Say you knew me, and you saw me coming out of a bar leaning on the arm of an unknown man. I bet you wouldn’t say, “Oh, look! Susan’s brother is in town, and isn’t it sweet they’ve gone out together.”
No. You’d think the worst, wouldn’t you, and I wouldn’t blame you. It’s the looks of the thing, isn’t it?
I’m reminded of that when looking at our state government and its half-hearted attempt – if you can call it an attempt – in providing health care choice for citizens.
At question is the state’s primary care case management program (PCCM), known as Husky Primary Care. An alternative to state-run HMOs – activists call this a way of running Medicaid without HMOs – Husky Primary offers consumers a health care professional who oversees their care. The professional is paid for services provided, as well as for managing care (that latter at about $7.50 a month per patient).
No insurance company stands between a patient and care, and high administrative costs – including pesky executive bonuses – are eliminated.
There are all kinds of stories out there about PCCM, but the state of Oklahoma, which recently went all-PCCM-all-the-time in just a few months, saved about $86 million in medical costs in the first fiscal year of implementation. More important, according to a 187-page report from 2009, care improved immeasurably. Outpatient visits went up. ER visits and preventable hospitalizations among adults went down. Some 40 percent more providers signed on.
To get the program going, the state spent nearly $7 million – which it rather quickly recouped, and then some.
And that’s not just Oklahoma’s SoonerCare’s success story. According to Ellen Andrews, executive director of the CT Health Policy Project, about 30 states successfully use PCCM.
Yet in Connecticut as of March 1, just 342 people have enrolled in the program since its launch last year.
That looks like a failure, but it’s hard to be successful when the state has consistently sabotaged the thing. The program could have been launched in Hartford or New Haven, where interest was high, but it wasn’t. At state-sponsored events and activities, talks revolve almost entirely around HMOs. Doctors believe marketing guidelines preclude them from speaking to clients about PCCM – even if clients come in complaining. So how does the word get out?
At a frustrating appropriations committee meeting in February, representatives from the Department of Social Services showed stultifying slides charting the program’s bleak history while activists proudly displayed buttons (“Ask Me About PCCM”) and posters they had made to advertise it.
Legislators seemed shocked that advocacy groups had taken that upon themselves. Shouldn’t that be the job of the state? I mean, if they wanted the program to succeed, that is?
Again – it’s the looks of the thing. Why the lethargy?
Advocates think people in power who should be throwing their weight behind this might be nervous about the messiness that accompanies any new program. That, or the governor’s blighted Charter Oak Health Plan (insurance for all, except when it’s not) is tied to the success of state-sponsored HMOs. If patients get a taste of the autonomy offered in Husky Primary Care, they might leave HMOs in droves.
But isn’t good health care the point?
The state has scheduled an evaluation of Husky Primary Care for July. Andrews, a former researcher who knows her way around numbers, says it’s set up to fail. The state needs to bring in someone with fire in the belly to get this going. Until then, the looks of the thing is that the state has launched a boat with no keel, no rudder and no life jackets. Of course it’s going to sink.
* Courant staff writer and columnist Susan Campbell can be reached at scampbell@courant.com.
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