Capitol Correspondence - 08.09.19

ICYMI: Business Acumen Weekly Update

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From Donna Martin, Director of State Partnerships & Special Projects:

As the work of the ACL Business Acumen grants comes to a close, I will be shifting the focus of these weekly updates to include information about ANCOR’s work on the broader topics of Alternate Payment Models (APM), Value-Based Payment (VBP) structures and emerging best practices. I will include updates from the APM Work Group, and at times profile what we are learning as we navigate this changing environment

The APM workgroup reconvened last week following the successful release of the ANCOR’s white paper, “Advancing Value & Quality in Medicaid Service Delivery for Individuals with Intellectual & Developmental Disabilities,” earlier this year. The work group will now be focusing on an environmental scan of all things related to APM, VBP, and managed long-term supports and services as we look for emerging best practices across the country. The group will also develop recommendations for initiatives that may be scalable or could be implemented as pilots. There will undoubtedly be interesting outcomes from this work group.

Relative to best practices, I have had the opportunity to visit a few Pennsylvania-based members over the past two weeks and have seen that the great state of Pennsylvania seems to foster an environment of creativity and flexibility for pilot programs that have tested different models. I visited an integrated care program, a provider-led ACO/MCO, and a PACE-like model of service delivery.

One of the programs I’d like to profile this week comes from Woods Services in Langhorne, PA. Last year they launched a primary care coordination model which has the potential to significantly bend the cost curve for health care services. In this model people supported receive integrated primary care at a full service medical clinic run by Woods. A member of the nursing staff serves as the central point of coordination and can navigate the individual between home, the health center, and other specialists as needed. They can divert people transitioning from hospitals to nursing home/rehab care because they have the supports on hand to manage most rehab situations at home. After just one year of this pilot, they are seeing significant reductions in emergency department visits and hospitalizations. They are making these strides trough a comprehensive continuum of care that connects prevention, wellness, education, behavioral health, and social services with coordination of integrated health care delivery.

Next week I will profile the two other innovative Pennsylvania based models I visited: state association RCPA’s ACO and Keystone’s ACAP program for adults with autism.