Gainsharing and caring for dual eligibles are hot topics for healthcare providers — and rightfully so — experts said Thursday.
There is potentially good news for post-acute facilities, despite worries in the sector that include the sustainable growth rate, the 2013 deficit reduction and the sequestration cuts scheduled to start next year.
That’s because the new paradigm of reimbursement includes bundled payments, site-neutral payments and care outcomes, they feel. With bundled payments, providers are bidding on what the total cost of care will be, explained Eric Hammelman of Avalere Health during a webinar titled “An Expert Look at Priority Issues Facing Manufacturers, Managed Care, and Providers.”
For example, rehab facilities that can treat knee replacement candidates for significantly less in 30 days can share in the cost savings with the physician, Hammelman explained.
Dual eligible care coordination also is being addressed by about a quarter of the states.
The Centers for Medicare & Medicaid Services has said it hopes to enroll between one and two million dual eligibles into “integrated delivery models” by 2013, Avalere’s Bonnie Washington noted.
By Monday, interested health plans have to submit their notice of intent to participate in a capitated payment demo for 2013, with CMS intending to finalize three-way contracts between plans, the states and the agency by September 20. Twelve states already have released proposals for these integrated Medicaid care models. It is “a big opportunity to provide a single point of coordination,” Washington said.
