Meet Jane. Jane lives in Idaho. She has diabetes and high blood pressure, and she recently broke her wrist when she slipped on an icy sidewalk. Jane is a Medicaid participant. When she sees her primary healthcare provider for her wrist, the provider is aware of the diabetes and blood pressure conditions, even though that’s not why she’s in the office. That’s because the doctor has agreed to designate his practice as a patient-centered medical home. This means he will coordinate ALL of Jane’s care to make sure she’s receiving the right treatment to maintain or improve her health, at the right time, and at the right cost.
This is the future the Department of Health and Welfare sees as it works to ensure all Idahoans have affordable, available healthcare that works. A milestone will be marked on Jan. 1, 2020, with the start of the Healthy Connection Value Care Program for Medicaid participants.
The Evolution of Healthy Connections
The Healthy Connections Program in the Division of Medicaid started several years ago. In 2013, Healthy Connections introduced a nationally-recognized model of healthcare delivery called the patient-centered medical home. This model emphasizes three goals:
- Improved patient satisfaction
- Improved clinic staff satisfaction
- Increased clinic efficiencies
In the patient-centered medical home model, a primary care provider or healthcare team works with the patient to provide comprehensive and continuous medical care. The goal is to keep the patient healthy or improve their health, if possible.
To encourage medical care providers to adopt the patient-centered medical home model, a tiered system of payments was introduced in 2016 that supported efforts to change medical practices to align with the goals of a patient-centered medical home. Since that time, the Healthy Connections network has increased the number of patients being served in a patient-centered medical home setting from 24 percent of patients in the Healthy Connections program to 64 percent. That translates to about 150,000 participants!
The Next Step: Healthy Connections Value Care
Like all other state Medicaid programs, commercial insurance plans, and Medicare, Idaho faces unsustainable healthcare cost growth. The cost is growing at about 9 percent per year and will exceed $2.5 billion by 2020.
With the increasing cost of healthcare, an aging population, and Medicaid expansion on Jan. 1, 2020, Idaho has an immediate need to control costs without reducing quality of care. The department recognizes this need and has been collaborating with Idaho hospitals, primary care providers, and health plans to build a more accountable Medicaid program.
The Healthy Connections program, including the patient-centered medical home model and tiered payment system, have strengthened the network of providers in the Healthy Connections program. However, the program did not have the expected increases in quality outcomes and decreases in use of high-cost services, because it did not address how providers are being paid.
To respond to these challenges, Idaho is changing the Healthy Connections program. To date, the Healthy Connections program has paid healthcare providers based on a set fee structure. Providers also receive a per-member, per-month payment for case management, where the healthcare provider coordinates care with other providers as needed.
Moving forward, the Healthy Connections Value Care program will be rolled out and offered statewide. Participating providers, also called value care organizations, will be eligible to receive incentive payments when they maintain and improve health quality outcomes while lowering the total cost of care.
The program will begin Jan. 1, 2020, and any qualified medical care provider can choose to participate. Many medical care providers throughout the state, large and small, already are engaged and ready to help reduce healthcare costs and improve health outcomes in the Medicaid program.
The journey continues…
Idaho is committed to transforming its Healthy Connections payment structure to provide high-quality care in lower cost environments while holding healthcare providers accountable. The department is excited to work with those who are ready to work together to build this new system. As these efforts continue, all Idahoans will eventually have the ability to participate in a less expensive and more accountable system of care.
This is part of an occasional series of stories highlighting the innovative ways Idaho Department of Health and Welfare employees approach the work they do every day to effectively and efficiently help Idahoans live their best lives.
DHW Voice 