Suppose there was a way to provide more children with better health care and save taxpayer money at the same time-wouldn’t it make sense for the state to embrace such an option?

Of course it would. That’s why for years many state lawmakers have been pushing Connecticut’s Department of Social Services to use a Primary Care Case Management program for children in the HUSKY program.

PCCMs are simply a way of providing health care that is centered on the patient and puts doctors in charge of medical decisions. This model improves health care outcomes and reduces costs by having a primary care doctor coordinate care with specialists, hospitals, and pharmacists to reduce duplication, avoid errors and ensure patients follow through with their treatment plans. Having someone to manage care is proven to keep patients healthy and out of expensive emergency rooms.

Traditionally families in HUSKY, Connecticut’s health insurance program for children and teenagers up to age 19, choose a plan managed by one of three insurance companies. This means that in most cases insurers, not doctors, are in charge of patients’ medical care and decisions.

We at the legislature in 2007 created a trial program to allow some HUSKY families to opt for a PCCM plan that would allow the state to pay primary care providers directly for their services–costing taxpayers significantly less than the three plans run by private insurers.

Unfortunately, former Governor M. Jodi Rell resisted the PCCM option despite the fact that similar programs are functioning in a majority of states. DSS staff erected a variety of high barriers to ensure that very few doctors and HUSKY families participate in the program.

That’s why I was overjoyed last month when Governor Dannel P.  Malloy broke with Rell’s failed policies and announced the entire HUSKY program for about 400,000 Connecticut residents would be moved to a care management model.

Under Malloy’s plan the state will pay directly for all HUSKY health care services beginning in 2012, instead of leaving this to privately run insurance companies with high overhead and a direct financial interest in denying needed treatment.

It’s cheaper and kids will be healthier-sound good? Although it probably sounds good to you and most folks, there are a still a few key administrators at DSS who don’t think it is such a good idea. These bureaucrats seem bent on undermining quality healthcare that would save taxpayers’ money.

Over a month after Governor Malloy’s announcement, not one of the barriers preventing HUSKY families from using the PCCM model has been removed. For example, enrollees who do not choose a plan are being assigned to one of the three private insurers only to be moved again to a new plan in less than a year.

The governor’s budget chief has unequivocally endorsed PCCM saying it needs to be ramped up for 2012, but there are many other barriers that DSS staff has still not removed, like prohibiting doctors from initiating conversations with their own patients about the PCCM option.

At a March 11 public meeting, a DSS official was asked to explain why it had taken no action to expand the PCCM pilot in light of the Malloy Administration’s announcement. In response, he boldly declared: “PCCM does not meet my standards.”

DSS has a new Commissioner, Roderick L. Bremby, and I am hopeful that Commissioner Bremby will make sure the old attitudes of DSS bureaucrats do not prevent more children from receiving quality better health care and saving taxpayer’s money.

Leave a comment