Sales call illustrates the benefits of PCCM and a new way of doing business in Medicaid

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I had a call yesterday that illustrates the power and potential of CT Medicaid’s new self-insured PCCM model. A representative from a national medical service company wanted to learn more about business opportunities in our state under the new arrangement. They provide medical supplies for people with a common chronic condition and have non-clinical technicians go to patients’ homes to demonstrate how to use them. He wanted to bring a team of people from their company to make a presentation to “the company running the program”. He claimed great success with his products and services and wanted to know how they could get access to the market. I said that his company needs to become a Medicaid provider, and I was sure that DSS could help him with that. He informed me that they are already certified as Medicaid providers, but he wanted to make a presentation to a central, corporate group that would authorize them access to every Medicaid patient with that condition. I said that in PCCM each patient-centered medical home team, especially the patient, decides on the right array of services, how to deliver them, and from what vendor based on each patient’s individual care plan – not a corporate entity. He still didn’t get it – he said they usually make presentations to HMOs and they gain entre to patients without going through providers or consumers. I told him under PCCM he’d have to make thousands of presentations to every provider and consumer in the state. I still don’t know if he fully understands how this is supposed to work, and he definitely doesn’t appreciate the benefits, but he finally understood that this sales call wasn’t going to be productive.
Ellen Andrews