PCCM Subcommittee update

At today’s PCCM subcommittee of the Medicaid Managed Care Council, DSS unveiled their plans for the Mercer evaluation of the program to be completed by July 1st. Advocates raised many concerns including:
· The inability to get any meaningful information on health outcomes with only 200 members on average over the last year
· A survey of those few consumers and providers in the program is valuable, but misses exactly the population we need to be reaching out to – the far larger population of consumers and providers who have decided not to sign up – we need to know why, and adjust the program accordingly
· It is likely that consumers will say that they have not noticed a change since moving from HMOs to PCCM – does that mean the program has failed? A provider with 100 PCCM patients has received only $9,000 this year – not enough to hire a care coordinator or even to change policies significantly
· There is a lot in the evaluation about testing providers’ compliance with the contracts, but nothing to evaluate whether DSS has done any of the things they promised to do
· No evaluation of PCCM marketing (or lack of it)
· Strong concerns about measuring health outcomes at this very early stage – among 200 kids, on average only about half would have had a well-child visit this year, and of that number how many had health care needs that required coordination to even be evaluated?
· How can you test readmissions to hospitals (a relatively infrequent event) in such a small population over only a year
· Holding providers accountable for patients’ ER visits is unfair if DSS still hasn’t set up a system to notify providers when their patient visits an ER – how are they supposed to know?
· These are fairly intrusive questions that touch on sensitive areas for practices, the documentation burden will take time from overburdened administrative staff and serve as yet another barrier to signing up with the program
· Asking about EHR implementation is premature, and the contract also allows electronic disease registries – a mention was made to providers by DSS staff at one meeting that an Excel spreadsheet would work – it is completely unfair to change the rules at this point
· It is unfortunate that so far in this program DSS has spent less than $19,000 on care coordination (and zero on marketing) but is willing to shell out four times that amount for an evaluation that appears set up to label the program a failure
The Committee reviewed information from DSS that suggests that PCCM is more costly than the current HMOs; however DSS cautioned strongly that with such small numbers it is not a valid comparison. It was also noted that there is anecdotal evidence that because it is so small, the program is attracting disproportionately more medically needy and complex members than the rest of the HUSKY program. If true, this would serve to benefit the HMOs financially by removing more expensive patients from their roles. The Committee also discussed options to allow more willing pediatricians to participate and to recruit more adult medicine providers. The Committee discussed what should be included, and what should be prohibited, in an ASO contract to run the PCCM program; the Committee agreed to solicit input from other stakeholders before the next meeting. The Committee will draft a letter to DSS and CMS with our suggestions for improvements to the program.
Ellen Andrews