General Dynamics Health Solutions a leading provider of healthcare IT and informatics, supporting Medicare-related IT systems and professional services at the Centers for Medicare and Medicaid Services (CMS) as well as private-sector healthcare organizations across the country, where the State Innovation, Analytics and Population Health Management Forum Sponsor at the 2015 State Healthcare IT Connect Summit. Healthcare IT Connect conducted an interview in coonjuction with the Forom with Dr William Golden, MD, Medical Director, Arkansas Department of Human Services and Nena Sanchez, MS, PMP, Senior Director General Dynamics Health Solutions
State and local governments are moving beyond their traditional Medicaid programs and embracing new roles as leaders of statewide payment and delivery system transformation. How can state and local governments plan to manage the complexity of reform implementation and prepare for changes?
State Medicaid programs have evolved beyond claims processing and payment to become enterprises that collect and analyze data to both improve their internal processes and delivery quality systems. States now have the ability to target specific services to advance the quality of outcomes by empowering the health professionals at the core of the delivery system with clinical as well as administrative cost information.
States have developed their high level planning through their State Health Improvement Planning (SHIP) processes and with current funding through the Centers for Medicare and Medicaid Innovations (CMMI). State Innovation Model (SIM) efforts are in many instances ready to move towards testing these reform ideas.
Arkansas Medicaid launched their reform innovation in 2012, with the Arkansas Health Care Payment Improvement Initiative (AHCPII) which included the Patient Centered Medical Home Initiative in 2014. For both efforts Arkansas Medicaid’s leadership determined that they would require a strong analytics capacity to implement and provide ongoing support, including the measurement of the effects of both initiatives in the quality and cost of care.
Payment and delivery system reform represents a new era in Medicaid-provider relations, how are or can State’s manage this changing relationship?
Historically, the support for Medicaid providers, through customer relations, has mainly been based on the successful submission of claims for payment and the completion of the reimbursement process between the Medicaid fiscal agent on behalf of the state and the providers.
Detailed data reporting on patients is essential for providers to meet the changes in reimbursement schemes and to support providers who may be reimbursed based upon the delivery of both efficient and high quality care. The reporting could be based upon previous claims paid and certain clinical indicators that can be utilized to evaluate the provider’s performance.
In this new era of provider relations trained support staff is essential to enable providers to determine their standing with the Medicaid program’s payment initiative’s measurement. Providing appropriate support assists with ensuring financial stability in an era of multi-payer payment reforms with varying measurements and reporting methods.
Arkansas was one of the first states to implement a statewide payment reform initiative that rewards service providers for providing high-quality, cost-effective care under the Medicaid program. What are some of the key successes of the Arkansas Health Care Payment Improvement Initiative?
The AHCPII was jointly developed by the state and private payers to contain costs which were increasing by about 8 percent annually and threatening to cause a potential budget shortfall of $140 million. The AHCPII is the largest implementation of episode-based payment in the United States and creates financial accountability for more than 2,000 provider organizations by linking quality measures and outcomes data to financial incentives.
The AHCPII has resulted in reducing and stabilizing healthcare costs in certain cases, along with improvements in appropriateness of antibiotic prescribing and perinatal screenings. This initiative also rewards physicians, hospitals and specialists who provide patients with high-quality care at commendable costs.
The program has been recognized by the Centers for Medicare and Medicaid Services (CMS) State Innovation Models Initiative Model Testing Awards.
State governments are interested in enabling access to the right data at every level of the health care system. How do they overcome the challenge of what data and analytics are important and actionable?
The AHCPII’s analytic engine created by General Dynamics Health Solutions uses historical claims data and physician-entered information, gathered through a HIPAA-compliant online provider portal, to determine quality indicators and a reasonable cost of care associated with each episode. User friendly reports with detailed clinically relevant information assist providers with practice transformation and quality improvement activities. Providing informational reports to providers before the performance period begins allows providers to prepare and implement clinical reminders and best practices to efficiently improve quality of care. Providers then share in the savings or excess costs depending on their performance for each episode. This can be replicated nationwide by state health transformation programs.
Planned efforts are under way in states to reform their state Medicaid programs to revolve around the management of data to enable policy makers as well as program managers and care providers to have successful outcomes for their reform efforts.