This initiative aims to help Idaho Medicaid improve the health of Idahoans and move toward shifting healthcare reimbursement from volume to value. It will establish Value Care Organizations (VCOs) in four regions throughout Idaho with a goal of delivering a whole-person model of coordinated care, which is tied to a value-based payment system. Value Care Organizations will be comprised of primary care physicians, hospitals, and other healthcare providers who choose to form a cooperative structure to deliver improved cost and quality.

The department will also implement an Episode of Care program designed for specialists and other providers who deliver certain discrete clinical episodes such as surgery, oncology, and maternity care. Through this program, specialists will benefit as they deliver high-quality, cost-effective care within predefined episodes. The program will provide an automated claims data portal for VCOs and Healthy Connections Primary Care physicians to share information on the care they provide to Medicaid patients. Providers will be able to monitor their performance on nationally endorsed, quality measures to improve the overall health of their patients, leading to healthier people, and lower healthcare costs. Providers who take risks and meet the program’s targets for cost and quality performance may receive financial incentives for achieving a higher quality of care, in addition to their usual fee for service reimbursements. The intent is to expand accessibility to the PPA Portal to additional providers in the future, to support their effort to better coordinate patient care, improve health outcomes, and control costs.

Target program launch date: January 2020
Target end date for full implementation: January 2023

Authors: Idaho Division of Medicaid

Publication Date: 2019

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