Thursday, February 29, 2024

Investing in care pays off: Quality that pays in practice

by BIZ. Staff

A Center for Health Care Strategies, Inc., report indicates that more than 25 states’ Medicaid programs have physician incentives in place. For many states, the results have been mixed, due to incentive programs that weren’t clearly defined, or didn’t engage physicians. Yet research shows that when incentive programs are well-structured, include clear and measureable goals, and engage physicians, the results are positive. In Louisiana, one Medicaid Managed Care Organization’s investment in physicians has yielded significant improvements in quality care for the state’s most vulnerable patients.

In 2015, Louisiana Healthcare Connections, the state’s largest MCO with over 475,000 members, launched an incentive program for network physicians who achieve improvements in key quality measures, such as access to preventive care services. The program was designed to ensure the delivery of high quality care to patients, and in turn, to improve health outcomes and reduce overall costs of care.

Using the lessons learned in other states and the feedback of the state’s physicians, Louisiana Healthcare Connections built its model on clearly defined quality measures and financial incentives. Every targeted measure is data-driven and based on the specific healthcare needs of Louisiana’s complex Medicaid population.

One component of the program is centered on achieving improvements in adolescent well care, chlamydia screenings and comprehensive diabetes care – all areas in which Louisiana has historically ranked poorly. For meeting the designated targets, physicians receive a Per Member Per Month (PMPM) incentive.

Another component enables physicians to earn increased rates for providing after-hours care, and incentivizes OB/GYNs for conducting timely postpartum visits and completing key cancer screenings. These objectives are based on high rates of low birth weights and cervical and breast cancer diagnoses in Louisiana.

As part of its incentive model, Louisiana Healthcare Connections provides physicians with a comprehensive set of tools and resources, including access to timely, actionable data reports related to emergency department use, key quality measures and care gaps. The health plan also employs a statewide team of provider consultants who work one-on-one with physicians to provide support for quality improvement efforts and education.

The results of this investment are clear. Since 2015, adolescent well care visits and chlamydia screenings have each increased by nearly six percent. Well child visits for children ages three-six and adult access to preventive care have increased by three percent each.

These quality improvements were achieved while simultaneously supporting physicians in delivering care to a Medicaid Expansion population that includes thousands of residents who previously lacked access to preventive care.

These achievements contributed to Louisiana Healthcare Connections being awarded Commendable Accreditation status from the National Committee for Quality Assurance for demonstrating outstanding operations and clinical performance, and scoring near perfect in member satisfaction.

Louisiana Healthcare Connections has demonstrated that when incentive models are well planned, and provider buy-in is secured, quality improvements happen, patient outcomes improve, and significant savings for the state are achieved. An investment in quality-focused healthcare providers is an investment in the health of Louisiana – and it’s clearly a sound investment.

Joseph Tidwell, PT, MHA, CPHQ, is the Vice President of Quality Improvement for Louisiana Healthcare Connections. His extensive experience in strategic planning, business plan development and implementation, quality assurance and performance improvement support the health plan’s efforts to ensure accessible, quality-driven care to its members. Learn more at

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