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Healthcare Advocates Win Small Victory With Delay of Payment Reform

by | Oct 7, 2015 2:22pm () Comments | Commenting has expired | Share
Posted to: Health Care, Insurance, Legal, Public Health, Taxes

CTNJ file photo More than 20 health care advocates are claiming victory after a committee looking at how to revise payment methods for Medicaid patients put the brakes on a proposal.

The proposal would have required the state to move forward with finding a new payment method for one-third of Connecticut’s 700.000 Medicaid patients by July 2016. However, Lt. Gov. Nancy Wyman, who chairs the State Innovation Model (SIM) board, which is in charge of the project, agreed to delay implementation until January 2017.

“As we always do, we continually evaluate our ability to meet our various SIM timelines with the best interests of all Connecticut residents in mind,” Wyman wrote in a letter to advocates.

Advocates wrote Wyman that they felt the timeline placed an “arbitrary deadline” on the committee, and was not in the best interest of Medicaid enrollees. Advocates fear the state is moving toward a “shared savings” plan for Medicaid enrollees, which means the doctor will be paid extra for saving money on their patients’ health care costs. That means doctors have an added incentive not to tell their patient about a specific procedure because it could cause them to lose money.

But Wyman said if the state didn’t believe the shared savings model was in the best interest of the Medicaid beneficiaries it “would not be undertaking it.”

She said Connecticut is “committed to ensuring value for the money it spends on healthcare.”

Advocates who are participating in the process have been critical of the rush to change how Medicaid providers are paid for their services.

Ellen Andrews, executive director of the Connecticut Health Policy Project, said the accelerated timeline jeopardized the “hard-won accomplishments in our Medicaid program” and was also “a threat to state taxpayers.”

She said Connecticut’s Medicaid program has stabilized and reduced per person medical costs since moving to a non-risk, care coordination-based model. It’s actually bucking a national trend which shows the move from managed care organizations to accountable care organizations is costing the government more than projected. She argued moving away from the new model, which is working in Connecticut, may cost taxpayers more money.

In Connecticut, since moving to an accountable care organization in 2012, the state has increased the number of providers who agree to see Medicaid patients by 32 percent, reduced hospital admissions, and increased the number of patients getting primary care, such as immunizations and cancer screenings.

Wyman said the group is committed to giving all parties an opportunity to participate in the process and review the proposal before it’s put out to bid.

“Innovation is hard. Change is hard,” Wyman wrote. “But change we must to align with the shift to value and to make our Medicaid program even better.”

The deadline for the proposal has been delayed six months and the new shared savings model won’t be implemented until January 2017.

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(2) Archived Comments

posted by: oldtimer | October 7, 2015  5:30pm

Medicaid payment reform??? Malloy isn’t making his Medicaid payment for last quarter and is cutting $192 million in future Medicaid payments for this year’s budget… What’s to reform???

posted by: SB Chatterjee | October 8, 2015  8:54am

Kudos to Ellen Andrews of The Connecticut Health Policy Project and to other CT-SIM Committee Members for advocating this delay in implementation.
I remain skeptical of the ‘Shared Savings’ model because it’s performance-based contracting within a multiple entities network where most have performed only in an opaque manner (no price nor cost transparency). In most cases, even Wall Street is more transparent than the Healthcare Service provider industry - healthcare costs & price transparency remains a critical issue in healthcare reform.
While this may interest game-theory economists, it remains to be seen how governance contracts or fiduciary obligations will be met.

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