RBM (cont.) Can integrate into EHRs or access via RFP process, Contract the Web development Cons for CDS: Administrative burden on providers to go through CDS May have lower savings than RBM Pros for online interactive PA: Reduce incidence of medically unnecessary services Requests meeting criteria automatically approved in real time Care Coordination Plan to implement Care N/A N/A N/A N/A May be duplication of N/A for LTSS Coordination in 2013 PCCM/MCO services Cost barrier N/A Eliminate co-pays Pros: Encourage primary care utilization reduction ($9.2M) ($3.5M) SAVINGS for Long-term strategies $34.9M $13.0M Additional Task Force Strategy Recommendations Program Integrity N/A No cash for Addtl. Pros: Implementation Timeline: research research Discourage improper use of 6-12 mo. controlled needed needed Savings Realization Timeline: controlled substances substances 12+ mo. Cons: Changes: Systems, Potential administrative burden resource expansion or for pharmacies redirect Communication: Data review team, Internal policy team Document: Develop criteria
RBM (cont.) Can integrate into EHRs or access via the Web Cons for CDS: Administrative burden on providers to go through CDS May have lower savings than RBM Pros for online interactive PA: Reduce incidence of medically unnecessary services Requests meeting criteria automatically approved in real time RFP process, Contract development Care Coordination for LTSS Plan to implement Care Coordination in 2013 N/A N/A N/A N/A May be duplication of PCCM/MCO services N/A Cost barrier reduction N/A Eliminate co-pays ($9.2M) ($3.5M) Pros: Encourage primary care utilization SAVINGS for Long-term strategies $34.9M $13.0M Additional Task Force Strategy Recommendations Program Integrity N/A No cash for controlled substances research needed Addtl. research needed Pros: Discourage improper use of controlled substances Cons: Potential administrative burden for pharmacies Implementation Timeline: 6-12 mo. Savings Realization Timeline: 12+ mo. Changes: Systems, resource expansion or redirect Communication: Data review team, Internal policy team Document: Develop criteria
recommendation-report12-15-2012.docx