Goodbye Fee-for-Service, Hello Pay-for-Performance

One of the basic tenets of the transformation of healthcare, obvious from the outset, is that the current fee-for-service reimbursement model would diminish and pay-for-performance (P4P) would augment. P4P is manifesting itself under the auspices of titles liked "shared savings" and "accountable care" (the new "managed care"). We have long expected a shift of consumers from fee-for-service to new managed care models as quickly as the models became available. In the state of Louisiana, we are now seeing Medicaid patients being moved from fee-for-service into the kind of managed care models that will eventually become Accountable Care Organizations (ACOs) and patient-centered medical homes.  The state is so eager to get the associated savings that they are driving the transition using older managed care models. Not good but they, like many states, need the savings.


Jim Grue, O.D.

Part Of Louisiana Medicaid Overhaul To Begin.

The New Orleans Times-Picayune  (2/2, Barrow) reports, "The first leg of Gov. Bobby Jindal's Medicaid overhaul goes live today." The change "overhauls much of the traditional fee-for-service system in which the state makes direct payments to health care providers who treat Medicaid patients. ... When implemented statewide, the system will affect more than 800,000 people and shift $2.2 billion in Medicaid insurance spending - about a third of the total $6.7 million budget that comes mostly from the federal treasury - to the private firms."

The AP  (2/2, Deslatte) reports, "Nearly 246,000 Medicaid recipients, mostly children, across southeast Louisiana were switched to the managed care networks in this first phase of the insurance-based model, called Bayou Health." Of note, "Medicaid recipients who won't be covered by the networks include nursing home residents, disabled and elderly residents who receive home- and community-based care, those enrolled in specialty service programs and recipients who receive both Medicaid and Medicare services."