As part of Idaho’s pursuit of the Triple Aim, we will move from a FFS payment model (current environment – Category 1) that rewards volume of service to new value based payment models to incentivize better models of care and lower overall medical costs. This statewide payment transformation will involve a variety of approaches on the part of Idaho’s major payers, including commercial payers, Medicare and Medicaid. Idaho recognizes the importance of offering flexibility to payers in defining how they will support payment reform. Each payer is at a different place on the APM framework. For example, one payer is incentivizing providers through an accountable care organization model with shared, upside risk, expecting to evolve to a full risk model in the future.
Within this broader statewide payment model transformation, several of Idaho’s payers have committed to alternative payment arrangements with Idaho’s healthcare providers. These new payment models will incentivize, support, and reward the improved care given through the PCMH model, which will reduce high-cost care through patient management, including lowering ED utilization, hospital admissions and re-admissions, reduce neo-natal intensive care use, and increase the use of generic prescription medication. It is anticipated that these trends will decrease the cost of healthcare in the State.
Idaho has adopted the LAN framework of Alternative Payment Models and remains committed to transitioning Idaho from a fee for service structure to a population based payment structure. Commercial payers have demonstrated their commitment to negotiations that will lead to value-based payment arrangements with providers within their network that advance the goals. The payment transformation, both at a statewide level and in support of the SIM PCMHs, will not occur immediately. Transforming payment requires negotiations and contracting between the payers and providers. To avoid anti-trust, each payer must negotiate separately with each provider.
Idaho Office of Healthcare Policy Initiatives