Connecticut will receive $12 million from the Centers for Medicare & Medicaid Services (CMS) to slow rising health care costs statewide.
Gov. Ned Lamont said the federal funds will finance the expansion of primary care and more community health programs while transforming payment models.
Connecticut has established a primary care spending goal with a goal of increasing primary care spending to 10% of total health care spending by 2025.
Statewide primary care spending accounted for 4.9% of all medical spending in 2022, below the 5.3% target.
Commercial health spending was 4% and Medicare Advantage was 3.2%, below target. Medicaid exceeded target at 7%.
The Total Cost of Care model will hold participating states accountable for health care outcomes and quality, while reducing health care costs under Medicare, Medicaid, and private health insurance.
This last part is causing some concern within the Connecticut Hospital Association.
“Questions remain about how the model can achieve these goals if it bases budgets on Medicare and Medicaid payment rates that fall far short of covering the cost of care — a problem that has contributed to many of the problems this model seeks to correct,” the association said in a statement.
Connecticut residents with employer-sponsored health coverage have seen their premiums nearly triple over the past two decades, according to the Office of Health Strategy. Residents have also paid an increasingly large share of their total health insurance premiums.
“Participation in AHEAD [the States Advancing All-Payer Health Equity Approaches and Development Model] “This will further strengthen our statewide approach and give us new tools to meet our goals for investments in primary care, chronic disease management, health equity and cost growth,” said Dr. Deidre Gifford, Commissioner of the Office of Health Strategy. “Our state Medicaid agency, [Department of Social Services] DSS, Medicare and commercial payers, along with our hospital and primary care colleagues, will be essential partners in the initiatives we launch through this model.”
Hospital participation is voluntary.
Vermont and Maryland are also among the first states to participate in the program – selection was made through an application process.
