Last year, we covered the launch of the Magellan Facility Incentive Program (MFIP) (see Magellan Launching Performance-Based Reimbursement For Inpatient Services), as well as heard about the program in detail from Matt Miller, National Vice President, Behavioral Health Network, Magellan Health Services (see P4P In Practice @Magellan). Last month, we caught up with Mr. Miller, who noted that this program continues to expand – MFIP is expected to have 25 to 30 facilities in the program by the end of 2015, with the goal of bringing the total facilities in the program to at least 40 by the middle of 2016.
This program is a nationwide, voluntary performance-based reimbursement program for inpatient and residential services. Under the original program, participating facilities that improve and sustain high-quality performance will be eligible for performance-based reimbursement. Each participating facility will be assigned to a level based on a review of one-year of claims data – “Early Engagement,” “Partner in Care,” and “Preferred Partner in Care.” Incentives (reimbursements have not been released) are correlated with each tier and scorecards are used to manage facility quality scores on a quarterly basis
- At “Early Engagement” Magellan will provide more touch points and supportive interactions to help increase quality scores.
- At the “Partner in Care” level, the facilities will demonstrate ongoing, sustainable improvements in patient outcomes and quality of care. As quality increases, touch points/management interactions with Magellan decrease.
- At the “Preferred Partner in Care” level the facilities will function as regional Centers of Choice and will assume more risk for overall patient care, including costs.
- In addition, Magellan has added a Center of Excellence tier for the highest performing facilities.
Performance will be based on benchmark ratios determined by an algorithm that creates case-mix adjusted scores for average cost of care per episode, readmission rates, follow-up after hospitalization, and administrative metrics. Participating facilities will be assigned to one of three oversight levels based on the algorithm scores. Magellan expects to be paying bonus dollars in their biggest market by the fourth quarter of 2014.
Also in performance news from Magellan was improved community tenure from evidence-based Assertive Community Treatment (ACT), using data analysis for inpatient admissions, emergency department visits, and substance abuse residential services for ACT members. Magellan developed a three-tiered rate structure (the better the results the higher rate/reimbursement tier) based on overall program goals informed by national fidelity standards (DACTS). The results available so far?
- 25% decrease in global inpatient admissions
- 11% decrease in global readmission rate
- Average admissions went from 7.8 to 6.2 per quarter
- 5 of 12 teams advanced to middle tier rate and achieved financial incentive
- All 12 teams improved their performance.
It is important for provider organizations to understand the fundamental risks in risk-based contracting and gainsharing arrangements – but understanding that is only understanding part of the overall picture. It is important for provider organizations to understand all the arraignments before they take a contract.
For more, join the OPEN MINDS team at the OPEN MINDS Strategy & Innovation Institute for the session, Using Data To Improve Accountability & Outcomes In The Era Of Care Coordination & Value-Based Contracting, presented by Karen W. Linkins, Ph.D., Co-Founder & Principal, Desert Vista Consulting, and Steve Weatherbee, Ed.D., President & CEO, eCenter Research.