Idaho has been moving toward an outcome-based approach to Medicaid services the past few years, but now it wants to broaden that model to encompass all health care services in the state.
A group of industry stakeholders used a $3 million federal grant to develop a “statewide health care innovation plan” last year. The plan outlines the steps needed to create a statewide, patient-centered, medical home delivery system. This outcome-based approach would differ from the existing system, which reimburses providers based on volume of services.
The medical home model links providers, hospitals and health and social service agencies in such a way that primary care physicians can coordinate an individual’s overall health care needs. The intent is to reduce duplication of tests, reduce costs and produce better outcomes.
This approach “will move Idaho from a system that rewards the volume of (medical) services — through predominantly fee-for-service arrangements — to a system that rewards the value of services through quality incentives, shared savings, etc.,” according to the plan. “The model is a grass-roots effort that builds collaboration and momentum for change, rather than depending on mandates and legislative action.”
Idaho Medicaid Division Administrator Paul Leary updated the Idaho Legislature’s joint budget committee on the status of those efforts this week. He said the SHIP plan will serve as the basis for a second grant application that could provide “significant funds” — upward of $40 million by some estimates — to address the computer, communications and billing system infrastructure needed to support the medical home model.
Rep. Shirley Ringo, D-Moscow, said she’s heard concerns from some providers about this new approach, given that they have little control over their patients’ lifestyle choices.
“From a provider’s perspective there’s no guarantee patients will follow through (with a doctor’s orders),” she said. “Yet we seem to be holding providers responsible for the outcomes.”
Leary said that’s one of the issues that needs to be addressed as the state moves forward with the initiative.
“That’s why it’s so important this is an Idaho initiative and not a Medicaid initiative,” he said. “It’s about how we move in this direction without doing harm.”
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