Council on Medical Assistance Program Oversight

Care Management (PCCM/PCMH) Committee

Legislative Office Building Room 3000, Hartford CT 06106

(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306

Co-Chairs: Rep. Michelle Cook & Rep. Charlie Stallworth

July 09, 2014 at 10:00 AM Agenda LOB Room 2A

Attendance: Beil Halsey, Erica Garcia, Laura Deweyer, Deborah Amato, Annie Jacob, Sandy Carbonari, Rep. Abercrombie, Rep. Cook, Rep. Stallworth, Sheldon Toubman

There was introduction of PCMH Committee. Rep. Cook opened this meeting at 10:00 AM.

Participants- PCMH approved NQVA I/III

Implement plan of action

-This is done with ctps at onsite visit it’s not an audit.

How they refer or do behavioral test.

-Allowed pr. practioners, large model practice could use often to BH service

-Space to that person.

DSS -PCMH Program Update

  • Sandy Carbonari discussed the Behavioral Health quality measure for the PCMH program. The difficulties of private practices.
  • They are seeking consultation for the services meeting that requirement
  • Sandy also spoke on medical providers- referring those with broad mental health issues.
  • Have access mental health will be better.
  • Erica Garcia talked about incorporating 2014 NCQA standard, that also speak on mental health.
  • Sandy asked a question about the member to provider ratio.
  • Erica responded with the PCMH approved providers have been raising.
  • Want to spread news and share with members. 2 large groups with huge amount of members like Hartford and Pro Health physicians.
  • Sheldon Toubman commented on the website and the searchable.
  • Erica said, there was a recent development for provider search directory for it to be easier.
  • Working on getting info through members from mailing informing on what PCMH is.
  • Want the info to be accessible.
  • They can call member services, direct them to PCMH providers.
  • Annie Jacobs said the getting members to primary care and good point, impressed with progress made.
  • Sheldon interested in the annual review, get your certification, PCMH quality assurance form and must have elements review. Specifically NCQA- document on the evaluation form how the practice meet the criteria in reference to the NCQA must have elements.
  • Some of the FQHC have JACHO and NCQA recognition. What does the commission do?
  • Process is renewed every three years; it’s a self-evaluation-attestation.
  • There are an application and glide path and they are given enhanced fees. This is done to make sure they are functioning appropriately. It is easier with practices they worked with glide path because they know how they are working with and support.
  • Sandy Carbonari – are people not wanting to renew.
  • Laura D. - HHC physicians NCQA decided not to not pursue renew. Most of the practices 16 total expire in august. Hartford Healthcare.
  • Rep. Abercrombie - huge issue, FQHC reporting structure some in place through them. Hartford Healthcare and where we go from here meeting that needs to take place.
  • Erica Garcia- did our best, Dr. Zavoski tried to intervene and have the discussion with them directly.
  • Deb Amato- joined in October 2013, there NCQA recognition in coming up. Some physicians were not participating in Medicaid at the time and some were.
  • Sandy Carbonari- nationally starting to be more pushback with NCQA.
  • 84 PCMH program participants (3 practices have sites in both PCMH and Glide Path programs).
  • 318 individual sites (includes pending)
  • 46 PCMH approved practices
  • 170 sites
  • 727 PCMH approved providers
  • 2 pending PCMH practices (4 sites with 5 providers)
  • 1 pending PCMH site (1 provider)
  • 24 Glide Path practice participants
  • 38 sites
  • 129 Glide Path providers
  • 1 pending Glide Path practice (1 site with 1 provider)
  • 14 PCMH Accreditation participants
  • 104 sites
  • 362 PCMH providers
  1. Southwest Region:

13- PCMH practices with 18 sites

4 Glide Path practices with 8 sites

5 FQHC practices with 8 sites

3 PCMH pending practices with 5 sites

1 Glide Path pending practice with 1 site

  1. South Central Region

7 PCMH practices with 45 sites

4 Glide Path practices with 8 sites

3 FQHC practices with 18 sites

  1. Eastern Region

16 PCMH practices with 45 sites

1 Glide Path practice with 1 site

3 FQHC practices with 18 sites

  1. North Central Region

9 PCMH practices with 50 sites

5 Glide Path practices with 5 sites

4 FQHC practices with 22 sites

  1. Western Region

9 PCMH practices with 39 sites

11 Glide Path practices with 16 sites

3 FQHC practices with 9 sites

  • 266 practices continued since 1/1/12:
  • 84 practices enrolled
  • 76 prospective practices in open status
  • 51 practices on watch list
  • 55 practices on closed list
  • EHR status of 76 practices in open status
  • 56 practices (74%) have live EHRs, purchased or are implementing an EHR.
  • 5 practices (7%) are searching for an HER
  • 2 practices (2%) have no EHR
  • 13 practices (17%) the EHR status is unknown at this time
  • 55 practices on closed list
  • Not interested in enrolling in the PCMH program or joining/merging with a PCMH/GP practice already enrolled.
  • 51 practices on watch list
  • Follow-up takes place periodically based on the feedback received from the group.

PCMH Regulation- there is no update with the regulation.

SIM Grant and PCMH Program

Rep Cook introduced the discussion about having the Medicaid Portion of the SIM process going through the PCMH Committee.

  • SIM and its effect on the PCMH program.
  • SIM wants PCMH to retain all of the good values it has. Going to be paying the enhanced payment not the pmpm (per member per month), enhanced care.
  • Sheldon-Doesn’t want the components of PCMH to change.
  • SIM with shared savings will mess with PCMH; it is not going to build on it.
  • Shared savings, under service-lack of medical care.
  • Sheldon- Does not want to put Medicaid clients into the shared savings, see how shared savings works with other programs first.
  • Grant won’t go through unless large amount of Medicaid patients are involved (children, parents, and families); At least 200,000 people will be put into the system.
  • Independent consumer advocates are unanimously opposed to 200,000 Medicaid shared savings.
  • Enhanced payments were taken away because FQCS were denied.
  • What happens after the application is submitted in January 2015?
  • Trying to improve care coordination to reduce unnecessary ED and re visits to the hospital.
  • Do not want shared savings by itself, breakdown. Cost reduction is not considered in the first year.
  • Providers will be penalized for those children who are hospitalized? Most are not unnecessary hospital utilization.
  • Sheldon does explain where the number comes from.
  • Next meeting possibly in august to discuss the problems.
  • SIM oversight as well, where they are.
  • Every other month will be the next reporting.

The next meeting will be held on August 13, 2014 at 10:00 AM.