January 4, 2010
Vol. II, No. 17
Connecticut Expands Primary Care Case Management Pilot for Medicaid Children, Families
Connecticut's Department of Social Services has expanded its Primary Care Case Management (PCCM) pilot program to additional clients in the state's HUSKY A (Medicaid for children and families) program.
The state's HUSKY A clients enroll directly with their primary care providers (PCP), who in turn coordinate their care. The pilot pays participating PCPs $7.50 per member per month (in addition to fees paid for direct service) to coordinate care of patients who enroll with their PCP directly, rather than with a Medicaid managed care health plan.
PCPs then provide case management services in addition to their direct patient services, which include care coordination, developing care plans for enrolled clients, managing patients’ diseases and offering after-hours availability to patients for telephone advice. PCPs can be pediatricians, internists, family medicine practitioners, OB-GYNs, nurse practitioners and physician assistants (PAs), as well as specialists who obtain prior approval.
Launched in February 2009 with PCPs in the greater Waterbury and Windham/Willimantic areas, the program is now available in the greater New Haven and Hartford areas for member enrollments effective this month.
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The National Committee for Quality Assurance (NCQA) has appointed two committees to help revise its landmark evaluation of medical practices through the Physician Practice Connections®-Patient-Centered Medical Home™ (PPC®-PCMH™). A 23-member advisory committee will help the NCQA to revise standards that continue to be feasible for individual practices and that also encourage better coordination and integration across systems. A second task force will explore how to apply the medical home standards and other quality requirements to accountable care organizations (ACOs) and provide guidance to the broader committee.
The PPC-PCMH advisory committee will apply findings from research and practical application of the medical home model in demonstration projects. The committee will explore how to define aspects of the model that can improve quality and save money, incorporate patient experience and clinical care results into the evaluation of practices, recognize the role of non-physician clinicians and align standards with federal “meaningful use” requirements for EHRs.
The advisory committee will propose draft changes to PPC-PCMH standards in the first quarter of 2010. Public comments will be sought in the second quarter of 2010, and NCQA will approve final recommendations in late 2010 and publish them in January 2011. Since its introduction in 2008, NCQA’s PPC-PCMH program has recognized more than 300 medical practices across the United States.
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Just two days remain to join the more than 110 healthcare companies that have already described how their case managers contribute to care coordination, cost management and quality improvement. Submit your responses to HIN's Survey of the Month on Healthcare Case Management by January 6 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.
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Healthcare Trends Update: Reducing Hospital Readmissions
With public and private payors sharpening their focus on and realigning reimbursement with hospital readmission rates, particularly among Medicare patients with heart attack, heart failure and pneumonia, more healthcare organizations are taking a hard look at readmission rates and launching programs to reduce these rates. This white paper summarizes the responses of 107 healthcare organizations to HIN's November 2009 Reducing Hospital Readmissions e-survey, which set out to identify the rudiments of readmission reduction efforts in the healthcare industry, from target populations and conditions to responsibilities, roles and ROI.
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ReadmissionsRx LAUNCHING IN JANUARY 2010!
A new monthly e-newsletter delivering strategies to reduce hospital readmissions that encompass care plan development, case management, care transitions, pre- and post discharge planning, medication reconciliation and much more — with a special focus on reducing rehospitalizations among the Medicare population.
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