Medicaid PCMH

Last year, the Center for Health Care Strategies (CHCS) reported in their policy brief 10 key factors for reducing disparities.  Focused on small practices serving high volumes of low-income and racially and ethnically diverse patients with diabetes,  their conclusions highlight what is needed to support these practices that are overburdened with both complex chronic illnesses and adverse social determinants of health.  

This three-year study of 36 practices east of the Mississippi River showed that there are key themes that improve care for the 2,781 diabetics enrolled.  While no improvements were noted in clinical outcomes, an analysis of processes in the practices documented the following findings:

1. Practice leadership and culture being the most important – and subjective – factors for success.
2. Maintaining practice engagement was a major challenge.
3. Practices needed both practice facilitation and care management support.
4. Practice facilitation was most effectively provided by an entity external to the practice with the relevant experience and skill set.
5. The belief that the practices would ultimately “take over” and provide care management activities proved unrealistic.
6. Investment in the practices needed to be ongoing, more flexible and “hands-on” because the practices did not have the capacity for uninterrupted or smooth changes.
7. Although financial incentives were viewed as important, incentives were not the primary motivator or driver of change.
8. Healthcare IT was too overwhelming for most practices to implement to its fullest capacity.

While practices associated with MCOs embraced the opportunity to improve, the day-to-day application of Quality Improvement was more challenging for them.  Improving quality and reducing disparities in practices will likely be more sustainable when assisted by primary care case management programs or the state Medicaid agency.

State Medicaid agencies could support small practices by identifying overburdened practices, encouraging support for these critically important practices, by facilitating some of all of the following:

• Reimbursement Health Homes for quality and volume
• Learning collaboratives, initiatives to link small practices with more specialists including behavioral health specialties
• Technical Assistance 
• Analytic information and support
• Care management teams
• Leadership, vision and focus

“Medicaid agencies can partner with health plans and other payers to provide ongoing supports and technical assistance to practices, and ensure that small practices are not left behind.”  CHCS

Place Matters

We have all heard about the social determinants of health and that zip codes correlate to health outcomes (see Life Expectancy in New Orleans below). The evidence as well as the solutions were nicely reviewed at a session of the 2014 National Health Policy Conference.  This is important to all providers because these factors (that are outside of your control) may decrease you performance rankings and perhaps drive patients and clients away from your business.  How can you provide service to vulnerable populations without excessive risk?

"Community Health & Disparity: Moving Beyond Description" is a webinar that lasts about an hour and 30 minutes.  This time well-spent is filled with information, knowledge and wisdom about healthcare disparities.  This is essentially a call to organized action at the community level and providers of healthcare must be well-represented.  As wealth gaps and opportunities for economic equality become political battlegrounds, healthcare delivery systems are dragged into the spotlight because our performance is really a key indicator of the health of the entire community.  The health of your patients says as much about their zip codes as it does about than about your care.

The solutions to the provider's dilemma are complex.  Providers will not be able to hide cherry-picking and patient dumping strategies.  These are not viable even as near-term solutions.  However, a number of policies and practices expressly for optimizing both your clinical practice and payments are available.  For example, if you next step is community engagement, contracting with a physician support entity, upgrading your EHR, or workforce development, reach out to MED+Works to make it happen. Contact us.