PCMH (no Plus) program continues to grow and improve care

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At MAPOC’s Care Management Committee meeting Wednesday, the state provided the latest numbers from the successful Person-Centered Medical Home program. PCMHs are primary care practices that coordinate care for patients, offer expanded hours, and address population health needs. The program continues to grow, adding 52 primary care providers and seven new sites of care in the last quarter of 2019. For the 2019 entire year, they recruited 41 new sites and 94 new providers. But they aren’t resting on their laurels, for 2020 they are recruiting 25 more practice sites and 49 new providers identified as most likely to enroll. Overall, the percent of Medicaid members attributed to PCMHs has risen from 42.7% in the third quarter of 2016 to 51.6% in the last quarter of 2019, even as total enrollment grew 58,471. Contrary to common perception, the large majority of PCMH providers are community providers, not working in community health centers. Despite three-fold higher reimbursement rates, only one in four PCMH providers practice in community health centers. This is especially true for Internal Medicine. Unfortunately, the percent of all Medicaid members attributed to a primary care provider has remained stubbornly stuck at around 70%. Adults in the program are about 10% less likely that children to have a usual source of primary care. Providers and former providers at the committee meeting believed that PCMH certification was a barrier to participation and suggested that it wasn’t meaningful. However consumer advocates have always cited strong evidence of the PCMH model’s effectiveness in improving quality and lowering costs. It was noted that when CT Medicaid implemented PCMHs (while also moving away from private managed care companies), per person costs were controlled, saving the state almost $1 billion last year. And the longer a practice has been certified by independent organizations with national standards, the better their performance. Concerns about ED rates by community health center patients in Medicaid were also discussed.