It has been over six years since the Affordable Care Act (ACA) was passed by Congress, but many states are still feeling the positive impacts through the growth of innovative healthcare payment programs, expanded coverage, and improved healthcare quality. In Nevada, this is no exception as the state has embraced the changes that have come as a result of Medicaid expansion and the shift towards more value-based payments in healthcare.
As of early 2015, over 73,500 consumers were offered and enrolled in quality, affordable health insurance coverage through the Nevada Marketplace.1 Of those enrollees, 53% obtained coverage for $100 or less after any applicable tax credits, and 100% had the option of doing so.
In addition to coverage offered via the Marketplace, Nevada is one of 32 states that has expanded Medicaid under the ACA as of June 2016. As a result, Nevada’s Medicaid enrollment has grown by 68% since 2013, with almost 560,000 people covered as of mid-2015.2
To help ensure that Medicaid and Children’s Health Insurance Program (CHIP) participants in Nevada are receiving high-quality care from participating physicians, the Division of Health Care Financing and Policy (DHCFP) developed a Quality Strategy model that would help evaluate the effectiveness of these state programs.
The DHCFP’s Quality Strategy aims to make a difference for Nevada Medicaid and CHIP beneficiaries by:
On the private payer side, UnitedHealthcare’s Medicare Advantage plans in Nevada were named to the U.S. News & World Report list of Best Medicare Advantage Plans for 2016. UnitedHealthcare’s Medicare Advantage plans in Nevada had an average rating of at least 4.5 out of five from the Center for Medicare and Medicaid Services (CMS) Star Ratings program, and all UnitedHealthcare plans in the state had at least three stars. Star Ratings are intended to help consumers compare health plans on a variety of factors and are based on a plan’s performance on metrics related to quality, operations and member satisfaction.
Health plans are not the only healthcare organizations that are leveraging the ACA to advance quality, as more physician groups and provider organizations have started implementing new payment models and quality improvement programs.
In 2011, WellHealth Quality Care established itself as Nevada’s first commercial Accountable Care Network. The WellHealth network is built on a comprehensive healthcare delivery system, designed specifically to improve the patient, provider, and payer experience by delivering healthcare through a model driven by outcomes and elevating the patient experience.
The WellHealth Network implements a pay-for-performance model that measures patient care and controls costs based on standard criteria set forth by physicians in each medical specialty. Physicians must reach established performance benchmarks to stay in the network, and those who exceed the normal standards can receive bonuses, helping to incentivize participating physicians to deliver high quality care to patients in the network.
Another example of physician groups embracing quality is the Community Health Alliance, a Federally-Qualified Health Center (FQHC) that has used funding from the U.S. Department of Health and Human Services and the Health Resources and Services Administration (HRSA) that became available under the ACA to try out new approaches to behavioral health integration in Nevada. Patients who qualify for care at Community Health Alliance’s Center for Complex Care have the option of receiving more personalized and team-based care delivered by integrated teams consisting of a primary care provider, clinical social worker, care coordinator, and a medical assistant, with other clinical staff available as needed.
Providers working at the Center for Complex Care have fewer patients to manage and are given the time and resources needed to help the most complex patients with their needs. After ACA changes went into effect, CHA was able to provide care for newly Medicaid-eligible patients who had been served at state mental health facilities and those in the community who were not eligible for Medicaid before expansion.
Physicians in Nevada who have not already seen changes as a result of Medicaid expansion and other ACA-driven initiatives should know that they will continue to grow in coming years as both public and private payers move rapidly towards pay-for-value. While the addition of newly insured patients and Medicaid beneficiaries has caused some problems related to consumer access to care, Medicare payment reforms that started initially with the ACA and will be expended under the MACRA legislation will start to hit provider pocketbooks as well. Is your physician organization prepared for new payment models and quality programs in your state? Stay up to date on quality programs and other healthcare legislation by subscribing to the Able Health newsletter.
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