Twenty: The number of emerging payer priorities ranked from 1 to 20 by commercial, Medicare Advantage and Medicaid managed care plan leaders are featured here in the 15th edition of our Healthcare Payer Index. A conference call to discuss the list will be held today, Friday, February 14th at 1 o’clock eastern. Dial 800-874-4559 (password is Cote41810).
Nursing Rehab Center Turnaround: A northeastern nursing & rehab center is poised to turn a profit on their Medicaid business after years of losing millions, and has created a new behavioral health team of psych social workers, clinical psychologists and full-time music therapists as a way to reduce psych-related medication use, head off potential Medicare readmission penalties, and better manage dementia and Alzheimer’s patients. Read the interview by clicking here.
Incentive Pay for SUD Treatment: A new value-based payment model now encourages substance use treatment providers in New Jersey to contract with a leading payer and, if successful, may be rolled out to other behavioral categories. The model offers case rates for an episode, with different rates for different levels of care, along with value-based incentives, and payment regardless of the length of the stay or visits. There are no administrative requirements, no pre-approval. An incentive payment of about 10% of commercial claims is available to providers who meet several outcome measures, like readmission reduction, and process performance measures, like ‘engaging the patient on MAT’, stepping the patient down effectively to the next level of care, and communicating with the PCP. A higher incentive (~15%) is available to providers who can manage Medicaid patients too, although interestingly the incentive will be based on commercial claims. The insurer stops short of seeing a single payment for full-year engagement of a substance use patient in this market as it can be difficult to assign care to one provider, but there are other commercial insurers trying capitation and full-year engagement models. BCBS of North Carolina has recently contracted with Eleanor Health on a multi-year global capitation risk arrangement, while Anthem partners with Aware Recovery to provide in-home treatment under a yearlong PMPM arrangement.
Extra Point: I love my folks. They are part Frank and Estelle Costanza, part Cosmo and Rose Castorini from the classic Moonstruck. And they drove me a bit nuts this week after I bought them cell phones. On Tuesday alone, my mom called me 27 times, only half of which were on purpose, the other half were voicemails of her asking dad which button to press and how to talk into the phone. One message was an hour and 33 minutes long, and I’m 90% sure it was during her visit to the dentist. They are in their late 70s, frail and aging - dad dealing with the balance issues from vertigo after a serious fall hospitalized him 5 years ago, mom juggling heart disease and osteoarthritis and all the diet and exercise confusion those conditions bring. But now with their new found google map app toy they have a way to get to their doctor visits or to the kids games without asking me directions every 5 minutes...but I’ll say this, I’m lucky they are here, love that they make me laugh, and happy they still like to grab a table at Silvanos for spaghetti on Valentine’s Day because “they just have the best sauce Bry.” Here’s to managing your parents’ health, one cell phone call at a time.