Friday’s Medicaid Council meeting focused on new initiatives
to rebalance care for long term supports and services. Through a impressive
quilt of waivers, DSS has improved incentives for providers, expanded
available services, reduced and eliminated waiting lists, and reduced costs
allowing fragile people to remain in their homes avoiding costly and unwanted
nursing home stays.
Last week’s meeting of the council’s care management
committee highlighted continued
success engaging and supporting CT practices in transforming to
patient-centered medical homes. 282,232 CT Medicaid members can now access
coordinated care that meets national accreditation standards at 327 individual
sites across the state, up 300% since the beginning of 2012. And 51 more sites
are on the glide path to PCMH recognition. DSS and CHN deserve a great deal of
credit for their success in delivering quality care, sustained over years,
turning around a program that has languished for decades.
Unfortunately a conflict between SIM and MAPOC has arisen
over control of Medicaid policymaking; independent advocates are concerned that
the program’s successes are at risk. In alignment with a letter
from the Lieutenant Governor and DSS Commissioner, legislative leaders have
assigned MAPOC’s Care Management Committee the task of advising the state on
“all aspects of the shared savings program design and the selection of provider
participants.” This mirrors the very successful model of
collaboration between MAPOC’s Complex Care Committee and DSS in developing
a strong model of shared savings for dual eligible members especially a consensus
set of standards
protecting fragile members from inappropriate underservice. Unfortunately SIM
staff is insisting that a SIM committee, dominated by private insurers, retain
control over development of the crucial under-service measures for the entire
Medicaid program. Advocates are concerned that the committee does not include
sufficient Medicaid expertise and questions the dominant role of private
insurers who no longer operate our state’s Medicaid program, in large part
because of inappropriate underservice. Since
private insurers left Medicaid, quality of care is up, more providers are
participating, and per person costs are down.
