OP-ED | Advocates Must Inform Consumers of Risks When the State Won’t
This week, independent advocates launched PCMHPlusFacts.org, a campaign to give HUSKY members balanced information about an experimental, new payment model expanding across the program.
PCMH Plus has risks for consumers along with possible benefits, but HUSKY members aren’t aware of them or that they have the right to opt-out of the new payment model. The state sent a federally-required notice last year to the first 137,037 consumers enrolled in the program, but the consensus notice, developed in a transparent process with all stakeholders involved, was weakened significantly at the last minute under political pressure from the large health systems that stand to profit from PCMH Plus. HUSKY members were confused by the adulterated notice and do not understand anything about the program.
Under PCMH Plus, large health systems receive half of any savings they can generate on their members’ care. The right way for those systems to save money is by keeping us healthy and reducing duplicate tests and treatments. But they could also save money the wrong way, by denying necessary care, as happened with the private insurers in the 1990’s who were paid under a similar payment scheme. HUSKY ditched that payment model five years ago and moved to a care coordination model that does not reward denying necessary care but does reward quality.
Since then members are getting the care they need when they need it, more providers take HUSKY patients, the quality of care is up, and per person costs are down. Connecticut is savings hundreds of millions of taxpayer dollars every year under the new model, far more than any state using the PCMH Plus payment model. But unfortunately Connecticut has decided to spend millions to move backward into it anyway. The state shouldn’t “fix” something that isn’t broken.
Independent advocates have had grave concerns about PCMH Plus from the beginning, but we worked hard with the state, in good faith, to make the program as successful as possible while protecting members’ health and taxpayer dollars. Unfortunately, implementation of PCMH Plus has been problematic. The state has lots of great data on whether the program is working but won’t share it with other state analysts with expertise in monitoring and evaluation. Despite the lack of an evaluation on the impact on the first 137,037 people defaulted into PCMH Plus, the state plans to add another 200,000 next month. Regular planning meetings with the large health systems that can profit from the program are held behind closed doors, not open to HUSKY members, advocates or the public.
Our campaign, PCMHPlusFacts.org, gives HUSKY members the balanced information they need to assess if the program is right for them and their families. We also give them the tools to opt-out of the program if they are concerned and places to go for more information. This was a difficult decision for advocates, as the state budget is tight, and 13,000 HUSKY parents have been cut from eligibility, but we had no choice. It is our job to give people accurate, understandable information about their health coverage, even if the state won’t.
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