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Episode-based care delivery PowerPoint PPT Presentation


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The shift to paying for results is just one part of a broader program to improve the way that care is delivered in Arkansas. Objectives. Improve the health of the population Enhance the patient experience of care

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Episode-based care delivery

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Episode based care delivery

The shift to paying for results is just one part of a broader program to improve the way that care is delivered in Arkansas

Objectives

  • Improve the health of the population

  • Enhance the patient experience of care

  • Enable and encourage patients to take a more active and informed role in their own care

  • Reward providers for high quality, efficient care

  • Reduce or control the cost of care

For patients

For providers

How care is delivered

Medical homes + Health homes

Episode-based care delivery

Four aspects of broader program

  • Results-based payment and reporting

  • Health care workforce development

  • Health information technology (HIT) adoption

  • Expanded access for health care services


Episode based care delivery

The goal

How it works

Incentive

The Arkansas approach is designed to reward coordinated, team-based care across the whole person and for specific conditions or procedures

How we are implementing it…

Medical homes andHealth homes

Episode-based care delivery

Our overall approach

  • Providers proactively work as a team to manage a patient’s overall health

  • Patient journey: all healthcare and support services needed by a patient over time

  • Patient journey: all services related to a specific condition, procedure, or disability

  • Typically one provider is designated as ‘quarterback’ for all patient needs for a period of time

  • Quarterback: the provider in best position to influence prevention and management of chronic disease

  • Quarterback: ‘Principal Accountable Provider’ in best position to influence cost and quality of services for the episode

  • Providers are rewarded for providing high-quality care at an appropriate cost

  • Outcome measured includes overall health of the provider’s patient population (across all conditions and episodes)

  • Outcome measured is average cost and quality of care for all patients that experience a given ‘episode’ (e.g., a surgery)


Two types of episode based care delivery

Two types of episode-based care delivery

Likely model for most CFCO services

Assessment-based episodes

  • Clinical guidelines are clear and predict the level of need

  • Diagnosis is concrete and reliable

  • Trajectory of the episode is consistent across clients

  • Condition is of a meaningful size

  • Diagnosis is “separable” from (not consistently associated with) other conditions

  • A reliable assessment that accurately predicts need exists

  • Trajectory should be consistent with assessment results for a defined period of time

  • The assessment covers a majority of the client’s needs in that area

Criteria

  • Guidelines-based episodes

  • Acute medical episodes, e.g., URI, pregnancy

  • Some behavioral health conditions, e.g., ADHD

  • Support services driven by level of functional need, e.g., developmental disabilities, LTSS

Examples


Process flow for needs based episode

Process flow for needs-based episode

PRELIMINARY

Universal assessment determines episode amount

Performance transparency helps clients select provider

Integrated person-centered care plan written

Provider score card

Saline county

2011 episode score

2011

health home score

Provider

A

A

Provider 1

B

A

Provider 2

C

B

Provider 3

Services begin

Provider submits encounter data and receives payment

Provider receives periodic report to track amount

Last year budget: $25k

Budget

$20k

$10k

$30k

Actual

$18k

Recipient: John Smith


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