For the last several years, I have advocated for the State of Connecticut's adoption of the Primary Care Case Management model, “PCCM”, for HUSKY, Connecticut’s Medicaid program that provides health coverage for low-income children and families. PCCM does not involve insurance companies or HMOs. Under it, primary care providers are paid extra to coordinate care and keep their patients out of more expensive settings. This Medicaid model could deliver better quality care at a lower cost. Apart from savings from care coordination, eliminating the HMOs currently contracting with the state means eliminating high administrative costs and, in the case of two of them, the portion of the taxpayers’ money which goes to producing profit for their shareholders. It also would allow the Department of Social Services to set Medicaid policy directly, without worrying about how these policies are implemented by contracted HMOs with a financial incentive to deny care.
In 2007, the legislature created a pilot program that would offer the PCCM option, now called HUSKY Primary Care. Although delayed, this rolled out in two small communities in February 2009 and then to the Greater Hartford and Greater New Haven areas in January of 2010. The efforts of healthcare advocates at New Haven Legal Assistance and other organizations may soon result in the HUSKY Primary Care option going statewide. Statewide PCCM for the HUSKY Program is being investigated by the Medicaid Care Manageement Oversight Council and is supported by Governor-Elect Dan Malloy.
On September 2, 2010, thirty-two advocacy, provider and consumer organizations sent a letter addressed to Sen. Toni Harp and all other members of the Medicaid Council. We urged the Council to seriously pursue the option of statewide PCCM , coupled with an administrative services organization, in place of the current HUSKY system of capitated managed care through HMOs. PCCM is a model that is now in use in a majority of other states’ Medicaid programs.
As a result of our coalition letter and other advocacy, the Medicaid Council is pursuing statewide PCCM as one of several specific options for HUSKY restructuring. The Council has formed a workgroup to review each of these options with a consultant provided through the CT Health Foundation. The goal is to produce recommendations for restructuring of the HUSKY A and B programs. This could also include the new Medicaid group of low income non-disabled adults without minor children (referred to as “Low Income Adults” or “LIA”). Ultimately, the model the workgroup proposes, if adopted, could potentially be applied to the elderly and disabled Medicaid population as well. Great care in assessing the options is necessary.
Regardless of the results of this process, expansion of PCCM to be statewide also is likely to be embraced by the new administration in Hartford. Governor-Elect Dan Malloy has identified statewide PCCM has an important component of his health agenda:
“Expand Connecticut’s Primary Care Case Management (PCCM) system, HUSKY Primary Care, to 400,000 low income children and parents in the HUSKY program. Participants in PCCM receive comprehensive care that is coordinated by a primary care physician to optimize and integrate all of their health care needs. PCCM is key to prevention, early treatment and maintaining health. Like the pooling bill, this will deliver better care at a lower cost.”
The Policy Project- Health Care, page 4/6(A Healthier Connecticut, A More Cost-Effective System)
PCCM has had a difficult time getting started in Connecticut, but not because of a lack of interest by providers or HUSKY enrollees who learn about it. A new day is coming and we expect the new administration to be guided by what works for HUSKY patients and their providers, and what is most cost-efficient. PCCM is an important part of the solution.
For more information, please contact Sheldon Toubman, New Haven Legal Assistance Association., at 203-946-4811