Connecticut Awarded $12 Million for Healthcare Reform, but Concerns Linger on Payment Rates and Coverage

Connecticut has been awarded $12 million from the Centers for Medicare & Medicaid Services (CMS) to help reduce healthcare costs across the state. Governor Ned Lamont announced that the federal funds will be used to expand primary care services, support community health programs, and overhaul payment models. The ultimate goal is to increase primary care spending to 10% of total healthcare spending by 2025. However, current statewide primary care spending is only at 4.9%, which falls short of the target of 5.3%. Commercial healthcare spending stands at 4%, and Medicare Advantage at 3.2%, both below the target, while Medicaid has exceeded the goal at 7%.

The new Total Cost of Care model will hold states accountable for health outcomes and quality, with the aim of reducing healthcare costs across Medicare, Medicaid, and private insurance. However, the Connecticut Hospital Association has raised concerns about this approach, questioning how it can succeed if budgets are based on Medicare and Medicaid payment rates that do not cover the cost of care. According to the Office of Health Strategy, residents with employer-sponsored health coverage in Connecticut have seen a significant increase in premiums over the last two decades, along with a higher share of total healthcare costs paid out of pocket.

Dr. Deidre Gifford, commissioner of the Office of Health Strategy, stated that participation in the States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD) will help the state meet its target benchmarks for primary care investments, chronic disease management, health equity, and cost containment. The involvement of partners such as the state Medicaid agency, Medicare, commercial payers, hospitals