When the state of Oklahoma’s Medicaid program switched from HMOs to Primary Care Case Management (PCCM) in 2004, the state saved $85.5 million in medical costs in the first full fiscal year and the quality of care improved including check-ups for children, appropriate asthma medications, and dental care.
Connecticut’s HUSKY clients need this alternative. The current HMO-based HUSKY program, CT’s Medicaid program for families, has been deeply troubled since its start 15 years ago. HMOs received a 24 percent rate increase in 2008, while an independent audit commissioned by the Comptroller’s Office last year found $50 million in overpayments. In 2007, barely half of HUSKY children received scheduled checkups, and more than one in ten did not get any health care at all.
Despite passage of PCCM into Connecticut law in 2006, the program has been delayed and hamstrung by the state’s own Department of Social Services, which has created so many roadblocks to implementation that only 322 people have successfully enrolled.
The push-back from DSS has been frustrating, and threatens both the cost savings the state desperately needs and the improved care that HUSKY members deserve.
PCCM is not a new idea; this method of running Medicaid managed care is being used successfully by thirty other states. In PCCM, consumers are linked to a doctor who coordinates their health care for a small monthly payment. PCCM is a form of the patient-centered medical home model, featured in both national health reform bills, adopted by Medicare, and most large private payers. The program also features prominently in the CT Comptroller’s request for proposals for the new state employee plan contracts.
In approving PCCM three years ago, the legislature envisioned the program as a viable alternative to HMO-based administration for HUSKY. Patients can choose between an HMO and PCCM using market competition to improve both programs. With no entity between the state and families served, PCCM affords the state better transparency in tracking both finances and care utilization. States with PCCM programs have found equal or better patient satisfaction levels. The core of PCCM, care coordination, supports the doctor-patient relationship that is the basis of good care.
Health care advocates hailed the passage of PCCM in Connecticut and offered their help in implementing the program to meet the legislative requirement of enrolling 1000 people. Instead, we have battled DSS to overcome myriad roadblocks they have created including limiting provider applications to a very short timeframe, limiting enrollment of families, refusing to print brochures, and going back on agreements with the advocate/DSS working group and limiting the program to only two small communities.
Some barriers created by DSS would be comic if they did not have such a troubling impact. Marketing guidelines prohibit doctors from telling their clients about PCCM, but they can respond to questions if asked. But who would know enough to ask? To address this contradiction, the advocates purchased and distributed lapel buttons for doctors that say “Ask Me About PCCM.” We have also produced and distributed thousands of posters, brochures and FAQs about PCCM at schools, churches, doctors’ offices and community groups. However DSS approved millions for HMO marketing including free ice cream and haircuts, billboards and radio ads.
Perhaps our greatest concern is despite very low enrollment, DSS intends to go ahead with plans to evaluate PCCM by July 1st. A premature evaluation could bias the result and inaccurately label the program a failure before it has a fair chance to reach its potential.
In these difficult times, when each dollar of state money is precious, the state must take every available step to ensure that those dollars are well spent. We cannot let a deep bias toward the HMOs squash this valuable and cost-saving program. The legislature can and must step in and ensure PCCM is properly implemented and fairly evaluated.
Ellen Andrews is Executive Director of the CT Health Policy Project, a non-profit research and advocacy organization working to expand coverage to affordable, quality health care for all Connecticut residents. The Project provides policymakers with information about options for coverage and provides assistance to consumers struggling to access health care in Connecticut. www.cthealthpolicy.org