PCCM Update

At yesterday’s Appropriations’ Human Services Subcommittee meeting, DSS reported on progress toward implementing a pilot Primary Care Case Management program for HUSKY. DSS has been busy researching other states’ PCCM programs, including a January trip to MA to hear from several states’ about best practices and collecting PCCM provider contracts. DSS generously invited this advocate and another to join their staff on the MA trip. Lessons learned included needing a critical mass of patients at Primary Care Provider (PCP) sites, the need for an adequate specialty referral network, and that reimbursement should support chronic care and prevention. The department plans to phase-in the program starting with high volume HUSKY providers; they are in the process of identifying those providers. Potential criteria for provider participation include requiring electronic medical records, minimum caseloads, and ability to handle care coordination and reporting. PCP responsibilities, performance measures, and case management reimbursement levels also need to be defined. Other next steps include DSS systems modification, developing and issuing an RFA for PCPs.
Ellen Andrews