Today, (Jan. 18 starting at 10 a.m.) the legislature’s Human Services Committee will hold an all-day informational hearing dedicated to the concerns of the state’s Medicaid managed care system. Alternatives to contracting with HMOs will be discussed and the public is invited to testify in the afternoon. The hearing is not on any specific bill, but will help add to the discussion regarding disclosure issues and access to care. A recent study by the Department of Social Services found patients that participate in the state Medicaid system have trouble getting calls back from doctors who accept their health insurance. The independent study found that only 26 percent received calls back. Many advocates will testify in favor of a primary care case management system. Continue reading to find out more about the primary care case management system by clicking on the headline above and scroll down.
The information below was compiled by the Legal Assistance Resource Center of CT, Inc.FACTS ABOUT PCCMWHAT IS PRIMARY CARE CASE MANAGEMENT (PCCM)?Primary Care Case Management (PCCM) is a way of running Medicaid Managed Care without HMOs. Recipients choose a Primary Care Provider (PCP) who acts as their “medical home”. The PCP is responsible for managing their care including providing preventive health services, coordinating care, and, in some states, acting as a gatekeeper to specialty services. Providers bill the state directly for the services they provide. PCPs also receive a flat per member per month fee or an increase in their preventive service fees to pay for case management services. Providers bear no financial risk for the services they provide or approve. IS PCCM USED IN OTHER STATES?Yes, currently 30 states use some form of PCCM; the majority have both PCCM and HMO programs, often in the same area of the state. Several states with both PCCM and HMOs maintain that parallel systems make both programs stronger as well as give consumers more options.WILL PCCM SAVE CT MONEY? Of the 40 states that spend less than CT on the amount spent for the average child enrolled in Medicaid, 64% have PCCM programs. States see a decrease in emergency room use, a decrease in specialty services and an increase in the use of preventive care over fee for service levels. HAS PCCM BEEN SUCCESSFUL FOR BOTH PROVIDERS AND CONSUMERS?Providers in PCCM states are generally satisfied with the program and are far more positive about PCCM than HMOs. They have more control over medical decision-making and their administrative burden is far less. Surveys from states with PCCM programs report greater satisfaction among consumers with PCCM. Consumers who have a choice between PCCM and HMOs overwhelmingly choose PCCM. HOW WOULD PCCM WORK IN CONNECTICUT?Consumers may not notice much change at all. They now choose a PCP after they choose a health plan, and must get approval from the PCP for referrals. They should notice an increase in the number of available providers, both because more providers may be attracted to the program, and because they can choose any provider who takes Medicaid, not just one from their health plan’s network. They will no longer have to figure out where to call with what problem – they should call their PCP.
