Bayou Health Medicaid Coordinated Care Networks - Shared Savings plans

In 2012, Bayou Health implemented new phase of the Coordinated Care Network Program. A Shared Savings CCN is a primary care case manager that provides enhanced primary care case management in addition to being the entity contracting with primary care providers (PCP) for PCP care management. The CCN will expand the current roles and responsibilities of the primary care providers through the establishment of patient-centered medical homes and create a formal and distinct network of primary care providers to coordinate the full continuum of care while achieving budget and performance goals and benchmarks.

The Shared Savings Plan model provides for an enhanced Primary Care Case Management (PCCM) organization, which incorporates many of the features historically associated with an MCO, such as utilization management. A Shared Savings Plan’s provider network consists of primary care physicians (PCPs) only, and all providers must also be enrolled in Louisiana Medicaid. The Shared Savings Plan is expected to coordinate specialty care and hospital care with providers enrolled in the Medicaid provider network. The Plan receives a monthly fee for each enrolled member $10.24 for children and healthy adults; $15.74 for pregnant women and members with disabilities – to provide enhanced management services, with the opportunity to share in any savings to the State that result from the improved coordination of care. While the Shared Savings Health Plans “pre-processes” claims, the state continues final processing and pays provider claims through its fiscal intermediary.