Provider Incentives Now Offered Through HHSC Medicaid Disease Management Program

By Esteban López, M.D.

In November 2004, the Texas Health and Human Services Commission (HHSC) launched an ambitious new disease management program called the Medicaid Enhanced Care Program (MECP). MECP was designed to help Texas Medicaid Fee-For-Service (FFS) beneficiaries learn new ways to better manage their chronic illnesses, such as such as asthma, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease and diabetes. Primary Care Case Management (PCCM) beneficiaries outside of Managed Care Organizations were added to the program in September 2005. In November 2007, a health and wellness program that includes management of obesity and smoking cessation was added. Today, the program serves approximately 42,000 Medicaid clients across the State.

In January 2008, an innovative physician incentive pilot was introduced as part of MECP.

Physicians whose practice includes program-eligible Medicaid patients that live in three targeted regional areas will have the opportunity to participate in the MECP Provider Incentive Pilot. The incentive pilot is one of only a handful of programs nationwide that have been implemented for physicians caring for Medicaid beneficiaries who participate in a state-sponsored disease management program.

The MECP was created during the 78^th regular session of the Texas Legislature through House Bill 727, which was authored by former House Pubic Health Committee Chairwoman State Representative Dianne White Delisi. Through the program, HHSC has worked closely with physicians to ensure that Medicaid beneficiaries followed their provider’s care plan, took medications as prescribed and utilized the primary care physician as their main source of care. For Medicaid beneficiaries, the goal was to improve health and wellness through health education and strategies intended to help participants better manage specific chronic illnesses.

MECP, administered by HHSC’s disease management vendor McKesson Health Solutions, provides services to Medicaid FFS and PCCM beneficiaries throughout the state. The program utilizes community-based and telephonic registered nurses who deliver disease education to participating beneficiaries. Promotoras function as community health workers, ensuring that the participant’s services are delivered in a timely and culturally-sensitive manner. Nurses and promotoras also travel to participants’ homes to provide assistance as necessary. The promotoras and community-based registered nurses focus their outreach on underserved areas throughout Texas, including the Rio Grande Valley.

HHSC’s Provider Incentive Pilot will test the effectiveness of offering incentives to physicians who have patients enrolled in MECP. The outcomes of the pilot may be used by HHSC to evaluate future physician incentives for participating in certain program activities.

The incentive pilot is designed to facilitate:

• more rapid and complete beneficiary identification and enrollment, and program retention;
• improved collaboration between clinicians and MECP staff; and
• higher quality and better chronic care services delivery to Medicaid beneficiaries.

Medicaid providers in Region 4 (Upper East Texas), Region 7 (Central Texas) and Region 11 (Lower South Texas) are eligible to participate in the pilot. Beneficiaries who live in these regions have an especially significant need for healthcare services. To participate in the pilot, providers must have at least 10 Medicaid beneficiaries as patients who are also eligible for MECP. Providers in these three regions may receive up to approximately $1,800 when participating in the pilot.

Incentives are available for:

• supporting the program and facilitating the enrollment of Medicaid beneficiaries in the disease management program;
• locating and furnishing contact information for eligible patients; and
• completing a chronic care assessment for each eligible beneficiary on the clinician’s patient roster.

Eligible physicians will receive a payment when they support the program by communicating its value to eligible patients and allowing the use of the clinician’s name as an endorser when patients are asked to enroll by MECP staff. These physicians also should be familiar with the program so that they can provide program details to patients.

Participating clinicians also can receive incentives for helping to locate and furnishing member contact information – such as a correct phone number or address – for patients that MECP staff are unable to locate.

The third incentive opportunity is made available when the MECP staff receives a completed chronic care assessment form for each patient on the clinician’s confirmed patient roster. The practice will provide various types of information about each patient, including a list of medications taken, relevant lab values and patient education requirements.

MECP provider outreach coordinators will conduct intensive outreach in the targeted regions during the first four months of the pilot in order to engage as many physicians as possible.

Texas physicians already participating in the MECP have reported positive experiences, according to a 2006 survey. Fifty-six percent agree that the program is useful to providers and their practice, and 65 percent agree that the program is helpful to enrolled beneficiaries.

Participants also have benefited from the program. The MECP regularly measures the clinical outcomes of program participants. The goal is to see improvements in important clinical measures that signal better control of a chronic illness. The following is a sample of those outcomes from 2007.

 Over the past three years, the MECP has been committed to complementing the care delivered by physicians by having registered nurses and promotoras provide support. By forging a greater level of collaboration among clinicians, care managers and patients, HHSC can help Medicaid beneficiaries improve their health and wellness by providing specific tactics that can help beneficiaries better manage their chronic conditions.

For more information about any aspect of the Medicaid Enhanced Care Program, please contact me at esteban.lopez@mckesson.com. For general information, please visit www.hhsc.state.tx.us/medicaid/ProviderInfo/index.html.

Dr. Esteban López practices Internal Medicine and Pediatrics in San Antonio and is a member of the Texas Medical Association. He is the Local Medical Advisor for the Texas Medicaid Enhanced Care Program administered by McKesson Health Solutions.