In yesterday’s meeting we
heard more about continuing PCMH
success. The number of participating practices is accelerating every quarter.
Even as enrollment climbs with the ACA expansion, the percent of members served
by a PCMH remains at 32%, matching growing capacity with growing demand.
Unfortunately since the last report, a large hospital-affiliated practice
decided not to renew PCMH certification citing financial reasons. It was
reported that some payers increasingly prefer to reward large practices with
advanced analytic and other capacities that support shared savings (as well as
quality in some cases) at the expense of PCMH supports (which focus on quality
and access to care, but do save as well).
The SIM update reiterated the intent, over advocates’
objections, to have the underservice and quality measures developed by SIM’s
Equity & Access and Quality Committees apply to Medicaid. To improve
chances of getting the federal SIM grant, the Quality Committee adopted
Medicare ACO quality measures as the basis for the entire state population.
Advocates have argued that Medicaid serves a very different population with
different needs than Medicare or commercially insured populations. Advocates
are concerned that the SIM committees are dominated by commercial insurers, who
no longer have a role in the state’s Medicaid program, and little Medicaid
consumer representation. We were told that the PCMH SIM committee, that
includes Medicaid expertise, can review the SIM committees’ decisions, but
cannot use a more appropriate set of standards.
