Pay for performance/incentives
A county-based accountable care organization integrates medical, behavioral health, and social services and assigns a care coordinator to newly enrolled Medicaid beneficiaries to promote use of appropriate services, leading to fewer readmissions and emergency department visits and lower costs.
Partners in an accountable care organization share risk via an annual global budget and implement initiatives to improve efficiency and quality, leading to reductions in hospital use and overall health care costs.
The health department in New York City uses subsidies, upfront and ongoing technical support, and quality of care feedback to promote implementation and use of electronic health records by primary care practices in medically underserved areas, leading to better care for patients in these practices.
The Children's Healthcare Access Program offers financial incentives and support services to primary care medical homes serving children covered by Medicaid and their families; the program enhanced access to primary care, increased the percentage of children with asthma action plans, reduced emergency department visits and hospital admissions, increased well-child visits, and reduced costs.
A State-based, public–private partnership supports quality improvement in pediatric practices, leading to greater adherence to evidence-based care and improved care coordination for children and adolescents, and to higher staff satisfaction in participating practices, and highly rated quality of care for children.
Five clinics in remote parts of Alaska and Washington state receive additional reimbursement from Medicare and dedicated Federal funds that allow them to provide around-the-clock care, leading to fewer medical evacuations (and associated cost savings), better quality care, and high levels of satisfaction in the communities they serve.
As part of a comprehensive initiative, State legislation enables trained primary care medical providers to receive Medicaid reimbursement for preventive dental care provided during well-child visits, enhancing access to these services for low-income children younger than 6 years.
A comprehensive, multi-stakeholder program combines training and higher reimbursement for dental providers with outreach, education, and support to families, leading to enhanced access to dental care, less tooth decay, and lower dental care costs for young, low-income children.
A State-based, public–private partnership adapted its successful primary care medical home model to serve pregnant Medicaid beneficiaries, leading to enhanced access to comprehensive prenatal care (including intensive case management for high-risk pregnancies), better adherence to evidence-based care standards, and reductions in low–birth weight babies and rate of primary Cesarean sections.
An alliance of government and not-for-profit agencies aided the passage of various legislative provisions in Massachusetts designed to create a more stable, systemic role for community health workers, leading to greater professional recognition, an expanded workforce and training infrastructure, and increased funding of services.