The diabetes crisis and pay-for-value evolution are coming to a head, helping change provider reimbursement in Medicaid.
Centene's Superior HealthPlan is slated to become the first Texas Medicaid plan with a value-based reimbursement program for diabetes care.
Superior HealthPlan, which covers some 900,000 Texans on Medicaid, CHIP, Medicare and exchange plans, is teaming up with the Health Care Incentives Improvement Institute to implement the "Bridges to Excellence" value-based program initially for 2,600 members with diabetes and 1,160 different clinicians.
The insurer says that providers in its network with an open panel and who are recognized by the program can receive bonus payments on a per-member, per-year basis ranging from $100 to $150.
While primary care pay-for-value programs have been taking off for general care that includes chronic conditions like diabetes, this one targeted at diabetes is aiming to hone in on a very specific problem that can have downstream effects in individuals, with diabetes raising the risk of heart disease, strokes and other complications requiring expensive acute care.
Along with much of the South, the Lone Star State -- by some estimates the nation's second largest insurance market -- is going to be a proving ground of sorts for preventing or at least mitigating the worst of the diabetes epidemic.
More than 30 percent of Texans are obese and at least 10 percent have been diagnosed with diabetes. Based on current trends, according the Texas Health Institute, the number of diabetic Texans could double, triple or even quadruple over the next several decades, to the point where 8 million residents of the 26 million-strong state have the disease.
"Paramount to Superior is ensuring that our members receive the highest standard of care," said Superior HealthPlan chief medical officer David Harmon, MD, in a media release. "We hope to further encourage exemplary service from our network of doctors while also recognizing them for the excellent care they provide."
The Health Care Incentives Improvement Institute's excellence program recognizes clinicians who deliver the best outcomes in diabetes management, and in the management of other chronic diseases, including asthma, heart failure, coronary artery disease, chronic obstructive pulmonary disease, and inflammatory bowel disease.