Florida Provider Service Networks (PSNs)
Program Location:
Tallahassee, FL
Payer Type:
Medicaid
Parent Program:
Payers:
Medicaid
Reported Outcomes
Description:
According to a June Health Services Research article, Florida Medicaid PSNs share many of the accountable care attributes to “ACO-like” organizations, specifically: the provision of care across a continuum to a defined population, the ability to support comprehensive performance measurement, the identification of specific performance targets, payment mechanisms that encourage quality improvements and cost reduction, strong primary care medical home base, prospective planning, and health information technology to support care coordination and quality improvement.
Unlike ACOs, PSNs are not yet accountable for total cost of care and payments are not tied to quality performance.
Florida legislation allowed PSNs to remain fee-for-service. So far, no PSNs have moved to risk-adjusted capitation and no payments are based on quality performance measures.
Payment Model:
The waiver included risk-adjustment to HMO capitation rates and authorizing the PSN as option enrollees could select as their managed care organization. The state pays PSNs a PMPM admistrative fee and pays PSN providers on a FFS payment method; if they achieve cost savings in a particular time perios, they recieve a portion of the payment.
Improved Patient/Clinician Satisfaction:
Department of Health Services Research (March 2011)
- PSNs in demonstration counties had slightly greater levels of enrollee satisfaction with their health care, health plan, personal doctor and specialty care
Cost Savings:
Health Services Research (June 2014)
- PSNs reduced expenditures by $135 PMPM for individuals on Supplimental Social Security Income (SSI) compared with non-demonstration sites
- PMPM expenditures for Temporary Assistance for Needy Families (TANF) recipients decresased by $4 PMPM for PSN enrollees and increased $28 for individuals in non-demonstration sites
- The PSN demonstration was successful in bending the cost curve
