Care associated with oversight & Communications: Providers, Coordination to monitoring Members assist transition Provider incentive program Member Incentive Pros: N/A Implementation Timeline: program ($7.5M) ($2.8M) Pay for outcomes and quality (not just 1-3 years quantity of services) Changes: Systems Cons: Communication: Providers Not much research done on long-term Document: Incentive health outcomes criteria & benefits Value-based N/A Care Management $1.8M $0.7M Pros: May overlap with Implementation Timeline: purchasing with Organization Tie in savings guarantee (funding goes short- and mid-term 18-24 mo. Care Management back to if savings not met) strategies Savings Realization Timeline: Organization (CMO) Technical expertise, specialized 2-4 years knowledge Changes: Systems (IT) Brings together all initiatives 1 Communication: Providers, responsible entity Members Cons: Document: RFP process, Perception of duplication with Contract development, CMO services provided in medical home readiness review (can be overcome with contracting strategies) State needs resources to monitor CMO Less potential savings than Capitation (softer model)
Care Coordination to assist transition Provider incentive program associated with oversight & monitoring Communications: Providers, Members Member Incentive program ($7.5M) ($2.8M) Pros: Pay for outcomes and quality (not just quantity of services) Cons: Not much research done on long-term health outcomes N/A Implementation Timeline: 1-3 years Changes: Systems Communication: Providers Document: Incentive criteria & benefits Value-based purchasing with Care Management Organization (CMO) N/A Care Management Organization $1.8M $0.7M Pros: Tie in savings guarantee (funding goes back to if savings not met) Technical expertise, specialized knowledge Brings together all initiatives 1 responsible entity Cons: Perception of duplication with services provided in medical home (can be overcome with contracting strategies) State needs resources to monitor CMO Less potential savings than Capitation (softer model) May overlap with short- and mid-term strategies Implementation Timeline: 18-24 mo. Savings Realization Timeline: 2-4 years Changes: Systems (IT) Communication: Providers, Members Document: RFP process, Contract development, CMO readiness review
recommendation-report12-15-2012.docx