Making progress towards our strategic goal 1 to ensure accessible and available health care that works – DHW Voice

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The Department of Health and Welfare (DHW) is pleased to announce the launch of an innovative program designed to change the way Medicaid pays for health care. This long-awaited and pioneering program called “Healthy Connections Value Care” is a collaboration between DHW and health care providers that seeks to make sure Idahoans have access to health care that makes them healthier. It is designed to reverse the way Medicaid pays for medical procedures, community-based services, and support for people with disabilities, but does not link payments to actual health outcomes for the people we serve.

In contrast, the Healthy Connections Value Care program rewards healthcare professionals when they provide high-quality, affordable healthcare. These hospitals and primary care providers, called Value Care Organizations (VCOs), partner with DHW to keep healthcare costs under control. Part of the deal is that VCOs agree that if their healthcare costs exceed a target, they will return a portion of that money to the Idaho Medicaid program. This approach incentivizes health professionals to provide quality health care that is also good value for state taxpayers. Ultimately, we anticipate a winning outcome for both participants and Medicaid providers.

Improvement of health outcomes and data

VCOs rely on many types of data to adapt their practices to meet criteria in contracts. Their contracts specify that during their “performance year”, they will use data provided by ACS to make measurable improvements to their health practices.

DHW provides data to participating suppliers to show how effective various medical and health prevention activities are in improving health, while reducing costs for suppliers. Based on this data, participating healthcare professionals make decisions about how much risk they choose to take in their personalized contract.

Quality measures

The program focuses on VCOs that are committed to improving a number of different quality measures. Choosing these measures involved a significant amount of work to investigate the positive health outcomes and cost effectiveness of various health practices. After considering many different quality measures that can be obtained from the existing Medicaid complaints system, the program and health professionals settled on six.

  • Breast Cancer Screening
    • Wellness visits – ages 3-21
    • Wellness visits – newborns
    • Reduction in the number of outpatient visits to the emergency room
    • Reduction of patient admissions within 30 days of discharge

The future of Medicaid in Idaho

The mission of the Division of Medicaid is to pay for better health. Providers also have the same goal of providing high quality care, as evidenced by the amount of time and resources they have devoted to this effort over the past three years. By July 1, 2023, DHW is committed to ensuring that 50 percent of Medicaid payments are tied to measurable outcomes of better health and cost-effective care. By rearranging Medicaid payments to pay for high-quality, affordable healthcare, we can reward healthcare professionals who do best and carry out our mission: to strengthen Idahoan’s health, safety, and independence.

As we work to strengthen the health, safety and independence of Idaho people, we are proud to share our work with the people of Idaho as we advance in our strategic goals. You can follow our work and read more about ours Strategic Plan on our website.

Children between the ages of 5 and 11 are now recommended to get the safe and effective COVID-19 vaccine

The Centers for Disease Control and Prevention (CDC) have recommended two doses of the Pfizer-BioNTech pediatric COVID-19 vaccine for children aged 5 to 11. The vaccine is free as well as safe and effective.

The Pfizer COVID-19 vaccine has been shown to be over 90% effective in preventing COVID-19 in children ages 5 to 11. By choosing to have your child vaccinated, you can help protect them from COVID-19 and keep them in school and active in extracurricular activities.

I encourage all parents to discuss the vaccine with their doctor. As a reminder, COVID-19 vaccines have undergone – and continue to undergo – the most intensive safety monitoring in US history.

Appointments for COVID-19 vaccines for children ages 5 to 11 are expected to be available the week of November 8.

To find a vaccination place near you, contact your child’s pediatrician, visit Vaccini.gov, or contact yours local public health district.

For more information on COVID-19 pediatric vaccination, visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/children-teens.html or talk to your child’s pediatrician.

See a recording of DHW’s November 2 media briefing that included information on pediatric COVID-19 vaccines on: https://youtu.be/02GoBvSPFbI

I hope you all have a safe and healthy weekend.

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