Medicaid update: Quality improving but lots of work to do

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Friday’s Medicaid Council meeting focused on quality performance in the program. The good news –

  • ED visits and readmissions continue dropping across the program, although community health centers’ performance remains a problem
  • Well-child visit and lead screening rates are higher than the national average
  • Routine care is increasing and inpatient care is decreasing

The bad news —

  • Less than half of people discharged from the hospital are getting follow up from community providers
  • Too few children are getting behavioral health or developmental screenings
  • Prenatal and postpartum care are well below national averages but bundled payments may be to blame, causing under-reporting
  • CT needs to do much better in avoiding antibiotics for people who don’t need them
  • Community health centers’ performance is worse than other providers across several measures especially ED visit rates; it is unclear if they recognize the problems or whether they are addressing them

In-depth studies found that the total cost of care for women diagnosed with breast cancer was lower if they were screened early, and that people with diabetes with controlled HbA1c levels also have lower total costs of care, but both may result from better access to primary care. CHNCT is looking into that possibility.

It is also unclear if the increase in community health visits is due to the controversial trend of shifting hospital primary care clinic patients to CHCs.

DSS promised to dis-aggregate the data and provide performance measures by health system. At December’s meeting we learned about large variability between health systems in PCMH+. DSS will again look into publicly disclosing providers’ performance reports, similar to Medicare, to allow Medicaid members to choose the provider that best fits their needs and to highlight best practices. There was no answer on the request, repeated often over the years, to measure and report on avoidable ER visit and hospital admission rates. Health systems have reported to Medicare on these measures for years and OHCA used to report them as well.

At next month’s meeting we will get updates on Medicaid’s costs of care.