Palmetto Physician Connections, a new government-sponsored health plan, is launching a medical home care model as it looks to build its managed care business with South Carolina's Healthy Connections Choices Medicaid program.
Under the new plan, Columbia, S.C.-based Palmetto will work with 700 providers to provide case and disease management services for at-risk members and those with chronic conditions. The goal of the program is to provide proactive, preventive care with the aim of improving outcomes while lowering costs.
[See also: Florida pushes forward with plan to shift Medicaid to managed care; Wisconsin announces Medicaid Managed Care contract]
"Where we are different from a lot of the other people in managed care is that our model shares savings with the physicians," said Cesar Martinez, president and CEO of Palmetto Physicians Connections. "So our model looks a lot like the ACO rules that just came out from CMS. Some folks even call us a Medicaid ACO, if you will. The physicians are part of the process."
To achieve savings under the program and get physician buy-in, Martinez said it's important to have an information infrastructure that allows physicians to quickly pull data on both individual patients and the entire population of patients they serve under the Palmetto plan. For that, the company turned to MedHok, which leverages a cloud computing model to collect and standardize patient data – data Palmetto uses to help manage patients while also measuring performance against national HEDIS measures.
"A comprehensive, user-appropriate patient view is crucial to ensure that all participants in our medical home network have the information they need to evaluate and monitor patients and, when necessary, respond when care gaps or status changes are identified," said Gerald Harmon, MD, Palmetto's medical director.
Under the plan, physicians in the Palmetto network will continue to be paid under the traditional fee-for-service model. Palmetto will be paid under a contract with the state to manage the patient population in the plan. To the extent individual providers are exceeding quality and cost benchmarks, they can receive additional payments from Palmetto for their performance.
While Palmetto counts only about 1,000 members so far, officials hope to capture a solid chunk of the Medicaid market as South Carolina transitions to a managed care model in the coming years. The state serves about 700,000 people through its Medicaid and CHIP programs and has plans to transition around 100,000 of those members to some form of managed care over the next year.