Many states are pursuing various Medicaid alternative payment models; however, often APMs' affect on cost of care and health outcomes remains unclear, Deloitte reported in a recent policy brief.
For the analysis, the New York City-based consulting firm's Center for Health Solutions examined 30 state and federal reports evaluating 45 APM programs across 28 states.
Here are five takeaways from the brief.
1. Many APM initiatives include Medicaid's patient-centered medical home model. Last year, 29 states served some beneficiaries under a PCMH model, with 13 states eyeing similar programs or expansion of their programs this year. In addition, 32 Medicaid Health Homes models operated in 21 states and Washington, D.C., as of May 2017.
2. However, Deloitte notes cost control and health outcome findings from the models "have been mixed, with some older initiatives such as North Carolina's PCMH saving money over time and some newer initiatives such as Ohio's specialty Health Home increasing costs despite improving care in the short term." Ohio's specialty Health Home program for beneficiaries with serious mental illness was linked to a monthly $561 per-member increase in Medicaid program costs despite improvements in care coordination and patient satisfaction.
3. Deloitte also evaluated Medicaid's Episode of Care Payments, which only three states — Arkansas, Ohio and Tennessee — implemented in 2016. At the time, Connecticut, New York, Oklahoma and South Carolina were contemplating implementing the bundled payments. Arkansas in particular achieved some positive outcomes through its multipayer bundled payment initiatives, as attention-deficit/hyperactivity disorder EOC payments increased the average number of behavioral health visits and decreased ADHD patients' treatment costs by 15 percent, the report states.
4. Ten states implemented Medicaid ACOs as of June 2017, with at least 13 other states pursuing the APM. Deloitte found early results from Oregon and Colorado show ACOs can decrease unnecessary healthcare use and lower costs, but their effect on quality remains unclear.
5. As potential results from Medicaid APMs can rest on how much providers' revenue derives from Medicaid, Deloitte said alignment with other payers may be necessary to incentivize providers to participate in APMs. In addition, researchers said, "Medicaid models may need to evolve to incorporate more financial risk and increase participants' meaningful use of EHRs to qualify as advanced APMs under [the Medicaid Access and CHIP Reauthorization Act]. This may require new or additional investment in technology and data analytics tools."