More than two years ago, Connecticut launched a patient-centered medical home model for its Medicaid population. It’s a model where a patient relies upon their primary care physician to coordinate all of their care and actively remind them about preventive screenings or exams.
The idea behind the model and the payment method was to increase access and lower the amount of money the system pays to treat these patients by improving their health outcomes and keeping chronic conditions under control.
In order for a physician’s office to receive a higher reimbursement for these patients they have to meet or prove that they are on a path to meet standards set forth by the National Committee for Quality Assurance (NCQA). There are about 1,193 providers serving more than 250,000 Medicaid patients who are qualified to receive these higher reimbursements. It costs a practice of about five physicians $2,500 a year to maintain their certification.
Advocates say that’s a small price to pay for the additional $150,000 the average practice receives in higher reimbursements for managing the care of their Medicaid patients.
But a small group of state officials are questioning whether the decision to subscribe to these national standards is the best way to proceed.
Mark Schaefer, the director of the state Office of Health Reform & Innovation who previously advocated for the adoption of NCQA standards when he was the director of Medicaid for the Department of Social Services, said his position on the issue is evolving.
Schaefer said there are some in the industry who feel it would be best if Connecticut adopts standards similar to NCQA’s, but with a greater emphasis on the transformation of a practice into a medical home. He said the standards he envisioned the state creating would be “more likely to assure that everybody — patients, payers, and so-forth — that transformation had actually happened.”
“What we’re focusing on is really a teach and do model,” Schaefer said Friday. “We want to teach you how to do care coordination and . . . we want to actually go to your practice and see that that’s happening.”
He said it wasn’t clear that the NCQA standards were really “value-added.”
There are other national standards and accrediting organizations out there, but NCQA is more frequently used and better known, according to advocates who defended the standards at a meeting last week.
Schaefer said the state should focus on helping practices transition to patient-centered medical homes rather than focusing on the standards.
But consumer advocates like Alta Lash, executive director of United Connecticut Action for Neighborhoods, said she worries that if the state comes up with its own set of standards it could fall prey to whatever political party is in power. She said a new governor could come in and decide “they have a bigger brighter idea about this.”
She said it’s obvious that there needs to be payment reform, but as payment reform goes, there needs to be quality standards.
“If these standards are in place and there is somebody to certify them why would we spend the money in Connecticut to do that ourselves?” Lash said. “I think that spending money to reinvent the wheel is not a good use of funds.”
Dr. Robert McLean, who advocated for a new state-specific model, said the impression he gets hearing from the comments of consumer advocates is that “the state is ignoring these national standards and we are not.”
He said they want the state’s model to meet the standards and go beyond it by making them stronger with provisions that will help ease the transition to these best practices.
But then how would Connecticut compare itself to other states?
Schaefer said he’s confident the state could compare itself against other states on metrics that are widely used across the healthcare industry, such as the quality of diabetes management or the degree to which patients are receiving colonoscopies.
Marilyn Denny, an attorney with Connecticut Legal Services, didn’t believe Schaefer or McLean gave a very clear explanation as to why exactly the state decided to create its own new set of standards.
“I find it really disheartening for consumers and advocates who have really spent a lot of time studying the issue, endorsing the issue, expressing their reservations and then not having a very clear explanation as to why a new decision has been made,” Denny told the Healthcare Innovation Steering Committee on Thursday.
There could be ramifications to not endorsing national standards, Denny said.
Ellen Andrews, executive director of the CT Health Policy Project, said re-creating the standards could cost Connecticut $10 million and take eight years to implement. That’s in addition to falling prey to political winds in state government and delaying the improvements that are already under way.
Andrews will have another chance to make her case because Schaefer recommended sending the proposal back to a subcommittee for further discussion.
The Practice Transformation Task Force will consider the issue June 24. If they come up with a recommendation, the steering committee can take that up at its next meeting, Schaefer said .