Set it up this way
What we did was the state said for our tri county area, here is the money we are allotting you in the budget to take care of these 14,000 Medicaid patients. You administer it as you see fit. Us and the other 3 big organizations of docs in the area teamed up to care for them. Let the doctors groups assume the risk. As a group we would do utilization review and decide what meds get approved, what procedures, surgeries, etc. If we manage the population well, we get to keep any cost savings. If we dont, we have to eat the cost as an organization. Only caveat is we have to meet certain quality benchmarks. Certain # of pediatric patients that have had their vaccines, certain number of diabetic patients whose blood sugar control is at a certain threshhold. Certain numbers of cardiac patients at goal blood pressure. Extensive list of measures. It doesnt have to be expensive if the right people are in charge and working as a team. This is so scaleable down to geographic regions. I guarantee you the docs of each community/city know the patients of their community, their habits and what works better for them and how that differs from one place to another in the country.
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In response to this post by Faz d. Hoo)
Posted: 02/23/2020 at 3:43PM