Comprehensive Medical  Care for Idaho Medicaid  David C. Pate, M.D., J.D. President and CEO St. Luke’s Health System Decem...
What is the hospital role in managed care? <ul><li>St. Luke’s believes that the focus should be on the greater delivery sy...
How can managed care improve coordination,  outcomes and access? <ul><li>St. Luke’s believes that the key aims should be b...
What are the negative aspects of managed care  models?  Do they cause barriers to care? <ul><li>Traditional managed care m...
What are the benefits or pitfalls of gain/risk  sharing, capitation, or Pay for Performance (PFP)? <ul><li>Gain/risk shari...
As we transition to a managed care model,  where can we most effectively focus our efforts? <ul><li>Accountable care </li>...
Where are the greatest opportunities  in managed care?  <ul><li>Traditional managed care: </li></ul><ul><ul><li>Short term...
What concerns you most? <ul><li>Insufficient time and effort will be given to engaging physicians. </li></ul><ul><li>Incen...
Comprehensive Medical Care for Idaho Medicaid
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Comprehensive Medical Care for Idaho Medicaid

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St. Luke's Health System President and CEO Dr. David Pate's presentation to at the state of Idaho's Medicaid Managed Care Public Forum held in Boise on Dec. 13, 2011.

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Comprehensive Medical Care for Idaho Medicaid

  1. 1. Comprehensive Medical Care for Idaho Medicaid David C. Pate, M.D., J.D. President and CEO St. Luke’s Health System December 13, 2011
  2. 2. What is the hospital role in managed care? <ul><li>St. Luke’s believes that the focus should be on the greater delivery system. The future system of care is not hospital-centric. </li></ul><ul><li>We believe that comprehensive medical care requires a clinically integrated network of providers that are financially aligned. </li></ul><ul><li>Finally, the success of the new system of health care delivery must recognize the importance of physician leadership. </li></ul>
  3. 3. How can managed care improve coordination, outcomes and access? <ul><li>St. Luke’s believes that the key aims should be better health, better care, and lower cost. </li></ul><ul><li>Traditional managed care is unlikely to achieve all of these goals, as well as those stated in the question. </li></ul><ul><li>St. Luke’s believes that the answer can be found in clinical integration and a value-based payment system. </li></ul>
  4. 4. What are the negative aspects of managed care models? Do they cause barriers to care? <ul><li>Traditional managed care models, short of capitation, have emphasized utilization management and decreases in reimbursement. </li></ul><ul><li>Episodic payments for personally performed services do not encourage preventative health services, team-based care, and do not effectively constrain low value or unnecessary services. </li></ul>
  5. 5. What are the benefits or pitfalls of gain/risk sharing, capitation, or Pay for Performance (PFP)? <ul><li>Gain/risk sharing – limited duration; inability of providers to repay losses; willingness to participate </li></ul><ul><li>Capitation – financial reserves; infrastructure; meaningful data; patient attribution models </li></ul><ul><li>PFP – structural design – often process oriented rather than outcome-based; provider alignment and attribution models; traditionally ineffective </li></ul>
  6. 6. As we transition to a managed care model, where can we most effectively focus our efforts? <ul><li>Accountable care </li></ul><ul><li>Provider alignment </li></ul><ul><li>Provider and patient engagement </li></ul><ul><li>Medical homes are a component of accountable care, but not the solution in and of themselves. </li></ul><ul><li>Promote team-based care </li></ul><ul><li>Electronic health records (EHRs) </li></ul><ul><li>We must find ways to better manage health, or we will undoubtedly be unable to manage the forecasted increase in the disease burden. </li></ul>
  7. 7. Where are the greatest opportunities in managed care? <ul><li>Traditional managed care: </li></ul><ul><ul><li>Short term – decreased utilization </li></ul></ul><ul><ul><li>Long term – limited access </li></ul></ul><ul><li>Accountable managed care </li></ul><ul><ul><li>Short term – chronic disease management </li></ul></ul><ul><ul><li>Long term – increased overall health of the population </li></ul></ul>
  8. 8. What concerns you most? <ul><li>Insufficient time and effort will be given to engaging physicians. </li></ul><ul><li>Incentives will not be aligned across all providers. </li></ul><ul><li>The care model and payment model will continue to promote fragmented care. </li></ul><ul><li>Health care costs will continue to rise because managed care only addresses one aspect of the cost equation (cost = price x units) by continuing to pay for volume instead of value. </li></ul><ul><li>The overall health of the population will not improve as managed care does not address population health. </li></ul>
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