Why is primary care slow to get established?

Is the state doing enough to promote a new health plan that promises better care by bypassing insurance companies? Advocates say no, but the commissioner responsible for the program–and some health professionals–argue that the plan puts a heavy administrative burden on physicians without adequate reimbursement.

“The word is out. This is a choice program and (physicians) have chosen not to participate. We cannot coax them to join,” said commissioner Michael P. Starkowski of the Department of Social Services.

The plan, HUSKY Primary Care, gives children and some adults in low-income families the option to have their doctors manage their heath care, from approving treatment by specialists to arranging tests, without the involvement of an insurance company. The option currently is available for HUSKY patients whose doctors’ offices are in Greater Hartford, New Haven and parts of Waterbury.

Advocates like Ellen Andrews of the Health Policy Project say the problem is that DSS isn’t working hard enough to get physicians to sign up. Only 200 doctors in the three pilot test areas have enrolled so far.

“The department’s response has been we are unwilling or unable. I am just disgusted,” Andrews said. Greater participation could save millions of dollars, she said: In other states where a primary care program has been implemented, health care costs have declined as expensive claims such as emergency room visits have decreased.

But Starkowski said other states have raised rates to compensate physicians for the administrative costs.

“This has worked in states where there is really an impetus to create significant rate increases for the participating physicians. That’s not the case in Connecticut. We have not the dollars to approve significant rate increases,” he said.

Some in health care agree that the issue is that the primary care program doesn’t pay doctors enough for the added administrative burden. Under the current system, HMOs contracting with the state handle things like referrals, billings to the state and payments to doctors; under the primary care program, those responsibilities fall on the physicians’ offices.

“We don’t have specific staff for this. Right now those on [HUSKY Primary Care] are my responsibility, but I have 10 other things to do at the same time,” said Christine Bianchi, director of community programs at StayWell Health Center in Waterbury.

Jillian Wood, executive director of the Connecticut chapter of the American Academy of Pediatrics, said the paperwork is one problem, but another is overall reluctance to deal with DSS.

“There are people who have just had it with working with DSS. There are just too many stumbling blocks,” she said. “They are always talking about dropping the reimbursement rates. The paperwork is difficult. Getting the credentials to qualify is hard and they deny services. They just make it too difficult.”

Starkowski said DSS is aware of the administrative issues.

“They have made it well known they do not like all the administrative work they have to do and don’t think they should have to,” he said. “Through [Husky Primary Care] they have the responsibility for all this paperwork that use to be handled by the managed care company that got the bill and dissected all this information and reported it to us.”

He said the department is working on a data document system to help improve the way the department does business. This new system will be fully operational by late 2011.

But state Rep. Toni E. Walker, D-New Haven, co-chairwoman of the legislature’s Human Services Committee, said DSS could be doing more to reduce the administrative burden.

“DSS creates the paperwork, so they should find a way to downsize the amount of work,” she said. “They are just making it a very difficult obstacle course for doctors.”

Despite the primary care plan’s limited enrollment so far, the Human Services Committee is considering a bill that would expand the program statewide – a move both Walker and the committee’s Republican ranking member Lile Gibbons of Greenwich support.

“That’s the only way we can see if it works,” said Gibbons. “If doctors want to be part of this, by all means we should be letting them.”