Aligning Incen*ves for Be1er Performance: Washington State Ini*a*ves

Transcription

1 Aligning Incen*ves for Be1er Performance: Washington State Ini*a*ves MaryAnne Lindeblad, Director, Division of Healthcare Services Washington State Medicaid Purchasing Administra>on Na>onal Forum June

2 Highlights Inspiring be1er performance through: Measurement and Transparency Public repor>ng of Medicaid managed care plan results Public repor>ng of Medicaid versus commercial results (Puget Sound Health Alliance) Sharing state administra>ve data (Medicaid PRISM) Successful collabora>ons with health centers GeNng to the Next Level Aligning Incen>ves Across Payers All- Payer Medical Home Reimbursement Project Implementa>on/refinement of CHIPRA measures 2

3 Public repor*ng: Medicaid managed care Health centers are key players Public annual repor>ng/valida>on of performance measures Use subset of NCQA HEDIS measures emphasis on quality and u>liza>on Incen>ve System 2004 Current Rewards plans for performance on childhood immuniza>ons; well- child care $2 million set aside 3

4 Public repor*ng: Medicaid vs. commercial Puget Sound Health Alliance: A regional partnership of employers, physicians, health centers, hospitals, patient advocates, and health plans 4

5 Source: Puget Sound Health Alliance, July 16,

6 High performance health centers: Interna>onal Community Health Services: Some of the best results for diabetes care in the region Diabetes Collabora>ve with mul>disciplinary teams EMR to track diabetes among pa>ents Blood Sugar Log Books, Blood Pressure Posters, Self Management Worksheet, Community Screenings, etc. In- language, illustrated self- management support tools shown to pa>ents by MAs to start a conversa>on They don t have a wai>ng room - - it s an Educa>on Room Source: Puget Sound Health Alliance, July 16,

7 All- payer claims database: Addressing health dispari*es: PSHA Community Engagement Team formed Making the Case - Increase awareness of health dispari>es Community Building - Iden>fy and convene community groups and health care providers who serve communi>es of color to bridge between the health care system and community service providers serving ethnic or racial groups Quality Improvement - Iden>fy useful materials and approaches to reducing health dispari>es 7

8 Predic*ve modeling 8

9 Other successful collabora*ons Emergency Department diversion grant Four health center/hospital collabora>ves co- managed with Associa>on King County Care Partners Consor>um of health centers providing care management to physically and mentally complex pa>ents Children s health care improvement system proposal 9

10 GeHng to the next level Aligning performance measures, transparency, incen*ves, and reimbursement for the medical/ health home All- Payer Medical Home Reimbursement pilot Integra>on of physical and mental health Implementa>on and refinement of CHIPRA measures of children s health care 10

11 Resources Division of Healthcare Services Medicaid Purchasing Administra>on, Washington State Washington State Medicaid managed care repor>ng: External Quality Review Child Health Act Legisla>ve Report hgp://hrsa.dshs.wa.gov/healthyop>ons/newho/reports/reports.htm Medicaid versus commercial repor>ng: Puget Sound Health Alliance hgp:// hgp:// 11

12 Ques*ons? MaryAnne Lindeblad Director, Division of Healthcare Services Washington State Medicaid