Medicaid update: Quality was rising through 2016, raising concerns about PCMH+

Friday’s MAPOC meeting focused on Medicaid quality and access information from CHNCT, DSS’s administrative contractor for the program. Across the 12 (of over 100) quality measures chosen, there was modest but sustained improvement from 2014 through 2016. However community health center performance consistently lags behind other PMCH practices across the quality measures. Of particular concern is community health center ED visit rates which are significantly higher than for other practices, higher even than people without a primary care provider. Asked about underservice measures such as avoidable hospitalizations and ED visits, long used by Medicare ACOs and other payers, CHNCT says they are working on it – an answer we’ve heard from DSS for years. There is considerable room for improvement — behavioral health screening (a PCMH standard) is only around 20%, less than half of members with asthma have received medication management, and less than half of patients discharged from a hospital get follow up within a week. CHNCT was asked to provide performance on all measures.

Given community health centers’ generally lower quality and access performance, questions were raised about DSS’s choice to reward them with a prominent role in PCMH Plus. Despite good intentions, advocates remain deeply concerned about shared savings incentives, with little monitoring, to deny necessary care.

We also heard about the impressive record of CHNCT’s Clinical Support Programs and Intensive Care Management (ICM) team. Between 2016 and 2017, the number of high-cost members (over $100,000 in paid claims in a year) dropped by 5% and the cost per high-cost member dropped almost 1%. Concerns were raised that the growing number of people enrolled in PCMH Plus will no longer have access to ICM’s exceptional services, will have to rely on the ACOs who report they are still ramping up services, raising concerns about both care for members and costs for taxpayers.

CHNCT was asked if they have plans to share performance data by practice with consumers. DSS said they will consider it. CHNCT said that, not surprisingly, with PCMH Plus the number of providers looking at their own performance measures has increased – which is a good thing. CHNCT was also invited by the Co-Chairs of the Complex Care Committee to share this information with that group with expertise on the needs of high-need, high-cost patients.