Primary Care Case Management: An Option for Connecticut Medicaid
Legislative Forum
Tuesday, March 27, 2007

Research Summaries

Primary Care Case Management: A Better Option for Connecticut Medicaid
Primary Care Case Management and Medicaid: 2006 Update
CT Health Policy Project
September 2006

Paper http://www.cthealthpolicy.org/pccm/pccm_medicaid.pdf
Brief http://www.cthealthpolicy.org/briefs/issue_brief_29.pdf

Analysis of PCCM in other states, how it works, how much is saved, consumer satisfaction and improved health outcomes.

Vernon Smith PhD, Perrisca Des Jardins, and Karin A. Peterson
Exemplary Practices in Primary Care Case Management
Informed Purchasing Series
Center for Health Care Strategies
June 2000

An extensive survey of states and analysis of best PCCM practices for provider recruitment and retention, quality improvement, utilization management, enrollment, reimbursement, management, coordination with behavioral health services, serving special needs populations, member services and education.

Charles Willson
Community Care of North Carolina: Saving State Money and Improving Patient Care
NC Med J; 66(3) p. 229
May 2005

A commentary beginning with a case study, that describes the evolution and the success of North Carolina’s primary care case management/medical home program including financing, physician champions, disease management, care management, evidence-based practice implementation, and the value of preventive care.

Stephen Wilhide and Tim Henderson
Community Care of North Carolina: A Provider-Led Strategy for Delivering Cost-Effective Primary Care to Medicaid Beneficiaries
American Academy of Family Physicians
June 2006

An extensive analysis of North Carolina’s PCCM program including impressive cost savings, care management, program structure, principles, planning and payment.

Maine Dept. of Health & Human Services, Bureau of Medical Services
MaineCare Performance Report, 2003
October 2004

Analysis of Maine’s PCCM program performance comparing favorably with contractual benchmarks. 98% of children ages 12 to 24 months visited their primary care provider during the year, exceeding Medicaid HEDIS benchmarks by 10%.

Curtis Florence
Nonurgent Care in the Emergency Department: Can We Save by Shifting the Site of Care?
Annals of Emergency Medicine; 45 (5) p. 495
May 2005

An editorial that cites statistics suggesting that we can save a significant amount of money by shifting the site of care from the emergency room to primary care settings

JJ Cotter, KA McDonald, DA Parker, et al.
Effect of different types of Medicaid managed care on childhood immunization rates.
Eval Health Prof.;23(4):397-408
December 2000

This study compared childhood immunization rates for three types of managed care organizations for Medicaid and found that found that children in primary care case management had significantly higher immunization rates than those in HMOs.

LF Rossiter, MY Whitehurst-Cook, RE Small, et al.
The impact of disease management on outcomes and cost of care: a study of low-income asthma patients.
Inquiry 37(2):188-202.
Summer 2000

This study was a large scale evaluation of Virginia’s PCCM asthma disease management programs demonstrating significant cost savings of $3- $4 for every dollar spent on asthma disease management due to reduced ER visits and increased use of asthma medications.

Office of Vermont Health Access Consumer Satisfaction Survey - 2001.

Found that customer satisfaction among PCCM members in VT exceeds most national Medicaid levels and is similar to satisfaction levels of private managed care plan members.

ET Momany, SD Flach, FD Nelson, PC Damiano
A cost analysis of the Iowa Medicaid primary care case management program.
Health Serv Res.;41(4 Pt 1):1357-1371.
August 2006

This large scale study compared actual costs to expected costs for Iowa’s Primary Care Case Management Program from 1989 to 1997. An estimated $66 million was saved during the study period, which is a 3.8% reduction from what was expected in the absence of PCCM. This large study was designed to address the methodological limits of previous smaller studies which found mixed levels of savings from PCCM. The study also includes comparisons with fee-for-service and HMOs and provides evidence that operating both PCCM and HMOs reduces costs in both systems. They found no evidence that healthier members were disproportionately enrolled in HMOs.

CS Minkovitz, AK Duggan, MH Fox, MH Wilson
Use of social services by pregnant Medicaid eligible women in Baltimore.
Matern Child Health J.;3(3):117-127.
September 1999

This study compared the access to social services for pregnant women in Maryland’s Primary Care Case Management Program and in HMOs in Maryland. The authors concluded that women who were enrolled in the PCCM program were more likely to receive a wide range of social services than similar women in Medicaid HMO programs.

Seeking Higher Value in Medicaid: A National Scan of State Purchasers
Center for Health Care Strategies
November 2006

A national survey of Medicaid administrators find strong support for dual HMO and PCCM systems to enhance value in Medicaid purchasing and improve innovation and competition. States are building their PCCM systems to include more sophisticated tools such as care coordination and quality improvement. “All of the states interviewed recognize that full-risk capitation is not the only vehicle for managed care expansion.”

Sharon Silow-Carroll and Tanya Alteras
Stretching State Health Care Dollars: Care Management to Enhance Cost-Effectiveness
The Commonwealth Fund
October 2004

An analysis of the potential of case management and disease management to improve health outcomes and reduce costs. A survey of best practices across states including PCCM programs.