Thursday, March 31, 2011
Wednesday, March 30, 2011
Tuesday, March 29, 2011
Monday, March 28, 2011
Sunday, March 20, 2011
They are beginning by setting up the framework to implement in 2017. Discussions this week revolved around timing and governance and staffing for the Green Mountain Care Board that will shepherd the plan. Questions included whether the Board should include one member from each stakeholder group (this is how we usually structure such things in CT, groups become massive and unwieldy and we get gridlock over and over – they quickly dismissed this idea), people with relevant expertise (health care finance, policy, etc.) or a set of good, smart people with guidance about working toward the greater good. Questions also revolved around the wisdom of ceding control of a large public trust to a non-elected board (similar to our SustiNet debate). Answers included that this happens in other areas, such as utility rate setting, and that this will be a law and can be changed by lawmakers if necessary.
Vermonters – legislators, staff, agency staff, advocates – are all exceptionally smart, knowledgeable about health policy as well as how it operates in the real world. Among them, Anya Rader Wallack who worked on our SustiNet plan, is leading the effort for the Governor’s office. I feel so much better after these trips – it’s restorative – kind of a spa trip for policy geeks.
Next week – New Hampshire.
Tuesday, March 15, 2011
Sunday, March 13, 2011
“Aetna does not have a process in place to require PCPs to develop a treatmentAmeriChoice’s care coordination appears to focus only on identifying enrollees with other coverage to ensure that other payers are paying their share.
plan as required by the contract between Aetna and DSS.”
“However no documentation of processes were provided. The current processCHN was not assessed in 2010 as they met the care coordination standards in 2009. Hopefully these performance reviews will be considered in choosing an ASO for the program going forward.
appears to be more reactive than proactive in nature.”
In very good news, DSS provided new, internally-generated HEDIS plan performance reporting on a variety of measures. While the program is changing radically next January, this is important benchmark information to judge and track progress under the new ASO/PCCM model. It is critical to know where we’ve been to figure out how to improve. The Council applauded the team of analysts at DSS that has developed this long-needed capacity.
At the PCCM committee meeting Friday afternoon we also learned that the dreaded PCCM evaluation has been re-tooled to become a constructive, qualitative study meant to identify barriers to implementation, not as a comparison with the current program. All agreed that with only 516 current PCCM members, no meaningful comparison is possible.
Unfortunately we also learned that does not DSS intend to build on prior collaborative, constructive, diverse planning processes that developed the current PCCM policies, but to start over from scratch in a lengthy process to add more bells and whistles to the program. Advocates and legislative leadership urged the department to continue to build on the foundational current program structure, which was highlighted in the administration’s ASO/PCCM announcement and enjoys strong provider, consumer and legislative support, while they are planning future improvements. Deep concerns were raised about a loss of momentum, and damage to future collaboration, if implementation of PCCM is further delayed. Concerns were also raised that delaying full PCCM implementation would jeopardize CT’s ability to access 90% federal health home matching funds for care coordination services. States only receive those funds for 2 years (eight quarters); if we start the clock ticking with the current 516 enrollees, we will squander an important opportunity to secure federal resources for care coordination. CMS has indicated willingness, eagerness even, to advocates to work with CT in applying the 90% match health home option to our PCCM program.
Thursday, March 10, 2011
As part of discussion of national health reform and SustiNet, questions have been raised about patient-centered medical homes (PCMHs) in our state. We have drafted responses to some of those questions including:What is a patient centered medical home? (Coordinated care delivered by a team that helps patients keep themselves healthy)
- What is a patient centered medical home? (Coordinated care delivered by a team that helps patients keep themselves healthy)
- Do patient-centered medical homes save money? (Yes)
- Does CT have any patient centered medical homes? (Yes, 82 of them to date)
- Is there funding for patient-centered medical homes in federal health reform? (Yes)
Wednesday, March 9, 2011
Tuesday, March 8, 2011
Monday, March 7, 2011
Friday, March 4, 2011
Thursday, March 3, 2011
Wednesday, March 2, 2011
Tuesday, March 1, 2011