Serving the safety net community

State budgets are often challenged by healthcare costs. An increasing number of states are exploring ways to reduce these costs through policies aimed at the intersection of healthcare costs and quality. At this intersection, we see potentially preventable hospitalizations, emergency room visits, readmissions and other utilization. As more states and Medicaid agencies move beyond the role of managing claims, they are exploring value-based purchasing policies that look like:

State policy → Reduce potentially preventable ED visits & hospitalizations

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MCO program → Reduce potentially preventable ED visits & hospitalizations

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Provider action → Reduce potentially preventable ED visits & hospitalizations
 

This is an example of a state’s intent to reduce cost and improve quality cascading into MCO programs that translate to provider action. This alignment provides a clear signal that helps those on the front lines of healthcare delivery understand what they need to do to succeed. 

An example of front-line action to reduce preventable ED visits or hospitalizations is identifying a segment of the population with high risks and reaching out to those individuals with resources that mitigate those risks. Iliana Gilman, now a Principal with Health Management Associates, describes her prior work as chief executive officer for El Buen Samaritano where they addressed the needs of Latinos living in poverty. Because of El Buen Samaritano’s ability to understand their population’s needs, they built robust programs in family planning, chronic condition management, mental health care, language training (ESL) services and more.

On this episode of the Inside Angle podcast, Ms. Gilman describes the work of standardizing documentation in the EMR, developing a data and quality team and implementing strategies that met the needs of the population while demonstrating to foundations and other funders the impact of their work.

For those considering policies to improve healthcare outcomes and costs, it’s useful to hear the challenges faced by those on the front lines and to consider ways to align policy, programs and action.

L. Gordon Moore, MD, is Senior Medical Director, Clinical Strategy and Value-based Care for 3M Health Information Systems.