Connecticut will receive $12 million from the Centers for Medicare & Medicaid Services (CMS) to slow the increase in health care costs statewide.
Gov. Ned Lamont said the federal funds will pay for primary care expansion and more community health programs while transforming payment models.
Connecticut established a primary care spending target with a goal to increase 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, falling below the target of 5.3%.
Commercial healthcare spending was at 4% and Medicare Advantage came in at 3.2%, falling below the target.Medicaid exceeded the target at 7%.
The Total Cost of Care model will hold participating states accountable for health outcomes and quality, while curbing health care costs across Medicare, Medicaid, and private health insurance.
That last part is causing some alarm at the Connecticut Hospital Association.
“Questions remain as to how the model can achieve these goals if it bases budgets on Medicare and Medicaid payment rates that are nowhere near covering the cost of care – a problem that has contributed to many of the issues this model seeks to correct,” the association said in a statement.
According to the Office of Health Strategy, Connecticut residents with employer-sponsored health coverage have seen their premiums nearly triple over the last two decades. Residents have also paid an increasingly higher share of their total health care premiums.
"Participation in AHEAD [the States Advancing All-Payer Health Equity Approaches and Development Model] will further strengthen our statewide approach and will give us new tools to meet the target benchmarks set 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, as well as our hospital and primary care colleagues will be critical partners in the initiatives we launch through the model.”
Participation by hospitals is voluntary.
Vermont and Maryland are also among the first states to participate in the program – selection was via an application process.
