Medicaid’s Care Management program is saving lives and money, but state paying twice and savings may be going to PCMH+ ACOs

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Last week, the Complex Care Committee of the Medicaid oversight council heard from CHNCT, the nonprofit that, among other things, administers our state’s Intensive Care Management (ICM) program. ICM is available to Medicaid members with complex health needs and, typically, high health costs. The ICM program includes regional teams providing comprehensive assessment and care planning, care coordination across a wide range of medical and social service providers, post-discharge care coordination, frequent consumer contacts as often as needed in the most effective setting, monitoring to ensure members are getting what they need, and that their health is improving. There is no wrong door to enter ICM. Member referrals come from members themselves, caregivers, providers, agencies, utilization reports, new member calls and screens, and predictive modelling.

The ICM program’s outcomes are impressive. The total cost of care for ICM members in 2017 dropped 12%. In 2017, ED visits for ICM members decreased by 25%, particularly for perinatal complications which were down 32%. ICM members’ hospital utilization dropped by 44% in 2017, particularly for asthma which dropped 43%, and readmissions for ICM members dropped by 46%. Hemoglobin A1c levels improved for 64% of ICM members with diabetes in 2017. Members with asthma and high use of the ED dropped by 62% in 2017 and ED visits for ICM members with sickle cell disease were down 17%.

CHNCT coordinates with Beacon Health, which runs the intensive care management program for members with serious mental illnesses. But we learned that 67% of PCMH+ members in CHNCT’s ICM program continue to receive services from the state-funded ICM program, and in their presentation last month, Beacon said they don’t drop any members from their ICM program regardless of PCMH+ attribution.  Concerns have been raised that the ACOs participating in PCMH+ are supposed to be providing enhanced care management, and community health center ACOs are receiving millions to provide that care. Consequently the state is paying twice for those services while half of any savings will be paid out to the ACOs under PCMH+’s shared savings model. While advocates are grateful that members are still getting these important services, we are concerned that taxpayers are paying for them twice and, in addition, that the very stretched state budget is not getting all the resulting savings from taxpayer investments.