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S.C. Department of Health to tie health to Medicaid payments

By Lauren Ratcliffe
Published Jan. 2, 2013

In an effort to tie Medicaid payments to patient health, the state Department of Health and Human Services announced an initiative, among several, targeted toward the Medicaid system.

The department will withhold $24 million from the fixed monthly payments given to health care providers based on the number of patients enrolled in the Medicaid program they serve.

Managed Care Organizations can receive bonus payments, despite the reduction, if they improve their patient outcomes compared with their own performance the prior year.

DHHS is targeting the following areas with their withholdings: prevention and screening, chronic disease and behavioral health, access and availability, and consumer experience and satisfaction.

Managed Care Organizations must demonstrate improvements in several areas, including well visits, access to ambulatory services, management and follow-up care for chronic conditions such as asthma.

Health plans and Managed Care Organizations can receive incentive payments for focusing on establishing patient-centered medical homes, and decreasing the numbers of premature and low birth-weight babies.

DHHS also has a Jan. 10 submission date for an incentive program around birth health care. The “Race to the Date” initiative aims to have hospitals throughout the state designated as “baby friendly.”

To achieve the designation, hospitals should be feeding infants with breast milk unless, after giving birth and being offered assistance, the mother indicates she has no plans to breast-feed.

Hospitals that submit a letter of intent to DHHS by Jan. 10 and achieve the designation from Baby-Friendly USA by Sept. 30 will be eligible for prize money. DHHS established a $1 million pool to pay hospitals that achieve the designation. Each hospital could receive a maximum of $200,000.

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