What is PCMH Plus (PCMH+) & What Does It Mean For Me?
If you do nothing, you will default and stay in PCMH Plus
Frequently Asked Questions
PCMH Plus is Connecticut Medicaid/HUSKY’s newest experiment to change the way health care is paid for. 137,000 HUSKY members were enrolled into PCMH Plus a year ago. The state plans to add another 200,000 this Spring. Eventually, the state’s plan is to have every Medicaid/HUSKY member in the program.
PCMH Plus is a “shared savings” model of payment. Under PCMH Plus, if your health providers are able to reduce the costs of your care, their health system gets half of the savings. Shared savings is new, and hasn’t been very effective in other states.
The goal of the program is to improve the quality of care while controlling costs for the state. Under PCMH Plus, the hope is that health systems will coordinate care better, reduce unnecessary treatments, eliminate duplicate tests, and expand preventive care.
As with the HUSKY managed care organizations in the 1990’s, it is possible that the PCMH Plus health systems will save money by denying you or your family the care you need. For example, you may not get referrals to specialists or expensive medications. You may not even hear about all your treatment options.
You may also be moved to another doctor or dropped entirely, depending on your health issues. This has happened in other states to avoid costly patients. If you are currently receiving Intensive Care Management (ICM) support from Community Health Network, you will no longer receive those services.
You may already be in the program – almost one in five HUSKY members started in the program a year ago. You may or may not have received a confusing letter last year notifying you that you are in the program. Even if you aren’t in the program now, you will be soon. The state plans to eventually have everyone in PCMH Plus.
If you usually get your care at one of the following health care systems, you likely are already in PCMH Plus.
- Cornell Scott-Hill Health Center
- Community Health Center, Inc.
- Charter Oak Health Center
- Fairhaven Community Health Center
- Generations Family Health Center
- Griffin Hospital
- Middlesex Hospital
- Optimus Health Care
- St. Vincent’s Hospital
- Southwest Community Health Center
- Value Care Alliance
- Western Connecticut Health Network
- Yale-New Haven/ Northeast Medical Group
No, you have the right to opt-out. Over a thousand people opted-out in the first round. To learn more about the program and how you can opt-out if you choose, click on the link below or call 203-427-8242.
Ask your doctor about ALL your treatment and medication options, not just the less expensive ones. If a treatment or medication isn’t working, let them know and ask for an alternative.
The federal Agency for Health Care Quality has an excellent list of questions you should ask your provider.
- What is the test for?
- How many times have you done this procedure?
- When will I get the results?
- Why do I need this treatment?
- Are there any alternatives?
- What are the possible complications?
- Which hospital is best for my needs?
- How do you spell the name of that drug?
- Are there any side effects?
- Will this medicine interact with medicines that I'm already taking?
Nothing will change if you choose to opt-out of PCMH Plus. It is your choice.
If you opt-out, your services will not change, you can still see any doctors or other providers you choose. You will still get care coordination and other benefits from your doctor’s practice. In fact, if you are getting Intensive Care Management from Community Health Network, you will lose those services unless you opt-out.
If you opt-out, you may not get some new special services such as help with getting housing or food, but you may get those services anyway. It is important to note that there is no guarantee that you will get these services if you choose to stay in PCMH Plus. If you opt-out, you may not change your mind and re-enter the program until next year.
If you do nothing, you will default and stay in PCMH Plus.