Date of Award
2020
Document Type
Dissertation
Degree Name
Doctor of Health Administration
College
College of Health Professions
First Advisor
Kit N. Simpson
Second Advisor
Elizabeth Brown
Third Advisor
Annie N. Simpson
Abstract
Public policy efforts to improve population health are important. However, any public policy may have unintended consequences, and the risk of these side-effects may be substantial if they include payment incentives to providers or economic incentives for patients. A recent policy initiative The Population Health Medical Home Contracts with MCOs to Improve Quality of Care is the focus of this study. The Center for Medicare and Medicaid Services (CMS) implemented a quality initiative to improve the quality of healthcare and services for patients with Medicare and Medicaid benefits to improve Healthcare Effectiveness Data and Information Set (HEDIS) Measures. As a part of this initiative, CMS assigns patients to healthcare facilities, which are deemed as Patient-Centered Medical Homes, located in geographic areas. The assignment is done through the patient’s health insurance carrier plans, and patients are allocated to geographically close health centers, which are then responsible for ensuring patients receive the services indicated by the HEDIS measures. In theory, this is an excellent way to assure patients access to quality care. In practice, there may be problems in the execution of the policy because health centers become responsible for all patients assigned to them and are subject to financial penalties if their HEDIS indicators fall short of programmatic. Meeting the HEDIS standards is essential for the financial health of entities that enter into population health service contracts. Unfortunately, the population covered in the contracts often includes members who are not current patients of the contracting health center. Thus, a contracting center becomes responsible for providing care to individuals that have never been seen as a patient.
Recommended Citation
Scott, Mildred, "Unintended Consequences of Population Health in Medical Home Contracts with MCOs to Improve Quality of Care" (2020). MUSC Theses and Dissertations. 59.
https://medica-musc.researchcommons.org/theses/59
Rights
All rights reserved. Copyright is held by the author.