be no advantage to the current HMOs should they choose to apply in scoring the RFPs, bonuses based on quality over savings to avoid any incentive to deny care, and to have the ASO responsible for recruiting and supporting providers. Advocates are also concerned that as DSS acknowledged, local systems of care are more effective; the closer care is to the patient, the more effective it is likely to be. However, leaving care management functions with the ASO until patient centered medical home capacity is built, requires the ASO to foster a system that eventually will reduce their functions and bottom line. It would be better, in the interim, to have a different entity provide care management to members who don’t have a patient centered medical home. The other advantage is that care management requires different skills and staff than more administrative ASO functions and separating the two could widen the pool of available bidders – giving consumers better service and a better price for the state.
The Council then heard about value-based purchasing and developed questions/priorities for the state as we move forward with payment and delivery reform.
Ellen Andrews