Ac­count­able care eases Med­i­caid pain in Rhode Is­land

Modern Healthcare - - NEWS - — Vir­gil Dick­son

Hos­pi­tal lead­ers in Rhode Is­land raised many of the same com­plaints as their Illi­nois coun­ter­parts about a founder­ing Med­i­caid man­aged-care pro­gram— slow cre­den­tial­ing, poor care co­or­di­na­tion, re­im­burse­ment woes and more.

“The co­or­di­na­tion of ser­vices was so frag­mented that the most com­plex pa­tients would de­fault to the high­est-cost set­ting, which is the in­pa­tient unit,” said Dr. Jim Fanale, chief clin­i­cal of­fi­cer at Care New Eng­land, a mul­ti­site health sys­tem in Rhode Is­land,

But the sit­u­a­tion im­proved last year, he said, fol­low­ing the state’s de­ci­sion to launch Med­i­caid ac­count­able­care or­ga­ni­za­tions. Un­der the model, Med­i­caid plans over­see groups of providers that are re­spon­si­ble for per­form­ing well on qual­ity, out­comes and cost. Providers hit­ting qual­ity and fi­nan­cial bench­marks are el­i­gi­ble for an in­cen­tive pay­ment.

Roughly 27% of Rhode Is­land res­i­dents are el­i­gi­ble for Med­i­caid; more than 100,000 ben­e­fi­cia­ries are part of an ACO, ac­cord­ing to the state Of­fice of Health & Hu­man Ser­vices.

Fanale said the ACO ex­per­i­ment has im­proved care for the sick­est Med­i­caid ben­e­fi­cia­ries, and that to­tal costs have de­clined. A study assess­ing the state pro­gram is ex­pected to be pub­lished soon.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.