SIM decision to use national PCMH standards affirmed – again

At last night’s SIM Practice Transformation committee meeting, consumer advocates were able to halt erosion of national standards for patient-centered medical homes (PCMHs). Following research and best practices and resisting misinformation, in June the committee voted to use nationally recognized NCQA standards for PCMHs in SIM. NCQA-recognized PCMHs are the foundation of CT Medicaid’s remarkable success in lowering costs, improving quality and engaging new providers in the program. Unfortunately, there have been more recent efforts in the committee to erode that decision. Last night’s meeting was frustrating to watch as much policymaking was based on misleading anecdotes, random conversations, and lack of understanding of health policies – thankfully advocates did their homework and cited published research to make their case. Eventually SIM staff reaffirmed that NCQA standards will be the “framework” and “backbone” for PCMH standard setting in SIM. It is important to note that Massachusetts has reportedly reversed their decision to create state-specific PCMH standards.

The committee also heard from AmeriCares Free Clinics that provide coordinated, high quality care to thousands of uninsured low-income state residents left out of ACA expansions. AmeriCares would like to earn PCMH status to further improve the quality of their care, despite the fact that they do not bill to payers and will not be rewarded financially. AmeriCares asked to be included in the SIM glide path providing technical assistance to earning PCMH status, despite the fact that they do not bill to Medicaid. Staff agreed to keep open the possibility for free clinics to apply for the funding, but priority will still go to the large Medicaid shared savings networks.