The Pennsylvania plan builds upon current private and public sector payer and provider initiatives to advance new care delivery models and payment methodologies. The plan places strong emphasis on the need for innovative models on transitions of care, telemedicine and care management. Through the promotion of accountable provider entities responsible for population based care, the state aims to develop a model that deploys community-based care teams to provide more appropriate services to “super-utilizers” and enhance access to public health preventive services by better integrating the services into the provider community. The model will also motivate alignment of patient, provider, and payer interest through gain-sharing models. Infrastructure to support the model design will incorporate expanded health information technology to facilitate health record data sharing, advanced telemedicine services particularly in rural areas, and objective measurement of healthcare workforce data to make improvements to existing training.
Pennsylvania has identified four inter-related delivery re-design models and payment methodologies that support delivery system transformation. These four interrelated models, three of which also represent payment models, serve as a centerpiece of Pennsylvania’s Health Care Innovation Plan. They are:
1. Accountable Provider Organizations with shared savings and risk assumption opportunities;
2. Patient-Centered Medical Homes with shared savings opportunities;
3. Episodes of care (EOC) with budgeted reconciled or prospective payments;
4. Community-based Care Management Teams
The State Innovation Model will Implement payment reform. Consistent with the direction of commercial insurers, the plan proposes a shift from a current inflationary payment system that rewards volume to one that rewards efficiency and quality. Two priority payment models, Accountable Provider Organizations (APOs) and Patient-Centered Medical Homes (PCMHs) with a specific focus on providing intensive care management services to high-risk consumers, and a third pilot model, Episodes of Care (EOCs), are recommended in the plan.
