PCCM update

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The bad news is that only 165 people having signed up for PCCM – now called HUSKY Primary Care, according to DSS at yesterday’s PCCM Subcommittee meeting. The dept. is spending a lot of time with a small number of providers developing care management plans, procedures, comparison charts, etc. A three page notice about PCCM was sent, along with a not-as-bad pamphlet on the program, to about 16,000 households in the Waterbury and Willimantic areas. However, few consumers or providers in the area know anything about the program, and even fewer are signing up. DSS has no plans to do more outreach, relying on providers to do all that work. Providers however are not confident about the program or DSS’ commitment to it. DSS is not even printing their own brochure, but expect providers to do that. And DSS is limiting what providers may do to promote the program. DSS is also steadfast in insisting that providers must sign a contract that includes irrelevant and unreasonable freedom of information burdens on individual doctors.

Many at the meeting noted that HUSKY families have been through a lot of painful and confusing transitions recently; voluntarily signing up for a new, unfamiliar program is not a high priority. Calls to the HUSKY phone line printed on the brochure do not offer PCCM as an option unless asked about it and if a patient’s doctor is not participating nothing is said about asking him/her to join. There are no provider recruitment materials or FAQ. One provider in the room stated his belief that mainly children with special health care needs are signing up for PCCM, creating a financial windfall for the HMOs by removing expensive patients from their membership.

The good news (yes, there is some) is that DSS appeared to hear the concerns. First, the room was packed including six legislators – Rep. Walker, Rep. Cook, Sen. Prague, Rep. Villano, Rep. Hamm and Rep. Ritter – all holding DSS accountable. After a contentious discussion about the need for parity between the massive resources devoted to the HMOs and the meager resources devoted to PCCM, as the meeting wore on, DSS came to understand that perspective. The good news is that DSS is looking into changing the default process so that the 20% of new clients who enroll in HUSKY from Waterbury and Willimantic but do not choose a program will be enrolled in PCCM. This was done in the past for AmeriChoice and Aetna to increase their share of the program. And DSS’ contractor agreed to train the staff that answer the phone about PCCM.

No mention was made of expanding the program to New Haven and Hartford as agreed in the waiver application hearing. In fact, a Hartford-based provider group that learned about the program got a frosty reception from DSS when they called to ask about participating. The next subcommittee meeting is Sept. 16th. We only meet every other month to accommodate DSS’ staff concerns. We will see what progress is made by then.
Ellen Andrews