An experiment launched in Hartford and New Haven—aimed at bypassing insurance companies in delivering health care to poor and working families— has gotten off to a slow start. The state says it’s too hard to market; advocates say they’re not trying hard enough.
Department of Social Services officials say the alternative Primary Care Case Management program is “too difficult” to explain to doctors and patients.
But advocates like Ellen Andrews, executive director of the Connecticut Health Policy Project, say the state isn’t trying hard enough because it’s too cozy with the insurance industry, which gets cut out of the new model.
Andrews says the idea is simple. Instead of having one of the three managed care organizations coordinate care for a patient, a primary care doctor will get paid $7.50 per patient, per month to make sure their patients get the medical attention and services they need, such as an appointment with a specialist.
To date there are 322 ‘Husky A’ patients and about 200 doctors participating in the pilot program. ‘Husky A’ is the state’s Medicaid health insurance program for low-income families.
Dr. Robert Zavoski, medical director for the Department of Social Services, told two legislative committees Friday that the goal is to have 1,150 patients enrolled in the PCCM program by June. Click here to read his Power Point presentation to the committees.
However, he said marketing the program during what amounts to the lunch hour for many of these doctors has been a daunting task for him and one other employee.
“PCCM is a new concept that’s hard to explain to providers,” Zavoski said. “It’s even harder to explain to patients.”
As the man in charge of marketing the PCCM program, Zavoski sounded like he wasn’t sold on it.
“My marketing of PCCM would be like marketing against the managed care companies and I can’t do that,” Zavoski said. He said he thinks hiring an outside administrator to do the work may not be such a bad idea.
An administrator is “probably going to do a better job than I’ve been doing,“ he admitted. However, when lawmakers asked how much they may cost he was unable to give them an answer.
Dr. Patrick Alvino, a pediatrician from Branford, said he would gladly participate in the program because it recognizes “what we’re doing right now and that‘s coordinating care for our patients.” He told two legislative committee’s that managed care organizations seem to do little in the way of care coordination for his 2,000 Husky patients, who often fail to get access to an adequate network of specialists.
Alvino wants to participate in the PCCM program, but at the moment it’s only being piloted for doctors and patients in New Haven and Hartford. Alvino said he would love to participate, but under the state’s arbitrary geographical rules he’s unable.
“It is inadvisable to shut out providers who want to participate in this program,” Alvino told lawmakers.
Rep. Michelle Cook, D-Torrington, said PCCM is never going to be successful unless it’s rolled out statewide.
Despite what the department has said about the program, she believes it can save the state money and improve health care.
“It’s a no brainer to me,” Cook said citing the millions of dollars North Carolina and Oklahoma have saved by instituting the PCCM model.
She said the program will also take pressure off hospital emergency rooms because the Husky A population will no longer be forced to go there to get treatment. And it renews the relationship between doctors and patients by cutting out the insurance company, she said.
“It‘s as though PCCM has to prove itself,“ Rep. Peter Villano, D-Hamden, said Friday.
“It would be wise for DSS to take a better look at what we’ve got and the promise of PCCM.“
Zavoski warned lawmakers that it’s still early in the process. Department officials have said advocates in favor of the program are spreading misinformation about it.
“We do not have a lot of staff resources to deploy on this at this time,” Zavoski said. “I think we are early in the process.”
In the absence of the state’s support for the program Andrews and an army of dedicated interns and volunteers have stepped in to recruit doctors and inform the 110,000 Husky A patients in the New Haven and Hartford areas.
Click here to read more about those efforts.
No decisions about the future of PCCM were made at the meeting. It was just a forum to update lawmakers on its progress.