2020 Provider Preparation Project: Financing Models Purpose: To - - PowerPoint PPT Presentation

2020 Provider Preparation Project: Financing Models

Purpose: To provide high level information

• n the project, process, and outcomes

Funding Models

Objective: Accessibility to quality services, sustainability of the network, and data that ensures stewardship of public funds.

O Past: Cost Plus. Total agency costs are paid plus an

additional percentage. The cost per unit can vary monthly and amongst providers.

O Current: Fee for Service (most outpatient programs).

Providers are reimbursed for each clinical service provided to eligible enrollees. Cost per unit is clearly identifiable.

O Future: Possible Hybrid Payment model and incentives for

completing ‘Special Projects’/achieving ‘Milestones’ related to system preparation for Integrated Managed Care

Hybrid Funding Model

O Primary Drivers: Quality, sustainability and

stewardship of services with public funds by:

O Increasing key performance indicator outputs for

clients served;

O Measuring outcomes of increased access and

penetration rate and quality service delivery;

O BHAs will have a ceiling for Cost Plus if BHA are

unsuccessful Fee for Service. Details will be provided in the future.

O Monitor to ensure reasonable and acceptable

service unit costs

Promoting and Incentivizing BHA Change

O BHAs ‘Special Projects’/2020 Milestones

examples * EHR implementation and modification for IMC * IT review and upgrade * Claims and Credentialing

O BHAs need to be whole in the short and mid-

term to year 2020 to enhance service delivery infrastructure with the hybrid funding model and special projects.

Crossing the Finish Line

O Progress BHAs have made in the last 2 1/2

years toward IMC * Examples from BHA’s

O Common Provider/GRBHO goal is improved

clinical service delivery and infrastructure to sustain healthcare reform to WA State BHAs, and adjust to the new single payer system. The focus will be maintaining our well- established and growing systems of care for all of communities served in our region