March 10, 2014

State of Alabama
Press Release: Medicaid

More than 225 participate in first meetings to inform RCO stakeholders

More than 225 healthcare providers, state agency officials and others interested in Medicaid’s plan to implement Regional Care Organizations in the state participated in one of two February sessions to hear an update on the effort and ask questions of state officials.

The two meetings, held February 4 in Montgomery and February 20 in Decatur, included an update on the Agency’s efforts to comply with legislation enacted in May 2013 to better control costs while improving patient care. Three more meetings are planned in March for Tuscaloosa, Birmingham and Mobile while an online session is planned as well. (Link to schedule)

Talking to participants, Dr. Donald Williamson, chair of the Medicaid Transition Task Force, explained that the RCO concept will not make the state’s Medicaid program cost less in the future, but will help state legislators balance the General Fund budget.

“The way that I have thought about this is fundamentally is that we are simply trying to create a managed care entity in Alabama to improve care and reduce costs over that which would otherwise be spent in the future,” he said. “The point that I have made repeatedly is no one believes that this model is going to cause the General Fund dollars to be less in Fiscal Year 2016 than today. It’s simply, hopefully going to slow the rate of growth and to make the cost more predictable.” 

Questions from participants ranged from covered services to the federal waiver needed to help the Agency make the transition from a fee-for-service system to a capitated, coordinated care model.

Of the 1115 waiver, Dr. Williamson emphasized that the 1115 waiver is essential to providing the resources necessary to make a successful transition to RCOs. If approved, the waiver would help fund the infrastructure needed for the new health care delivery system including expanded capacity to analyze and develop data, to reward desired outcomes, and to support hospitals as they learn to work in a different reimbursement environment. 

“If we are going to do this, it is important that we have a support system to maintain our hospitals as we go through this transition and as they learn to work in a different reimbursement environment. He added, “At the same time, we want to move to measuring outcomes. Instead of counting whether or not a certain test was done for a diabetic patient, we want to look to see if that patient’s levels are appropriate. This is a fundamental revision of how we pay, so that we pay for value and outcomes instead of volume.”

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