State cuts medical home incentives for health centers

The state is trying to encourage health care providers to take a more active role in Medicaid patients’ care, but as part of a budget cutting move, officials have cut off incentive payments for community health centers that do so.

The $900,000 cut eliminates money that was intended to compensate health centers for serving as “patient-centered medical homes” that take a proactive approach to patients’ health and coordinate their care.

Funding to encourage other health care providers to serve as medical homes is not affected by the cut, but critics say it could still cause some doctors to reconsider whether to participate in the state’s medical home program.

Deb Polun, director of government affairs at the Community Health Center Association of Connecticut, said most health centers will continue with the medical home initiative, even without the extra funding. But she said the cut could make other health care providers wary of participating in the program if they worry their funds could be vulnerable too.

“This is a really disappointing setback, and it means a shuffling of resources,” she said. “But for the entire Medicaid program, there’s people who are very nervous now that this whole [medical home] model is endangered based on this move.”

The cut was made as part of the deficit reduction deal reached by lawmakers last month, although it was not specified in the language approved by the legislature.

Department of Social Services spokesman David Dearborn said the cut was made because Medicaid was responsible for most of the state’s deficit and the health centers already get paid more money under Medicaid than most other providers. In addition, the health centers’ model is already consistent with the medical home model, meaning that they would “have lesser need for incentives than other providers,” he said.

As part of the program, health-care providers can earn higher fees if they serve as medical homes. Those that are in the process of meeting the medical home standards can receive start-up payments ranging from $13,000 to $25,000, as well as higher fees.

Currently, there are 17 practices recognized as medical homes in the Medicaid program, including one community health center. Altogether, they include 444 individual providers — 68 in the health center, and 376 in other practices.

Another 20 practices, which have 115 providers, are on the way to becoming medical homes and eligible for the start-up payments. In addition, 12 community health centers, which include 294 individual providers, are in the process of becoming medical homes.

“Medical home” refers to a way of running a medical practice, in which the health-care providers take a more active role in meeting patients’ needs.

Lori-Anne Russo, director of clinical programs for the health center association, said medical homes keep track of which patients haven’t had immunizations or recommended screenings and call them to remind them, rather than waiting for patients to make appointments. “You are proactive in soliciting them to come in and get these things done,” she said.

In the past, a doctor might have told an overweight patient to exercise every day, eat less and come back in a year. But in a medical home, Russo said, health care providers look into whether the patient can make changes and work with him to address any barriers to doing so.

Becoming a medical home, she added, requires time and resources to redesign how staff works.

Sheldon Toubman, an attorney with the New Haven Legal Assistance Association and a longtime supporter of the medical home model, said the “secretive cut” seemed to indicate a retreat from the administration’s commitment to medical homes.

“Providers are very unlikely to participate in this innovative, cost-effective initiative, in the face of such back-tracking,” he said.

Dr. Robert McLean, a New Haven internist and rheumatologist and governor of the Connecticut chapter of the American College of Physicians, called the cut a “potential concern” and said encouraging primary care will be critical to reforming the health-care system.

“Anything you can do to promote medical home development at any level is very important,” he said. “I would be afraid that this would be viewed as the state making a statement that encouraging primary care is not the highest goal. And I think that that is not a statement that they want to make.”