Friday, February 17, 2017

Advocates ask DSS yet again for a robust evaluation of risky experiment before expanding

Twenty-three independent advocates sent a letter today again urging the state to conduct a common-sense evaluation of the first wave of a risky new program before expanding the program, as promised. Advocates have learned that the planned evaluation will not be available until two months after the RFP for the second wave is finalized and released. In addition, current plans for the evaluation are weak, very similar to cursory evaluations of HUSKY MCOs that found no problems over many years despite obvious lapses and overspending. We also understand that data will not be available for a robust review in time to inform the second wave even if there were a meaningful evaluation. January 1st Medicaid enrolled over 100,000 members into a shared savings program, PCMH+, a new financial model that has struggled to save money and improve quality where it’s been tried. Advocates are concerned because this is a return to financial risk models that have failed spectacularly in the past. Since Medicaid moved away from financial risk five years ago, access to care and quality are up substantially and the state has saved almost $500 million. Another 200,000 members are tentatively scheduled to be defaulted into PCMH+ next January 1st before anyone knows if the historical problems have returned. The letter also outlines several other PCMH+ assurances of consumer protections that have not been honored.