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PRIMARY CARE CASE MANAGEMENT:AN ALTERNATIVE FOR MEDICAID IN CONNECTICUTMETHODOLOGYTo gain a better understanding of how states across the country manage their PCCM programs currently and historically, a telephone survey of various professionals from 22 states was conducted. States utilizing PCCM were identified using a HCFA table found on the HCFA website. This table lists Medicaid managed care plans and enrollments by state as of June 1999. Each of these states was geographically grouped. A survey developed by four Yale University School of Nursing graduate students was conducted to identify and highlight specific information concerning the use of the PCCM model within each state's Medicaid population. The major focus of the survey was to identify and highlight specific information concerning the use of the Primary Care Case Management model within each state's Medicaid population. The survey participants included those individuals who possessed specific knowledge regarding their respective state's program(s). Examples of these individuals include; Medicaid directors, bureau directors, program managers, policy analysts, social workers, and others. The questions were designed to gather information about each PCCM program such as; the extent, age, historical background, name(s), eligibility, PCP designation and availability, per member per month costs, methods of program evaluation, existence of perceived benefits, and any known clinical outcomes. Initial contact with each state was preceded by a search of the state's website where applicable. This was done for the purposes of obtaining baseline information of each program, as well as to ascertain the names and phone numbers of offices that administer or oversee each program. Once this basic information was obtained, states were contacted directly with requests for more detailed information. In order to obtain the desired information on a wide variety of topics, it was often necessary to contact more than one individual from each state. This was accomplished in several ways. Some states preferred to answer questions only after written requests via facsimile or mail were sent to individuals or offices. The majority of states agreed to interviews after messages were left at various offices requesting information through personal telephone contact. For several reasons, not all of the states that utilize some form of PCCM were able to provide data in a timely manner. Some states were uncooperative; some were unavailable, while others simply did not have the ability to provide the requested information. As a result, the survey includes data obtained from 22 states nationwide. These states are Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, Montana, New York, North Carolina, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Virginia, Washington, and West Virginia. States were compared using a variety of information including; per member per month (PMPM) costs, provider experiences and feedback, total program size, clinical outcomes, and important verbatim comments. All data was gathered not only from personal interviews, but also from available printed media. This includes published independent studies or reports, as well as 1915(b) "program" waiver applications. Because these waivers are granted for two year time periods (but may be continued indefinitely through renewal), states must track, document, and report certain outcomes during that period. Of significant importance is the PMPM cost data. However, for different reasons, not all states were able to supply these waivers. In retrospect, some approaches to the gathering of data were more effective than others. The more effective techniques include:
Less effective techniques include:
Paper | Acknowledgements | Executive Summary | Introduction | Methodology | Results | Implications | Conclusion | Appendix | References | Resources |