Delaware Public Media

Highmark to expand some Medicaid contracts to reach goals

Apr 15, 2018

Highmark Health Options Delaware is expanding some of its Medicaid contracts to add incentives for patient health. The Managed Care Organization is expected to reach a national standard of overall patient health by the end of the year, or be penalized by the state.

To start the year Delaware announced it would begin paying for Medicaid based on health outcomes rather than doctor visits and tests. Highmark already had value-based contracts with many of its providers, but Highmark CEO Dwayne Johnson says some of its existing contracts will be expanded to include new incentives for patient outcomes.

“I think we are talking about the same types of measures. We’re talking about the same program. We’re still talking about improving the overall care (right.) I believe what we are doing now is just furthering that conversation along with more providers than we have historically in the past,” said Johnson.

Johnson adds data is not currently available to see whether Highmark is currently up to the standards set by the state.

“We’re still working to pull that data together to see how the providers that we’re working with, or who we’re entering into these new initiatives or these new agreements with, to make sure they’re actually on board or on track for hitting those measures by the end of the year,” he said.

Highmark’s new incentives for its providers could include enhanced reimbursements for providers whose patients have better health outcomes.

The state will measure the overall health of Highmark Delaware’s Medicaid patients against a national standard. If Highmark does not start next year in the top 50% of seven health categories, it will face a penalty.