Delaware Public Media

New MCO is negotiating value-based Medicaid contracts with Delaware health providers

Apr 4, 2018

AmeriHealth Caritas joined Delaware’s Medicaid marketplace at the beginning of the year. Officials with the Managed Care Organization say they are looking forward to working within Delaware’s new value-based Medicaid payment system.

Delaware announced in January it will start paying for Medicaid based on health outcomes rather than doctor visits and tests. The Pennsylvania-based MCO AmeriHealth Caritas has had similar value-based contracts for the past decade.

The MCOs Corporate Chief Medical Officer Andrea Gelzer says under these contracts providers are incentivized for overall patient health.

“The programs are designed, really, to reward providers for timely appropriate care and positive outcomes.  So we’re incentivizing a provider to do an evidence-based screening test,” said Gelzer.

Gelzer says this may lead to annual health screenings and checks for chronic conditions during Medicaid doctor visits—no longer because providers are paid for the tests they conduct, but because the tests could help the patient’s health and save the provider money in the long term.

“So if Mrs. T, just for example, goes to her Doctor and say she’s got a sore throat and maybe she has high blood pressure. Well the visit is going to go beyond treating the acute symptoms,” said Gelzer.

AmeriHealth Caritas is in the beginning stages of negotiating value-based contracts with providers in Delaware.

Under Delaware’s new Medicaid payment system, the MCO must start next year in the top 50% of a national standard for population health or face a penalty.