Arkansas Health Care Payment Improvement Initiative

Transcription

1 Arkansas Health Care Payment Improvement Initiative Joseph W. Thompson, MD, MPH Arkansas Surgeon General Director, Arkansas Center for Health Improvement

2 Arkansas System Transformation Strategy Workforce Payment System Population Health Insurance Coverage Health Information Technology 2

3 Arkansas Payment Improvement Initiative s Integrated Model 3

4 Payment Model in Arkansas Approach Prevention, Screening, Chronic Care Acute + Post-Acute Care Supportive Care Patient Populations (examples) Healthy, At-Risk or Chronic Conditions CHF Diabetes Acute Medical & Procedural CHF Pneumonia Joint replacement Developmental Disability Long-Term Care Behavioral Health (mental illness/ substance abuse) Care/Payment Models Patient-Centered Medical Homes Care coordination Overall health mgmt s Rewards high quality, effective care for specific episode Health Homes + s Health home: care coordination

5 Current Multi-payer Cost Sharing Participation s Multi-Payer Participation Upper Respiratory Infection Attention Deficit Hyperactivity Disorder Perinatal Congestive Heart Failure Total Joint Replacement (Hip & Knee) Colonoscopy Cholecystectomy (Gallbladder Removal) Tonsillectomy Oppositional Defiance Disorder Coronary Artery Bypass Grafting Asthma Percutaneous Coronary Intervention Chronic Obstructive Pulmonary Disease Neonatal ADHD/ODD Comorbidity Patient-Centered Medical Home 5

6 How the Payment Model Works Shared Savings Savings/Cost Neutral Year 1 results Shared Cost High Average cost per episode for each provider Acceptable Commendable Low Individual providers, in order from highest to lowest average cost 6

7 How the Payment Model Works Shared Savings Savings/Cost Neutral Year 1 results High * Shared Cost Quality of care protected by limits on gain sharing and required quality metrics Average cost per episode for each provider Low Individual providers, in order from highest to lowest average cost Acceptable Commendable Gain sharing limit * 7

8 s of care year 1 results results include: perinatal, ADHD, total joint replacement, URI, congestive heart failure Increased screening for diabetes, HIV, Hepatitis B and other conditions in pregnant women 19% decrease in unnecessary antibiotic prescriptions for unspecified URIs 18% reduction in multiple courses of antibiotics prescribed for sinusitis and other URIs 29% drop in ADHD cost per episode 489 providers to receive financial incentive payments totaling $396, providers required to reimburse Arkansas Medicaid a total of $594,191 8

9 Arkansas Payment Improvement Initiative s Integrated Model 9

10 Arkansas Patient-Centered Medical Homes (PCMH) PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Key attributes Providers with responsibility for entire experience of patient panel Evidence-informed preventive care and improved wellness 24/7 access for all individuals / networked EMRs Coordinated integrated care across multidisciplinary provider teams Focus on management of chronic disease with avoided progression Referrals to high-value providers (e.g. specialists) Incentives Monthly fees to support care coordination efforts and transformation Upside-only shared savings model that rewards providers for controlling total patient costs while maintaining or improving quality 10

11 Patient-Centered Medical Home Participation Medicaid 50% of Providers 79% of Eligible Beneficiaries Health Care Independence Act Arkansas Blue Cross and Blue Shield National Blue Cross Blue Shield Multi-state Plan QCH Health Plan, Inc. Arkansas Health & Wellness Solutions (Ambetter) QualChoice Life and Health D-SNPs x5 Self Insured Public and Private 11

12 Health Homes Referral PRELIMINARY WORKING DRAFT; SUBJECT TO CHANGE Developmentally Disabled Medically Frail Serious and Persistent Mental Illness Independent Assessment PATIENT-CENTERED MEDICAL HOME Health Home 12

13 Coordinated Multi-payer Leadership Consistent incentives and standardized reporting rules and tools Change in practice patterns as program applies to many patients Enough scale to justify investments in new infrastructure and operational models Motivate patients to play larger role in their health and health care