PCMH+ quality reports surprisingly underwhelming

At the MAPOC and Care Management committee meetings we finally received the promised quality evaluation of PCMH +’s first year. PCMH+ is DSS’s experimental new payment program that now covers 165,432 HUSKY members. We only received information on the 13 mainly process measures. These measures were chosen as basis for shared savings payments, not for evaluation or for underservice monitoring and detection. But even on those 13 results were disappointing. Despite some improvement across the entire HUSKY program, ER visits and hospital readmissions, the only underservice measures, were significantly worse for members assigned to the PCMH+ ACOs than for the control group. There was no change in consumer satisfaction surveys despite very low performance on measures of providers talking with consumers about specific health goals and things that make it hard to care for themselves. These should be a hallmark of a community-based health program such as PCMH+. These are our best hope for improving health and generating savings. The report answered almost none of the questions submitted by advocates or reporting on any of the evaluation metrics provided to DSS, at their request, in developing the program. Frankly, we expected more. We expected to see progress by first adopters taking low-hanging fruit. Research usually finds that improvements happen early in metrics that groups are paid for, with erosion in others. But we did not see improvement in the PCMH+ payment metrics and we weren’t given others. It’s unclear why DSS did not wait until these results were available to add an additional 56,000 people to the program. There were no plans offered to address the problem, just promises that things will improve in the second year.

We will hear about savings from the PCMH+ program next month. The state’s presentation this month suggested that other shared savings programs achieve 18% savings. We look forward to seeing that. The state is spending $10 million per year on PCMH+; that is about the cost of care for 2,000 of the working HUSKY parents who were cut from the program in 2016.