WellPath has entered into new agreements with health systems and medical group practices designed to improve the quality and value of services provided and enhance patient outcomes. WellPath believes that health care professionals are in the best position to redesign the health care delivery system to enhance quality, outcomes, and efficiency. As a result, WellPath has focused on designing and implementing collaborative approaches to support redesign efforts to remove barriers and financial disincentives that make it difficult for provider groups to achieve these goals. Some of the key elements include: Support for patient-centered medical homes. For example, WellPath has worked with the provider organizations to change provider compensation to support necessary but previously non-revenue producing activities and to more closely align with evidence- based quality measures. Support for provider-led system redesign by aligning benefit plan design and compensation systems for the purpose of meeting the comprehensive needs of the patient/members and providing increased affordability. Comprehensive information sharing between WellPath and the provider organizations to support quality, improved health outcomes, and greater efficiency. Two of these arrangements will be operational early in 2012 to serve individuals within Medicare Advantage plans, small group and large group employer plans, and individual plans. Approaches for self-funded employers are anticipated to be available later in 2012. Contact: Peter Chauncey, FACHE, Executive Vice President and Chief Operating Officer, WellPath, A Coventry Health Care Plan. [email protected] North Carolina Health Care Facilities Association’s “Journey to National Best” demonstration of the effectiveness of nurse practitioners in skilled nursing care facilities . One of the initial efforts as part of the Journey to National Best (described more fully in Nursing Home Culture Change), supported by NC DHHS, has been a carefully evaluated demonstration of the utility and effectiveness of nurse practitioners in skilled nursing care facilities. This project, implemented in a single facility in North Wilkesboro, NC, showed the impact of an on-site nurse practitioner, as evidenced by lower rates of re-hospitalization, lower medication errors, and higher levels of patient satisfaction. Efforts are underway to negotiate with federal Medicare fiduciary agents and DMA to work out procedures for payment for these services (as has been the case with NPs in primary care) when the NP is an employee of the nursing facility, but supervised by multiple physicians responsible for individual patient care. Although some North Carolina nursing homes already employ nurse practitioners and have reported similar results, widespread adoption of this innovation awaits
Examining the Impact of the Patient Protection and Affordable Care Act in North Carolina Appendix H: New Models of Care in North Carolina Page 307 resolution of these payment arrangements with Title 18 and 19 authorities.
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