'Person-Centered Medical Home' Model to Expand

Statewide under HUSKY, Medicaid,

Charter Oak Programs

State Health Care Programs Serve 600,000 Residents

HARTFORD - Lt. Governor Nancy Wyman joined State Representative Michelle Cook (D-65 ^th District), Office of Policy and Management Secretary Benjamin Barnes, Department of Social Services (DSS) Commissioner Roderick Bremby and others to announce the next steps in Connecticut's plan to bring fundamental change to the way state health care programs serve nearly 600,000 residents.

The 'Person-Centered Medical Home' model is simply a way of providing health care that is patient focused and puts doctors, not insurers, in charge of medical decisions. This model improves health care outcomes and reduces costs by having a primary care doctor coordinate care with specialists, hospitals, and pharmacists to reduce duplication, avoid errors and ensure patients follow through with their treatment plans. Preventive medicine directed by a medical professional is proven to keep people healthy and out of expensive emergency rooms when they do need treatment.

Lt. Gov. Wyman welcomed a group of physicians who will help guide the state as it implements the 'person-centered medical home' model in the HUSKY, Medicaid and Charter Oak health care programs.

"The person-centered medical home concept is not only a better way to care for patients, but is a benefit for taxpayers because it is another step toward a self-insured coverage program that will mean significant savings over the existing managed-care system," Lt. Gov. Wyman said. "Today, we are asking all medical providers to join us in our goal of making our health care programs for children, parents, seniors and citizens with disabilities as effective, and as cost-efficient, as possible."

Rep. Cook, co-chairs the legislature's Medicaid Care Management Oversight Council's sub-committee on Primary Care Case Management (PCCM) that advises DSS on implementation of the HUSKY, Medicaid and Charter Oak health care programs.

"This is an exciting day in reforming health care across Connecticut. We are announcing changes that require the active partnership of providers to make our goal a reality," said Rep. Cook. "Person-centered medical homes are an active partnership between patients and their provider - and a partnership between providers and state government. We are here today to show our commitment to begin the dialogue for an intense planning process to craft this new program."

A person-centered medical home uses advanced health care information systems to help coordinate care and to identify the most effective or "evidence-based" treatments, all to help the patient and provider make the best health care choices.

Medical homes offer access to necessary health care advice 24 hours a day/7 days a week. The result is better health care services, greater satisfaction with care (for patients and their providers), and, most importantly, improved health .

"The first step is merging our various public health coverage programs under an 'administrative services organization' (ASO) structure, effective January 1, 2012," Secretary Barnes said. "Currently, we have HUSKY and Charter Oak under expensive managed care organizations, and we have adults in fee-for-service Medicaid with no support or care coordination whatsoever. This underlying change - coupled with the benefits of person-centered medical home as a model of delivering care - promises to bring better health outcomes to our citizens and more economies for the state."

The Department of Social Services is the administering state agency for Medicaid, Charter Oak and HUSKY (which combines a Medicaid program for low-income families and a non-Medicaid program for children in higher-income families).

DSS Commissioner Roderick L. Bremby noted that his department issued a request for proposals in early April for the overall restructuring.

"The Department of Social Services and the Medicaid Care Management Oversight Council will establish teams of medical providers and consumers to advise the department on the design of this new model," Commissioner Bremby said. "The work will include focus on the standards of care and the performance measures to ensure the outcomes we are expecting."

Commissioner Bremby noted that the new program will build on the state's experience with its innovative HUSKY Primary Care program, a primary care case management pilot in which DSS pays primary care doctors and nurses to coordinate their patient's care.

"Under the new model, the state will continue to pay a monthly fee to participating medical homes for coordinating care for HUSKY recipients. However, the program will be expanded and available to other individuals with Medicaid and other public coverage and also providers, no matter where they live or practice," Bremby said.

Physician groups support expanding the program state-wide. Dr. Sandra Carbonari, President -Elect of the CT Chapter American Academy of Pediatrics and Dr. Robert McClean, Governor of Connecticut Chapter of the American College of Physicians both spoke in support of broadening the scope of the program.

Under the new model, many individual doctors, practice groups and community health centers will qualify to serve as person-centered medical homes. Beginning in January, and expanding over the next several years, these medical homes will complement the administrative services organization in coordinating care for their patients.

The changes in health care administration will improve coordination of medical benefits and outcomes under Medicaid - a $4 billion program that covers over 394,000 children and parents enrolled in HUSKY A managed care; and 170,000 seniors and younger adults in fee-for-service Medicaid.

This includes senior citizens and people with disabilities, groups who have received little or no support or guidance to date in navigating the health care landscape. The same advantages will be felt in the smaller HUSKY B program for children (currently enrolling about 15,000) and Charter Oak Health Plan for uninsured adults (now serving about 10,000).

The state will contract with one or more 'administrative services organizations' for overall coordination of the system. The move to a self-insured administrative services organization format also means that the state will no longer pay outside firms to assume the financial risk for the cost of a medical claim, but will instead directly pay providers for patients' care.