Department officials presented changes to New Hampshire’s Medicaid care‑management procurement and the division’s quality strategy to the Health, Human Services and Elderly Affairs Oversight Committee on April 25, describing contractual tools intended to strengthen primary care, behavioral health integration, polypharmacy management and non‑emergency medical transportation oversight.

Henry Littman (department staff involved in procurement) described the contract changes and said the procurement shifts more payment toward providers and emphasizes creating "an authentic patient relationship" with primary care providers. He discussed targets to expand preventive care, reimburse medication reviews, and address polypharmacy among high‑risk patients.

Key contractual and program levers presented by Susan Drown, director of the Bureau of Program Quality, with implementation details from Erin Metcalfe and Meredith Toulouse:
- Quality withhold/incentive: a mandatory program that currently withholds 2% of an MCO’s total capitation (per member per month) and places unearned funds into an incentive pool to reward exceptional performers. Metrics are largely nationally standardized HEDIS and CMS Core Set measures; payout is annual and paid the following fiscal year.
- Performance‑based auto‑assignment: a voluntary, shorter‑term program that awards unassigned new members (the department averages about 1,000 per month) to MCOs that meet designated process or outcome targets. This lever is designed for monthly or quarterly performance periods.
- Liquidated damages: mandatory financial penalties for contractual noncompliance (for example, late or inaccurate data submission or failure to meet performance standards); penalties can escalate for repeated violations.
- Performance Improvement Projects (PIPs): MCOs must complete four PIPs during the five‑year contract (three clinical, one nonclinical) including a required SUD‑focused project; successful PIPs may allow MCOs to earn back withheld funds.

Why it matters: department leaders said these tools aim to realign incentives so MCOs and providers prioritize primary care access, care coordination for high‑need populations, medication safety and integrated behavioral health services. Officials estimated the reprocurement could direct up to $6 million more to community mental health centers by standardizing contract payments to those providers.

Discussion and provider concerns: committee members — including practicing physicians and representatives of primary care interests — raised concerns that increased quality reporting and data collection can burden clinicians and contribute to clinician burnout and corporatization of medicine. Henry Littman and other department staff acknowledged the point and said much claims‑based data are automated, and the procurement specifically aims to compensate provider work such as comprehensive medication reviews.

Ending: Department officials said the new contract begins September 1 and will be phased in; they invited further committee engagement on technical criteria for high‑cost therapeutics and other clinical decisions. Officials stressed monitoring and adjustments will follow initial implementation.