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Moving Toward Paying for Outcomes in Medicaid.

Billy Millwee1, Kevin Quinn, Norbert Goldfield

  • 1Millwee & Associates, Dripping Springs, Texas (Mr Millwee); 3M Health Information Systems, Wallingford, Connecticut (Mr Quinn and Dr Goldfield); St Peter's Hospital, Helena, Montana (Mr Quinn); and Baystate Medical Center, Springfield, Massachusetts (Dr Goldfield).

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Summary

Medicaid can enhance health outcomes and financial sustainability by adopting payment for outcomes models. Key performance indicators include reducing preventable hospitalizations and improving patient-reported results.

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Area of Science:

  • Health Services Research
  • Health Policy
  • Healthcare Management

Background:

  • Medicaid beneficiaries' health can be improved through outcome-based payment models.
  • Existing state precedents demonstrate the feasibility of payment for outcomes in Medicaid programs.

Purpose of the Study:

  • To explore the potential of payment for outcomes in Medicaid for improving beneficiary health and program sustainability.
  • To identify key outcome measures and criteria for prioritizing initiatives.

Main Methods:

  • Review of existing state-level Medicaid programs that have implemented payment for outcomes.
  • Identification and categorization of relevant Medicaid outcome measures.
  • Development of criteria for prioritizing payment for outcomes initiatives.

Main Results:

  • Successful precedents exist in states like Florida, Maryland, Minnesota, New York, Ohio, Pennsylvania, and Texas.
  • Outcome measures encompass preventable admissions, readmissions, ED visits, complications, early elective deliveries, mortality, patient-reported outcomes, and low-value care reduction.
  • Prioritization criteria include potential savings, model availability, health status impact, and Medicaid's influence.

Conclusions:

  • Embracing payment for outcomes offers a viable strategy for Medicaid to improve health and ensure future sustainability.
  • Five principles for success are proposed, focusing on clinical credibility and actionable data for providers.