PRIMARY CARE CASE MANAGEMENT:

AN ALTERNATIVE FOR MEDICAID IN CONNECTICUT

IMPLICATIONS FOR CONNECTICUT'S MEDICAID PROGRAM

In review of previous PCCM studies, little is known about how PCCM models affect the complex and fragile Medicaid Managed Care environment, which brings to light the need for ongoing systematic and comprehensive PCCM data collection. The information obtained from this study provides only a fraction of information regarding PCCM programs. None-the-less, it establishes a benchmark from which future change can be tracked and most importantly, this study will serve as a resource to Non-PCCM states exploring the option of primary care case management.

Historically, Connecticut's experience with Medicaid spending is comparable to other states. Increased beneficiary enrollment and uncontrolled health care costs is a national problem. However, Connecticut enjoys several advantages which suggest that a PCCM program would be successful. According to many key Medicaid administrators, strong legislative support is critical to the viability of a PCCM program. Legislation passed by the Connecticut General Assembly in 2000 requires the state to conduct a study of alternative delivery models for Medicaid Managed Care, including PCCM. Connecticut is home to several strong PCCM advocates and policymakers, at the local and state levels, who are willing to begin planning initiatives to establish a strong PCCM program in this state. Additionally, the absence of urgency allows for adequate planning. Currently, four health plans participate in Connecticut's Medicaid system. However, given the dynamic trends of the Medicaid system, the risk of HMO's withdrawing from the Medicaid system is a constant concern. If this happens, important decisions are less likely to be efficient when made under pressure.

Another advantage Connecticut offers is better access to care. There are 31 Acute-care hospitals in CT ( http://www.chime.org/ , 2000) and 3.7 primary care physicians to 1,000 residents ( http://state.ct.us/ohca/ , 2000). Also, the population density in Connecticut is less extreme compared to other areas studied, which eliminates a common challenge reported by many states. In other states, long traveling distance seem to seriously compromise PCP accessibility. Of the 8 counties in Connecticut, Litchfield is the largest (920 sq. mi) and least densely populated area (196 persons per square mile), with a population of 181,227 (  http://www.state.ct.us/ , 2000).

Naturally, with the implementation of any new program, Connecticut will encounter a multitude of challenges unique to this state. However, like other states, with appropriate planning, legislative support and creativity, PCCM offers the flexibility to accommodate the needs of both private and public sectors.

Implications of the issues revealed in this study are important for Connecticut's policy makers to consider in making decisions affecting health care services to vulnerable populations. Policy makers will need to appraise the efforts of those PCCM states that continue to make important contributions in the Medicaid arena. In light of the information gathered in this study, it is safe to say that implementing a PCCM model offers Connecticut an alternative strategy to improving access to health care, controlling Medicaid program costs, and offering beneficiaries the freedom to choose between health plans. The experiences of PCCM states, as documented in this study, has helped to create a "PCCM" template for Non- PCCM states. The following template is designed in respect to the Medicaid system in Connecticut.

• Demographic/Geographic Needs Assessment. Collect baseline of state vital statistics regarding logistical, cultural, and medical needs for each county (Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland and Windham).
• Pre-PCCM Planning. Contract with an outside agency to conduct this phase or independently dedicate professionals to begin PCCM program planning and designing to establish a solid PCP network and organizational infrastructure. Include all stakeholders, private and public, in each stage of planning (regulation, administration oversight, etc.) to ensure continued survival within the changing political context.
• Pilot Program. Implement a PCCM pilot program in two counties for comparison purposes.
• Marketing. Educate policy makers, the general public, eligible PCCM member and other individual affected by using the Internet, letters, brochures, and other areas of media advertising directly
• Organizational Structure. Designate one person or agency to oversee and coordinate the satellite offices in each region. Each regional office will coordinate private and public sector initiatives and strictly reinforce PCCM rules and regulations according to the needs for that region.
• National PCCM Association: Establish a local chapter of PCCM Advocates and participate in a national PCCM Association.
• Electronic centralized database. Design a quality assurance system that will systematically and continuously collect, critically analyze data, and generate valid and reliable feedback, in a timely and consistent fashion, to providers and consumers. Mandate one Independent Assessment every two years.

Paper | Acknowledgements | Executive Summary | Introduction | Methodology | Results | Implications | Conclusion | Appendix | References | Resources