Over the past several years, we have seen an increasing awareness of the need for evolution of Medicaid-funded healthcare from traditional “fee for service” to accountable outcome-focused care.
Through the help of technology, coaching, and improved protocols, in New Hampshire we have been able to drive this care from being clinic/hospital-based, to community based, and ultimately to in-home care and support. This has resulted in better outcomes, lower costs, and improved population health, while reducing the burden on physicians.
We see the largest impact of this transition in patients with complex chronic conditions, such as CHF and COPD, as well as with patients with substance abuse and mental health conditions, who need ongoing attention and support. These two populations account for the majority of Medicaid expense.
We recognize that it can be tragic to require patients to visit a clinician every time they have an element of an exacerbation under the historical fee-for-service model. Beyond cost, it causes a cumulative negative effect on their condition, and misses the ability to catch “early warning” signals of health issues between visits. Technology, integrated with coaching and community-based care, is a tremendous workforce multiplier for the healthcare system. A service such as Sensico System’s Ibis is an ideal platform to deliver this new model of care.
In my state of New Hampshire, we have received a Federally funded “waiver” to prove the efficacy of innovation in the delivery of care to Medicaid patients. We continue to drive towards choices for independence to keep patients in-home rather than in institutions. We have embarked on a program to create demonstrable results that we improve “triple aim” results through the integration of primary care and community. To this end, we have been granted $150 million to incentivize the demonstration of an integrated delivery approach. This will be an iterative approach, where we will be moving to an outcome-based model, removing the financial risk to clinicians to implement this innovation, and proving the effectiveness. Once we show success in a small population pilot, we will continue to expand, with the hope that we can transform our delivery system. Our expectation is that ultimately, the combination of community support and coaching, along with the integration of technology, will bring us one step closer to a more effective healthcare system for those with the most urgent need.
We look forward to making these improvements by leveraging care and technology to improve our healthcare system for better outcomes, lower costs, and healthier populations.
By Nicholas Toumpas, Principal Consultant at Karitsa Consulting Services, LLC, former New Hampshire Director of Health and Human Services