"Whatever Happened to the Idea of the Medical Home?" by Lori Abrams Berry

The Connector has determined that the best way to keep costs down is to have the Commonwealth Care plans bid and award the auto-assigned patients to the lowest cost plans. Low income people who did not understand the ins and outs of this complicated Health Reform program (confusing to us all at first!!) and did not respond to a dauntingly thick and confusing mailing from the Connector were auto-assigned to health care plans. 75% of patients who didn't choose a plan were assigned to the lowest cost plan that presumably had arrangements with providers in their service area and 25% were assigned to the next lowest cost plan. The problem is that in many service areas around the Commonwealth, the plans had no pre-existing arrangements with the community health center or the hospital in the service area.

In the Lynn Service Area, 25 % of people who were auto-assigned were "given" to BMCHealthNet, which had no contract with North Shore Medical Center or the Lynn Community Health Center. These are the only two facilities in the service area and the only two facilities even remotely accessible by public transportation. This kind of thing happened in a number of service areas around the Commonwealth, where patients were assigned to providers they did not know and away from the providers they had been seeing for complicated chronic conditions.

Many patients were auto-assigned away from their primary care provider. Some patients realized it before the 60 day deadline and requested to change their plan so they could maintain continuity of care with their own providers. Many others realized it too late to be able to change and they were locked into a plan and away from their provider.

Many of us have tried to get the Connector Board to waive the 60 day policy and allow patients to be able to change plans once during the first year of health reform. They have refused. In fact after discussions about this, they made it even harder for patients to get a waiver of the 60 day deadline on a case by case basis by requiring the primary care physician to sign the waiver request - a complete waste of time for busy physicians.

Jon Kingsdale, the Executive Director of the Connector, has stated that next year when he goes out to bid for health plans, he intends to do the same thing and that for the Lynn Service Area, if BMC is they low bidder they will get 75% of the auto-assigned patients for the Lynn Service Area, regardless of whether there are any services in Lynn their patients could use.

I hope every advocate for Access to primary care services and a Medical Home for all will join me in asking the Connector Board to take another look at the way we are contracting for services through these health plans. Noone should ever be auto-assigned away from an existing primary care relationship. That is not what Health Care Reform is all about.

Lori Abrams Berry
Executive Director
Lynn Community Health Center