Medicaid and Primary Care: How Connecticut is Leading the Way

A recent Hartford Business Journal article reported that more primary care physicians, nurse practitioners and physician assistants are joining Connecticut’s Medicaid program, just in time to meet the needs of the growing number of people gaining Medicaid coverage.  A major factor in this growth is that the Affordable Care Act (ACA) has funded increased reimbursement for these providers.  But there is much more to the story.

While the trend in most states is to contract with private Managed Care Organizations (MCOs) to operate the program, Connecticut has elected to manage the program more directly.  Instead of medical practices having to interact with multiple private insurance companies they only have to contract with one organization that is administering the program on behalf of the state.   This translates into less hassles, less mixed messages and less paperwork for providers.

Furthermore, Connecticut is a leader in the nation in redesigning its Medicaid program.  Following the path first suggested in the public option SustiNet plan, Medicaid is focused on implementing patient centered medical homes (referred to in Medicaid as person-centered medical homes or PCMH).  This emphasis on PCMH is taking coordinating and managing patient care out of the hands of insurance companies and putting it back into the hands of the doctors, nurses and support staff who know their patients best.  Medicaid is achieving transformation to this new delivery and payment model by providing assistance from practice transformation teams.  It is also offering additional financial incentives to reward practices committed to the PCMH model as well as to reward improved performance on quality measures.  As reported in a recent Connecticut Health Policy Project blog, the results of this change are starting to pay off, with quality measures shown to be higher in PCMH practices.

In another move suggested in the SustiNet plan, Medicaid is aligning its quality measures with those of the state employee plan.  Having providers follow the same standards from two of the largest payers in the state means more consistent performance and, again, less complexity for providers.  And it means better value for the dollars the state is spending on health care.

To learn more about the performance of Medicaid’s PCMH practices, go here to review the PowerPoint presentation on PCMH presented at the January 10 meeting of the Council on Medical Assistance Program Oversight.

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