Friday’s Medicaid
Council meeting focused on the controversial
PCMH+ shared savings program reminding many observers of years of rosy DSS
presentations about the very similar, failed HUSKY MCO program. PCMH+ started
six months ago with 137,000 members. The concept is to give Accountable Care
Organizations (large health systems) a reason to lower the total cost of care
for members by sharing half the savings with them. We heard inspiring stories
of consumers who have been helped by the care managers hired with PCMH+ upfront
funding. (Note that many of the anecdotes could/should have been covered under
the current successful PCMH (no plus) program.) To avoid the stunning failure
of the HUSKY MCOs, there was to be robust tracking of quality and
underservice metrics, higher spending (despite
the program’s name), and enforcement of policies to ensure that ACOs do not
cherry pick members to drive up false “savings” payments, as has happened in
other states. Unfortunately, DSS has not
lived up to their promises in implementation intending to expand the risky
program to another 200,000 people in six months without an evaluation of harm
or overspending. Advocates have expressed
deep concerns about this among other problems, but at the meeting Friday,
DSS refused to answer the question or explain their decision. Reportedly, the
capacity to evaluate and report on PCMH+ performance exists at UConn and they
are eager to help. We have not received an answer to that question either. Concerns
about sustainability of funding for the care managers were also ignored. As
questions were cut off, advocates are sending our questions to DSS and to the
ACOs individually. We’ll let you know if we get any answers.
