The state of Washington has reportedly saved $21.6 million in Medicare spending through a capitated, managed fee-for-service model that focuses on high-risk beneficiaries, including dual-eligibles.
The 6% reduction in that state's costs represents an “encouraging first look” at how use of health homes can improve quality and provide better coordination of services while still lowering costs, the federal agency said in a Friday post.
The Washington Health Home Program launched in July 2013 as part of a CMS initiative to test integrated-care models for Medicare and Medicaid enrollees. Health homes in the state act as a central point, or a bridge, integrating primary and acute care, behavioral health, and long-term care services for the riskiest beneficiaries.
The state pays the homes for delivery of services on a per-beneficiary, per-month basis, using three payment tiers. They include a one-time $252.93 fee for initial outreach and engagement, a $172.61 payment for intensive-care coordination and a $67.50 payment for each month that low-level care coordination is provided.
Initial findings, suggesting a total savings of $21,604,955 through Dec. 31, 2014, were released in a new report (PDF). It also evaluates differences in utilization of services and quality outcomes. The report found the risk-adjusted, all-cause 30-day readmission rate dropped from 22.9% at baseline to 15.4% at the end of 2014. The number of emergency room visits per 1,000 patients also declined from 200 at baseline to 185.
Though preliminary, the findings offer encouraging support for delivery-system reforms aimed at achieving better care coordination, said Dr. Patrick Conway, CMS' principal deputy administrator and chief medical officer.
“It is especially important to focus on the safety net population served by this model in order to reduce disparities and coordinate care for vulnerable populations.”
Additional information on the project, including analyses that compare the demo group to those not in a demo are expected later this year. According to the CMS' Financial Alignment Initiative, which sponsored the project, similar efforts are underway in 11 other states, including: California, Colorado, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, South Carolina, Texas and Virginia.
