In the past week, Idaho’s COVID-19 case count was above 1,000 for six out of seven days. On Nov. 17, Idaho recorded 35 deaths, the highest number to date for one day since the beginning of the pandemic. This is heartbreaking. It is unacceptable. We can do better. We have to do better.
As Thanksgiving approaches, it is a cause for concern. Gatherings have shown to be a main source for the spread of new cases. Traditionally, my wife and I host our extended family Thanksgiving dinner. Just last week, I had difficult conversations with my mom and other family members letting them know that we would not be hosting Thanksgiving dinner at our home. And I strongly encouraged them to celebrate Thanksgiving with their immediate households. I want to keep my family safe. I want them to be healthy for future holidays, so this is small sacrifice for the greater good.
The best and safest way to celebrate Thanksgiving is with only the members of your household. Virtual activities are also completely safe. If you do celebrate in-person with people outside of your household it’s very important to follow Centers for Disease Control and Prevention guidelines to reduce the likelihood of spreading the virus.
We know what helps limit the spread of COVID-19: wearing a mask, physical distancing, washing your hands, avoiding social gatherings and large crowds, and staying home when sick. These are the most effective tools we have to fight this virus and protect our families and friends, keep our hospitals operating within their capacity, and protect our small businesses.
Hospitals in Idaho and throughout the United States are getting stretched very thin. Widespread holiday gatherings, especially ones in which the above precautions are not taken, could make a difficult situation much worse. Please be safe this Thanksgiving and do your part to slow the spread of COVID-19.
Making progress toward DHW’s Strategic Goal 1: Ensure affordable, available healthcare that works
The Department of Health and Welfare is committed to making sure Idahoans have access to healthcare. But our mission reaches much further than that. The department is also determined to ensure that the healthcare Idahoans receive helps them become healthier. One of the ways we are doing this is by teaming up with hospitals and primary healthcare providers in a groundbreaking new program that rewards providers when they provide high-quality and cost-effective healthcare. We call this new approach “Healthy Connections Value Care.”
We are confident this plan will help improve Idahoans’ lives. We believe – and research and evidence overwhelmingly backs us up – that by encouraging healthcare providers to promote certain preventative healthcare practices, Idahoans who participate in Medicaid services will have improved health outcomes. And, as a bonus to both patients and providers, it also will save everyone money in the process.
The program financially rewards providers who form a Value Care Organization and show improved patient outcomes under certain healthcare quality requirements. However, Value Care Organizations also are held accountable for keeping healthcare costs in check. Part of the deal is that they agree if their healthcare costs increase, they will return money to the Idaho Medicaid program. This approach encourages healthcare providers to deliver quality healthcare, and it is good for state taxpayers. Ultimately, we anticipate a win-win outcome for both Medicaid participants and providers.
How the program works
- Healthcare providers commit to delivering preventative healthcare services
When healthcare providers come together to participate in the new value-based payment program, they are committing to improving key services and measurements. Our focus is on measurements we can obtain from the existing Medicaid claims system that are important for care. The providers in the plan are working to improve these quality measures:
- Breast cancer screening
- Early detection of breast cancer enables less invasive, less costly treatments, and improves survival rates.
- Diabetes testing
- Diagnosis and effective management of diabetes can significantly improve the health and avoid far more expensive medical treatments for unmanaged diabetes, such as kidney damage, eye damage, and increased risk for heart disease or stroke.
- Wellness visits
- Regular checkups help find warning signs for an early diagnosis, which improves the chances of effective treatment before a condition gets worse and more expensive to treat.
- Reduction in the number of ambulatory care emergency department visits
- When patients have a primary care provider, they are more likely to visit their doctor if they have health concerns, instead of waiting until the problem becomes life threatening and they have to call an ambulance.
- Reduction in patient readmissions within 30 days of discharge
- When patients get the right level of care in the hospital and follow-up care after they leave, they do better and are less likely to need readmission.
- Healthcare providers accept financial risks and rewards
Value Care Organizations participating in the program choose from a menu of risk options. For example, an organization could choose to participate with a lower level of 10 percent risk share or up to an 80 percent risk share, depending on what level is right for their members. If they meet the quality measures and their healthcare costs decrease, the Medicaid program will reimburse them for part of the amount that was saved. However, if their healthcare costs increase, they agree to return the at-risk percentage of the additional costs to the Medicaid program.
Win-win: Changing the future of healthcare in Idaho
There has been much interest in this program from hospitals and primary healthcare providers whose participation will be critical for its success. In October, Idaho Medicaid staff met with hospital representatives and primary care provider representatives together to work out the arrangements of their partnerships, and how they will team up to share the risks and the rewards. DHW staff and partners are getting close to finalizing the value-based payment plan. The contracts between the healthcare providers and the department are on track to being finalized by the end of November.
The Division of Medicaid’s mission is to pay for better health. With the value-based payment program, the department is working toward this goal by encouraging healthcare providers to deliver better quality of healthcare. Providers want to do the right thing and deliver high-quality care, but our current financial model is not structured to support this goal. We are confident this new program will change the future of how we pay hospitals and other healthcare providers and will help providers to improve the health of Idahoans.
As we work to strengthen the health, safety, and independence of Idahoans, we are proud to share our work with the people of Idaho as we move forward in our strategic goals. You can follow our work and read more about our Strategic Plan on our website.
I wish you all a happy and safe Thanksgiving holiday. My next blog will be available on Friday, Dec. 4. #MaskUpIdaho #MaskUpForTheHolidays