Dominick Pallone, govt director of the Michigan Affiliation of Well being Plans in Lansing, mentioned he helps the Medicaid initiative aimed toward bettering reimbursement techniques, calling the brand new workplace a “very constructive funding that may yield long-range advantages.”
Beginning in 2016, Pallone mentioned, Medicaid well being plans have been awarded new contracts that inbuilt performance-based funds for improved well being outcomes.
“Director Gordon is speaking about discovering methods to encourage extra value-based reimbursement, and we’re transferring in that path already,” Pallone mentioned. “We’re prepared, keen and in a position to embrace value-based reimbursement.”
Gordon acknowledged that Medicaid HMOs in Michigan are doing an excellent job bettering high quality in contrast with different states.
“We wish to assist plans and advance different fee strategies to verify everybody has pores and skin the in sport,” Gordon mentioned. “We wish to construct on successes and encourage plans to do much more.”
Pallone mentioned Medicaid well being plans have been growing the p.c of funds to suppliers which are linked to high quality enchancment, or value-based contracts. Within the 2015-2016 fiscal yr, 14 p.c of funds to suppliers included some value-based funds. At present, greater than 24 p.c is immediately linked to high quality, he mentioned.
“The larger the supplier group, it’s naturally simpler to work extra with value-based fee preparations,” he mentioned. “(There have to be) transparency and belief, which is the aim on the plan aspect.”
One drawback, nevertheless, that many doctor organizations have is that every Medicaid plan has a special fee incentive system. As a result of they’re administratively completely different, doctor organizations discover value-based fee techniques troublesome to handle, Pallone mentioned.
“We wish to discuss with (MDHHS) about it. We all know (the state) desires to focus the (transformation) workplace to maneuver on the value-based path. We have to take into consideration suppliers, however not stifle innovation,” he mentioned.
Marianne Udow-Phillips, director of the Middle for Healthcare Analysis & Transformation in Ann Arbor, mentioned it’s troublesome to foretell what improved outcomes might come from transferring to a extra value-based reimbursement system. She mentioned the state’s transformation workplace might in the end handle a lot of these points.
Nevertheless, there are already a number of clues within the governor’s funds request that might handle key well being areas. For instance, Whitmer’s funds program consists of funding for 3 packages that search to enhance high quality: a program to scale back toddler mortality, a program to supply a screening program to establish individuals affected by “social determinants of well being” and a 3rd program to hunt alternate options for seniors aside from nursing properties.
Wholesome Mothers and Infants is a $37.5 million program ($17.6 million normal fund) supposed to reinforce maternal and little one well being companies by growing well being protection and entry and increasing Michigan’s dwelling visiting packages. Amongst different issues, it will improve entry to behavioral and reproductive well being companies for anticipating and new moms and create 1,000 new home-visiting slots focused to at‐threat households.
“The Michigan Medicaid program now performs fairly nicely on price aspect of equation, however the place are these areas for enchancment?” Udow-Phillips mentioned. “We don’t do nicely on toddler mortality. It’s good for the state to discover that.”
A second funds request is $20.three million ($8.5 million normal funds) to assist seniors navigate long-term care with a community of impartial counselors to assist seniors and their households navigate the sophisticated array of long-term care help companies.
“With long-term care, (MDHHS) would not have sufficient sources to trace how nicely they’re doing with dwelling and community-based companies helps,” Udow-Phillips mentioned. “This could assist individuals qualify for” accessible packages to maintain seniors out of nursing properties, she mentioned.
Not less than half of people that attain age 65 will want some degree of help with duties of day by day dwelling as they age. Michigan has expanded its Program for All‐inclusive Look after the Aged and its MI Selection helps program. In 2015, the state additionally launched MI Well being Hyperlink in 2015, an built-in Medicare and Medicaid twin eligible program.
However Michigan ranks 40th nationally within the p.c of state long-term companies and help spending on dwelling and group‐primarily based companies.