Thursday, May 20th, 2010 - 23:35
Thursday, May 20, 2010 - 23:13
While Medicare has dominated most of the headlines, those watching the new health care reform law will also be taking a look at new efforts to improve Medicaid performance.
Medicare demonstration programs featuring new incentives for hospitals and physicians to provide the most efficient, high-quality health care possible have received considerable attention as part of the new health care reform legislation. But another provision of the law related to Medicaid encourages states to experiment with new delivery and payment models. Physicians will have an opportunity to receive more payment from Medicaid, but they will have to show results in the new demonstration projects in terms of efficient care and good health outcomes in return.
Some examples include:
- Pediatric Accountable Care Organization Demonstration Project. Participating states will allow pediatric medical care providers (e.g. Children’s Hospitals, pediatric physician practices) to be recognized as “accountable care organizations,” or ACOs, and receive incentive payments if they meet performance targets and savings requirements (January 1, 2012 through December 31, 2016).
- Medicaid Global Payment Demonstration Project. Participating states will change the payments made to eligible safety net hospital systems or physician networks from a traditional “fee-for-service” payment structure to a “global capitated payment model,” which features a fixed payment per Medicaid beneficiary for all health services (2010 through 2012). The hope is that this will encourage more efficient treatment decisions and lead to better health outcomes.
- Medicaid Emergency Psychiatric Demonstration Project. Participating states will pay institutions that are not publicly owned or operated to measure whether or not patients with mental illnesses have been stabilized. This mechanism for assisting adult patients will start on the third day of an inpatient stay and feature ongoing care management (2011 through 2015).
Health care providers have rightly complained that Medicaid payment rates are well below both Medicare and commercial insurance rates (Check out a recent story about the insufficiency of Medicaid payments here). These new payment arrangements could create incentives for the providers to get paid more if they develop delivery systems that save money and improve both patient safety and health care quality. To read more about the opportunities in Medicaid, check out this entry in the Health Affairs Blog written last summer before health care reform was passed into law.