Department of Health and Social Services Secretary Dr. Kara Odom Walker today announced an initiative to better prioritize patient outcomes in the state's health care system.
The agency will now give additional weight to what's called value-based care when determining payment to Medicaid managed care partners.
This network of providers receives Medicaid payments through the state to serve low-income patients. Their payments are currently based on the volume of care, such as the number of procedures, hospital stays and tests, rather than quality, impact of efficiency.
The initiative comes as the health care industry moves away from the traditional fee-for-service model towards a system that incentivizes improved patient outcomes.
"Through this historic initiative, we will reward our Medicaid managed care partners for embracing innovation and for providing our clients with high-quality care that focuses on improved outcomes and reduced expenditures," Secretary Walker said. "Rather than paying solely for volume of care "“ hospital stays, tests and procedures, regardless of outcomes "“ we will pay for achieving optimal health for our Medicaid clients and give our MCO partners flexibility in meeting that goal."
Steve Groff, director of DHSS' Division of Medicaid and Medical Assistance, said the initiative will create new quality performance measures related to the following: quality, access, utilization, long-term services, provider participation, spending, and member/provider satisfaction.
Delaware's Medicaid managed care partners are Highmark Health Options Blue Cross Blue Shield Delaware and AmeriHealth Caritas Delaware. Together they serve 200,000 of the state's 225,000 Medicaid patients.