Innovating Medicaid with the Medical Home Model

After reading Cheryl Clark’s interview with Dr. Bruce Siegel, President & CEO of the National Association of Public Hospitals and Health Systems, she points out that if the entities existing in one of the 30 states now threatening to refuse to expand their Medicaid eligibility rules to 138% of the federal poverty leveldon’t receive assistance, they’ll continue to provide uncompensated care for many of their sickest patients.  For organizations already stretching to deliver care to the most vulnerable populations, it was encouraging to learn that seven more states have joined the Medicaid ACO project, which targets low-income populations for care improvements and cost reduction via the medical home.

Will a move away from managed care to care coordination payments provide enough incentive for chronically ill Medicaid patients to obtain necessary primary care versus waiting for an urgent or emergent situation to send them to the emergency department?  Dr. Lisa Letourneau, executive director of Maine Quality Counts, a regional healthcare improvement collaborative and  physician champion for the Maine Patient-Centered Medical Home pilot, thinks so.  In order for the 108 practices that have applied for the Medicaid health home pilot, they must have NCQA medical home recognition or have applied for it, maintain an EHR and commit to 10 core expectations of medical home that go beyond National Committee for Quality Assurance (NCQA) conditions.

Although there are already more than 100 ACOs that serve Medicare populations, the Medicaid population is notably sicker, poorer and requires more resources – a complex and challenging equation to say the least.  In efforts to utilize the most efficient resources, advanced nurse led medical homes with patient engagement technology provide an alternative worth considering for those rural locations struggling to meet budgetary requirements. With the brightest minds recently convening at the World Congress 2^nd Annual Leadership Summit on Medicaid, one can only hope that they were discussing medical homes similar to Piedmont Health, North Carolina’s first community health center focused on delivering comprehensive primary care services and health education to its members.

With millions of dollars at stake and community health on the line, innovating Medicaid with the medical home model should be a priority today, and not tomorrow.

Healthcare’s New Imperative: Population Health Management

Now that the Patient Protection and Affordable Care Act (PPACA) has received the Supreme Court’s stamp of approval, healthcare providers must determine the best way to improve quality and safety while simultaneously reducing cost.  According to the Agency for Healthcare Research and Quality (AHRQ) Practice-Based Population Health:  Information Technology to Support Transformation to Proactive Primary Care Report, the proactive measurement and management of a panel of patients may be one means of transforming the current healthcare delivery approach.

As defined by the Health Research & Educational Trust, population health management provides a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:

• The distribution of specific health statuses and outcomes within a population;
• Factors that cause the present outcomes distribution; and
• Interventions that may modify the factors to improve health outcomes

To succeed at population health management, effective strategies for increasing the prevalence of evidence-based preventive health services and preventive health behaviors, improving care quality and patient safety and advancing care coordination across the health care continuum must be implemented.

The Care Continuum’s report, Measuring Population Health: 2010 Outcomes Guidelines Report Volume 5, sets forth a framework for achieving healthcare quality improvement.  Utilizing health risk assessments, medical claims, lab and other data, individual’s health/emotional risk can be quantified and addresses accordingly.  Through face to face, mail, email, telephonic, social media, online education & coaching and other interventions, healthcare providers can work with patients to modify behavior and improve health status.  In order to cement long-lasting and continued success, care coordination and appropriate incentives must flank the framework.  Through improved health status, by-products of higher satisfaction and productivity with corresponding decreases in health service utilization and cost will occur.

In order to prepare for increasing numbers of aging, chronically ill and insured patients in the face of value-based purchasing, many organizations have already started down the path of population health management.  While population health management remains in its infancy, the Care Continuum has identified key issues for future success of this increasingly important strategy:

• Accountable Care and Medicare Shared Savings Program – will these continue to be vehicles for healthcare reform?
• Consumer Use of Mobile & eHealth Technologies – healthcare is moving to a patient-centered, consumer-empowered, pull-rather-than-push model
• Reducing Medicare Hospital Readmissions – can this strategy effectively facilitate the Hospital Readmissions Reduction Program (HRRP)?
• Quality Improvement- the need  to demonstrate improvement in wellness and chronic care measures will drive expanded opportunities
• Improving Care Coordination for Dual Eligibles – can population health management drive efficiencies for the Federal Coordinated Health Care Office?
• Federal  and state health insurance exchange support of prevention and wellness

Having recently hosted the Population Health Innovations Showcase in Washington, D.C., the Care Continuum Alliance continues to keep the country focused on healthcare’s new imperative:  population health management.

*graphic courtesy of SHPS

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INFOGRAPHIC: Health Care Reform Readiness

In celebration of Independence Day and the national movement to free Americans from a burdensome and ill-fated healthcare system, it seemed fitting to share the healthcare reform readiness graphic below from Infosys.  In particular, I especially like their identification of three key strategies for success:  TRANSFORM, INNOVATE, OPTIMIZE

Let freedom ring!