Presentation on theme: "System Reform Efforts in Medicaid Kathleen Nolan National Assoc. of Medicaid Directors July 15, 2013."— Presentation transcript:
System Reform Efforts in Medicaid Kathleen Nolan National Assoc. of Medicaid Directors July 15, 2013
State Variability to consider Tools that are appropriate for your state will differ, depending on a number of qualities, such as: Managed care versus fee-for-service Competitive plan selection Delivery system factors Covered populations Health status, utilization patterns, and cost trends.
Why Medicaid can be a leader in delivery system and payment reform Medicaid is a major purchaser for: Births and pregnancy, Disability services, long-term care, chronic disease management and prevention: all of which are topics in delivery system redesign and important opportunities for quality improvement and cost containment.
Payment reform buckets Targeted payment adjustment policies Hospital errors or readmission rates result in a payment change. Managed fee-for-service Incentivizing care or services practice by practice in FFS environments. Bundled payments Single payment for a set of services, usually based on a health condition. Care management initiatives Add-on payments for non-clinical services and case management for chronically ill or disabled patients. Health homes Enhanced payments for a range of clinical and supportive services for a population.
Payment reform must be joined to quality Payment reforms must include quality monitoring and be connected to improvement in care and outcomes. Quality metrics must be developed and an oversight plan that will monitor system outcomes Payment must be tied to these quality outcomes, not just to reducing expenditures. Need strong data collection systems and analytics to ensure outcomes are achieved and avert unintended consequences.