OHLC

Payment and Reimbursement Reform initiatives aim to implement sustainable payment options for greater efficiency and quality.

The Payment and Reimbursement Reform Work Group was formed in early 2009. After exploring various payment approaches, the group narrowed their focus to two areas—the medical home concept and bundled payments for defined services.  In exploring the medical home concept, the group looked to the successful model piloted by Boeing in Washington, which demonstrated improved quality, improved employee productivity and lower costs. This model was used in part, to develop the Council’s High Value Patient Centered Care Model, which provides coordinated high-touch, high tech care to patients with chronic and complex conditions. This model was chosen as the best place to start, as it was seen to have the greatest opportunity in the short term to deliver results to employers. Once this initiative is launched, the group will reconvene to discuss other payment pilots including bundled services.

Updates on our work:

High Value Patient Centered Care Model

With the second year of the multi-payer High Value Patient Centered Care (HVPCCM) demonstration initiative for patients with complex and chronic conditions well under way, the five health plans, four of the State’s purchasing groups and 14 medical groups are participating. Earlier changes resulted in improvements to utilization reports, with information on patient use of emergency room visits, hospitalizations, prescription drugs, imaging and lab procedures and physician visits being provided to medical groups.

Twenty-three nurse care managers have been working with about 3,600 patients enrolled in the demonstration. Starting early February, nurse care managers have been participating in weekly collaboration calls known as “Office Hours.” During these hour-long calls, nurses discuss what is working well, how to address challenges, and other subjects. Call topics include case studies, patient and physician engagement, specific care management skill building (e.g. motivational interviewing), effective time management, tips in working on electronic medical records and more. The demonstration runs through February 2013 at which time an evaluation will be completed. The medical groups and health plans will begin work soon on developing a sustainable model to be put in place after the demonstration.