Applying the principles of coordinated and integrated care beyond the Medicare market is essential if this country is going to successfully manage healthcare costs. The momentum is beginning to build across both the private and government sectors – even before Medicare ACOs become a reality.
States look to accountable care for Medicaid patients
1. Community Care of North Carolina is leading in this area with a program that places a significant emphasis on primary care and care management. Primary care physicians are paid fees for their services, plus a $3 to $5 management fee for coordinating care per Medicaid recipient, per month
2. Incentives are available for practices to meet quality targets and a shared savings program for primary care physicians.
3. Other states, such as Alabama, where East Alabama Medical Center serves as one of three pilots sites for a similar program, are adopting medical home models and incentive systems to manage and to deliver care.
4. Resurrection Health in Chicago is one of the owners of a Medicaid managed care entity. It has served as a pilot site in Chicago and is looking at both expanding and implementing accountable care principles.
5. Legislation is pending in several states, such as New Jersey and Oregon, which would create accountable care Medicaid programs.
The burgeoning individual market will benefit from accountable care
1. Frustrated by increasing premiums, some business leaders and owners are backing away from employer-sponsored health plans. Instead, they are giving employees lump sums to purchase health insurance directly.
2. In addition, in states such as Massachusetts, individuals are purchasing insurance through an insurance exchange, buying policies with deductibles and benefits that suit them.
It will be important for healthcare providers to partner with payors that are willing to not only design products for individuals, but also to partner with the organizations to coordinate care. To keep costs down for individuals, it will be essential to include effective care and chronic disease management programs into the benefits package.
Participants of the Premier Accountable Care Collaboratives, which span more than 90 markets, are targeting additional populations beyond Medicare. These hospitals are driving toward new, value-driven models of care in lieu of traditional fee-for-service. They are leading the way in implementing improved care processes such as chronic disease management. This is the future of heathcare and we all need to be moving in this direction.
Kester Freeman blogs regularly at Action for Better Healthcare.