The Department of Health and Welfare (DHW) is pleased to announce the launch of a groundbreaking program, designed to change how Medicaid pays for healthcare. This long-awaited, trailblazing program called “Healthy Connections Value Care” is a collaboration between DHW and healthcare providers that seeks to make sure Idahoans have access to healthcare that makes them healthier. It is designed to turn around the system where Medicaid pays for medical procedures, community-based services, and supports for people with disabilities, but does not link payments to actual health outcomes for the people we serve.

By contrast, the Healthy Connections Value Care program rewards healthcare providers when they provide high-quality and cost-effective healthcare. These hospitals and primary care providers, called Value Care Organizations (VCOs), work together with DHW to keep healthcare costs in check. Part of the deal is that VCOs agree that if their healthcare costs exceed a target they will return a portion of that money to the Idaho Medicaid program. This approach incentivizes healthcare providers to deliver quality healthcare that is also a good value for state taxpayers. Ultimately, we anticipate a win-win outcome for both Medicaid participants and providers.

Improving healthcare outcomes and data

VCOs rely on many types of data to adapt their practices to meet the criteria in the contracts. Their contracts specify that during their “performance year”, they will use data provided by DHW to make measurable improvements to their healthcare practices.

DHW provides data to participating providers to show how effective various medical and preventative healthcare activities are at improving health, while reducing cost for providers. Based on this data, the participating healthcare providers make decisions about how much risk they choose to take on in their customized contract.

Quality measures

The program is centered on VCOs committing to improving a number of different quality measures. Choosing these measures has involved a significant amount of work investigating positive healthcare outcomes and cost-effectiveness of various healthcare practices. After considering many different quality measures that can be obtained from the existing Medicaid claims system, the program and healthcare providers have settled on six.

• Breast cancer screening
  • Diabetes HbA1c testing
  • Wellness visits – ages 3-21
  • Wellness visits – infants
  • Reduction in number of ambulatory care emergency department visits
  • Reduction in patient readmissions within 30 days of discharge

The future of Medicaid in Idaho

The Division of Medicaid’s mission is to pay for better health. Providers also have the same goal to deliver high-quality care, as demonstrated by the amount of time and resources they have dedicated to this effort over the past three years. By July 1, 2023, DHW is committed to making sure 50 percent of Medicaid payments will be tied to measurable outcomes of better health and cost-efficient care. By restructuring Medicaid payments to pay for high-quality and cost-effective healthcare, we can reward healthcare providers who do better and deliver on our mission – to strengthen the health, safety, and independence 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.

Children age 5-11 are now recommended to get the safe and effective COVID-19 vaccine

The Centers for Disease Control and Prevention (CDC) has recommended two doses of the Pfizer-BioNTech’s COVID-19 Pediatric Vaccine for children ages 5-11. The vaccine is free as well as safe and effective.

The Pfizer COVID-19 Vaccine is proven to be over 90 percent effective at preventing COVID-19 in children ages 5 through 11 years. By choosing to get your child vaccinated, you can help protect them against COVID-19 and keep them in school and active in extracurricular activities.

I would encourage all parents to talk to their healthcare provider about the vaccine. As reminder, COVID-19 vaccines have undergone — and continue to undergo — the most intensive safety monitoring in U.S. history.

Appointments for COVID-19 vaccines for 5 to 11-year-old children should be available the week of Nov. 8.

To find a vaccination location near you, contact your child’s pediatrician, visit Vaccines.gov, or contact your local public health district. 

For more information about pediatric COVID-19 vaccination, visit  https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/children-teens.html or speak with your child’s pediatrician. 

See a recording of DHW’s Nov. 2 media briefing that included information on pediatric COVID-19 vaccines at: https://youtu.be/02GoBvSPFbI

I hope you all have a safe and healthy weekend.