Becker's Hospital Review

18 Executive Briefing SPONSORED BY A lthough Medicaid has been slower than Medicare to embrace value-based care, an increasing number of states are defining Medicaid value-based care delivery systems and payment reforms. While significant variation exists, these programs generally emphasize increased alignment among providers, health plans and other stakeholders, and typically involve alternative reimbursement mechanisms that provide incentives to focus on improving the quality of care and managing total healthcare costs. Becker's Hospital Review recently spoke to three experts from Collective Medical, a PointClickCare Company about the importance of care coordination in Medicaid value-based payment models: • Nicole Sunder, Director of Health Plan Solutions • Nikki Starrett, Director of Value-based Care • Ian Bruce, Senior Clinical Solutions Lead The Collective Medical trio discussed common challenges related to Medicaid care coordination, such as tackling behavioral health and substance use disorder—and keys to addressing these through technology-enabled care collaboration. The pandemic has demonstrated the benefits of value- based care for providers Prior to COVID-19, many providers were reluctant to participate in Medicaid value-based care. Medicaid reimbursement rates are typically on the lower end of the scale and to be successful with value-based care, providers often need to make significant capital investments. The pandemic, however, highlighted how beneficial value-based care models can be during times of major disruption. "Providers receive stable revenue and are paid based on how well they care for patients, rather than how many services they perform," Ms. Starrett said. "Care delivered virtually can also be reimbursed." MCOs play a role in increasing adoption of Medicaid value-based care More than two-thirds of Medicaid beneficiaries receive benefits through managed care organizations (MCOs), according to the Kaiser Family Foundation. The ongoing transition to managed care is forcing MCOs to focus on network performance. "Contracts between MCOs and providers must be clear about expectations, as well as the upside and downside risks," Ms. Sunder said. "Shared accountability between payers and providers is more critical than ever, as it drives opportunity for a better experience and better clinical outcomes for Medicaid beneficiaries without impacting access to care." Behavioral health needs and substance use disorders often increase care coordination challenges The Medicaid population has a high prevalence of behavioral health conditions. Addressing behavioral health needs is crucial for reducing inpatient and emergency department utilization. This is often easier said than done. "Many behavioral health clinics lack access to the tools and technology needed for real-time visibility into hospital and post-acute encounters," Mr. Bruce said. "Due to interoperability issues, healthcare teams face challenges implementing real-time interventions during and after episodes of care." Another obstacle to care team coordination is patient consent for sharing sensitive information. Mental health information sharing is governed at the state level, while SUD treatment settings are governed at the federal level by 42 CFR Part 2. This introduces additional privacy requirements beyond HIPAA. Once patients are discharged from the emergency department or a hospital inpatient setting, behavioral health symptoms may make it difficult for these individuals to follow up with treatment plans. Social determinants of health, such as lack of transportation or housing instability, can also interfere with the post-hospital stabilization process. Ability to influence care in the ED, while not always easy, is essential for Medicaid care coordination The ED serves as the front door of the hospital. To reduce preventable admissions and readmissions, outpatient care team members must interface and communicate with that part of the care continuum. "Many Medicaid beneficiaries who reach the ED could be better served by an alternative treatment option, such as discharge to home with intensive outpatient support or a return to the SNF," Mr. Bruce noted. "Surfacing those opportunities to the ED staff is critical before the decision to admit occurs." Unfortunately, most emergency departments have limited access to patient records stored outside the hospital EHR system. This problem is exacerbated when ED visits occur outside of normal business hours. Solutions include leveraging technology to asynchronously communicate information that's critical to the ED visit and integrating information into the ED workflow. As Mr. Bruce explained, "The emergency department EHR is the native ecosystem where ED care team members review and enter clinical records—they often simply do not have the time to check multiple 3rd party portals. . Pushing clinical insights from outside the hospital into their EHR makes that information much easier to access for ED providers , being within their existing workflow, and is a key to success here." Technology tools can address coordination challenges across the care continuum Stakeholders involved in managing a patient's care need access to real-time admit and discharge data for hospital encounters, as well as encounter data for long-term and post-acute care settings and skilled nursing facilities. Under Medicaid value-based care models, this capability is especially important for behavioral health providers. Encounter data alone, however, isn't enough. Technology solutions must enable care providers to easily access and use patient centered information to deliver the highest quality and most cost-effective care. . "Push notifications help clinical teams care for vulnerable patients to the fullest degree," Mr. Bruce said. "Clinicians can proactively contact ED care teams to coordinate care around visits, deescalate patients and reduce the cost and length of stay." Connection to and use of a care coordination platform is also essential. Solutions like Collective Medical cut across care settings, geographies and disparate EHRs, seamlessly sharing care plans across the ecosystem. This gets the whole care team on the same page. Conclusion Ultimately, care collaboration is essential for success under Medicaid value-based care programs. "Instead of working in silos, we need a person-centered approach that aligns a patient's desires with community-based resources," Ms. Sunder said. "This means striking a balance between benefit, access, adherence and cost." n Care coordination: Critical to success in Medicaid value-based payment models

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